Surgical retrieval of spermatozoa

FNA/PESA – Percutaneous Testicular/Epididymal Sperm Aspiration

Azoospermia can be divided into obstructive and non-obstructive (or secretory) depending on whether the absence of spermatozoa in ejaculation is caused by an obstruction of the blood vessels of the epididymis and/or of the deferent ducts and/or ejaculatory ducts or by a primary or secondary alteration of spermatogenesis. The obstructive azoospermia can be:

  • Post-infectious
  • Post-surgical (vasectomy)
  • Congenital (bilateral absence of deferent ducts)

In all these cases spermatogenesis is preserved and it is therefore possible to recover the spermatozoa surgically. Secretory azoospermia may be due to:

  • Cryptorchidism
  • Orchitis
  • Testicular trauma or torsions
  • Radiation therapy or chemotherapy
  • Chromosomal abnormalities (Klinefelter syndrome or 47, XXY syndrome, syndrome 47,XYY, 46,XY of, yq11)
  • Unknown genetic causes

Based on the histological picture they can be divided into:

  • hypospermatogenesis
  • Sertoli cell-only syndrome
  • Maturation stops
  • Tubular sclerosis

The probability of finding mature spermatozoa surgically is closely linked to the said condition. In clinical practice various surgical techniques have been introduced for the retrieval of spermatozoa from epididymides and/or from the testis (MESA, PESA, TESA/FNA). These techniques can be useful for those patients in whom sperm production by the testes is normal but their emission with ejaculation is prevented by an obstruction that may be located at various levels of the seminal ducts. (obstructive azoospermia). They consist in the transcutaneous aspiration under local anesthaesia of spermatozoa either from the testes or epididymides by means of a simple IV infusion needle. The retrieval of epididymal spermatozoa can also be done via microsurgical procedure (MESA). The spermatozoa thus recovered are used for fertilization by ICSI.

TESE – Surgical retrieval of spermatozoa

The TESE procedure consists in collecting tiny fragments of testicular tissue in one or both testicles. This procedure can be done under local anaesthesia. This technique is indicated in the case of obstructive azoospermia when percutaneous aspiration (TESA/PESA) fails or is not convenient or in the case of secretory azoospermia. The spermatozoa thus recovered are used for cryopreservation and/or fertilization by ICSI.