PESA (Percutaneous Epididymal Sperm Aspiration)

PESA is a minimally invasive surgical technique used to retrieve sperm directly from the epididymis, primarily for men with obstructive azoospermia—where sperm production is normal, but a blockage prevents sperm from reaching the ejaculate. It is commonly used in conjunction with assisted reproductive technologies such as ICSI (Intracytoplasmic Sperm Injection).

What is PESA?

PESA involves inserting a fine needle through the scrotal skin into the epididymis (the structure where sperm mature and are stored) to aspirate sperm-containing fluid. This procedure is performed under local anesthesia and does not require a surgical incision, making it quick, relatively painless, and associated with a fast recovery.

Purpose of PESA

• To obtain sperm for use in IVF/ICSI when sperm cannot be ejaculated due to blockages (e.g., congenital absence of vas deferens, post-vasectomy, or scarring from infection or surgery).
• To offer a fertility solution for men who do not wish to undergo vasectomy reversal or for whom reversal is not possible.

Step-by-Step Process

1. Consultation & Evaluation

• Comprehensive assessment including medical history, physical examination, and diagnostic tests to confirm obstructive azoospermia and suitability for PESA.

2. Preparation

• The scrotal area is cleaned and anesthetized to ensure comfort during the procedure.

3. Aspiration

• The epididymis is stabilized between the thumb and forefinger.
• A fine needle (usually 21–26 gauge) attached to a syringe is inserted through the scrotal skin into the epididymis.
• Gentle suction is applied to aspirate epididymal fluid containing sperm.

4. Laboratory Analysis

• The aspirated fluid is examined under a microscope for the presence and quality of sperm.
• If sufficient motile sperm are found, they are either used fresh or cryopreserved for future IVF/ICSI cycles.

5. Recovery

• The procedure is quick, with minimal discomfort and a short recovery period. Mild tenderness may occur and is managed with simple pain relief and supportive underwear.

Ideal Candidates

• Men with obstructive azoospermia (e.g., post-vasectomy, congenital absence of vas deferens, scarring from infection or surgery)
• Couples requiring surgical sperm retrieval for ICSI
• Men for whom vasectomy reversal is not suitable or desired

Success Rate

• PESA usually yields a sufficient number of motile sperm for use in ICSI, with positive outcomes reported for fertilization and pregnancy rates.
• If PESA does not retrieve sperm, alternative methods such as MESA (microsurgical epididymal sperm aspiration) or TESA (testicular sperm aspiration) may be considered.

Advantages

• Minimally invasive and quick
• Performed under local anesthesia
• Low risk and fast recovery
• Can be repeated if necessary