Azoospermia &TESA &PESA
Sperm are initially produced in the testis in seminiferous tubules. In each testis these tubules are connected with the epididymis in which sperm remains for a short while after production. The epididymis is in turn connected to the vas deferens which lead to the urethra. Sperm must pass through this system in order to be deposited in the semen during ejaculation.
Azoospermia is a condition where there are no sperm present in a man’s ejaculated semen.
TYPES :
1.Azoospermia can be caused by an abnormality or blockage in the epididymis or the vas deferens. This is known as obstructive azoospermia. In these cases, sperm are being produced in the testes but does not come out.
2.sperm production in the seminiferous tubules does not occur at all or is happening at such a low level that sperm are not detectable in the ejaculate. This is known as non-obstructive azoospermia.
ETIOLOGY:
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- Testicular problems resulting in poor sperm production. These can be caused by various factors such as genetic issues, previous infection (e.g. mumps), maldescended testes.
- An irreversible obstruction of the genital tract (possibly caused by a previous infection, trauma or surgery)
- Congenital absence (absence from birth) of the vas deferens, which is common in carriers of cystic fibrosis
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- A previous vasectomy or an unsuccessful vasectomy reversal
- A previous vasectomy or an unsuccessful vasectomy reversal
Treatment:
Using surgical procedures to try and extract sperm from the epididymis ,percutaneous epididymis sperm aspiration(PESA) or to dissect it out of tubules from the testis, (TESA) can be an effective to get the sperm in a patient of obstructive azoospermia.
Even in non-obstructive azoospermia, where sperm production is occurring, PESA/ TESA can still be an effective way of sperm retrieval.
PESA involves passing a fine needle through the skin into the epididymis to obtain sperm. TESA involves passing a fine needle through the skin directly into the testes and retrieving a small number of the seminiferous tubules themselves. The tubules are then dissected in the laboratory and the contents searched for the presence of sperm.
Both of these surgical procedures can be performed under either local anaesthetic or
The number of sperm retrieved through PESA or TESA is usually very low compared to the number present in an ejaculate, so the sperm usually need to be used in combination with ICSI .
Female partnerundergoes an IVF cycle and, once her eggs have been collected (usually the same day as your PESA or TESA), husband’s sperm will be injected directly into her eggs. The fertilised eggs are then cultured for a few days in the laboratory before a healthy embryo is transferred into your partner’s uterus.
Sometimes sperm is retrieved for before IVF cycle to be frozen for use in future ICSI cycles, known as Trial TESA/PESA.