Percutaneous Epididymal Sperm Aspiration (PESA)- The use of non-ejaculated sperm coupled with intracytoplasmic sperm injection has become a globally established procedure for couples with azoospermic male partners who wish to have biological offspring. Surgical methods have been developed to retrieve spermatozoa from the epididymides and the testes of such patients.(Fig 11).
The method of choice for sperm retrieval (SR) is based on the type of azoospermia, which can be obstructive or non-obstructive, and the attending surgeon's preferences and experience. Obstructive azoospermia (OA) is associated with the inability to detect spermatozoa in the ejaculate and post-ejaculate urine after centrifugation due to the bilateral obstruction of the seminal ducts.
Hence in such cases Percutaneous Epididymal Sperm Aspiration is done. We have got successful results with PESA and we can keep the extra sample frozen for future use.
Testicular Sperm Extraction (TESE)- The extraction of the testicular tissue (Fig 12) for sperm search and isolation is done usually in PESA failed patients or proven obstructive azoospermia cases. For conventional TESE, a standard open surgical biopsy technique is used to remove the testicular tissue without the aid of optical magnification. This is a day care and minimally invasive procedure.