PESA (Percutaneous Epididymal Sperm Aspiration)

Types of Sperm Retrieval Procedures for IVF

Includes PESA, MESA, and aspiration techniques for obstructive azoospermia.

• TESA (Testicular Sperm Aspiration)
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Types of PESA Treatment India

Some of the types of PESA according to the techniques are:

• Conventional PESA
• Ultrasound-Guided PESA
• Micro-PESA
• Robotic-Assisted PESA

Conventional PESA

In this type of PESA, a thin fine needle is inserted through the skin into the epididymis. After that, a suction force is applied to the needle which allows for the aspiration of epididymal fluid that contains sperm. Conventional PESA is often the first line of treatment for sperm retrieval in cases of low sperm count or where there is a blockage that prevents the sperm from reaching during ejaculation.

Ultrasound-Guided PESA

In this approach, real-time ultrasound imaging is used to precisely locate the epididymis. The ultrasound provides a clear picture for the healthcare provider and increases the accurate placement of the needle for sperm retrieval. This method is particularly useful when dealing with cases where the epididymis is not easily detected.

Micro-PESA

Micro-PESA is a subtype of the conventional PESA technique. In this technique, a smaller and more delicate needle is used to reduce the chances of damaging tissue and reduce patient discomfort. This microsurgical approach has the advantage of dealing with patients who may be more sensitive to pain or when a procedure is performed on smaller structures within the epididymis.

Robotic-Assisted PESA

Some advanced medical facilities use robotic surgical systems to increase the accuracy and control of PESA procedures. The robotic-assisted approach can provide the surgeon with greater dexterity and accuracy that can be helpful to perform procedures in more complicated cases.

Procedure of PESA

The procedure of PESA is described below:

• Preparation: The patient is relaxed and the medications for cleaning the area are applied to the surgical site for the prevention of infection.
• Local Anesthesia: Anesthesia is administered to reduce the discomfort and pain during the procedure. Anesthesia can help in numbing the area under the procedure.
• Needle Insertion: A fine, thin needle is inserted through the skin of the scrotum and into the epididymis which is the part of the male reproductive system where sperms are stored. Sometimes a special type of needle is used to reduce the pain for sensitive patients.
• Aspiration: A syringe is attached to the needle and a suction force is applied to the needle. This suction force helps in obtaining the fluid within the epididymis that contains sperm. The healthcare provider carefully manages the needle to obtain the fluid according to the need.
• Sperm Collection: The collected fluid is then examined with special instruments in the laboratory for the identification of the sperm. A sufficient amount of sperm is obtained that can be restored for later use.
• Recovery: After the procedure, some pain, swelling, and discomfort can be felt by the patient but these complications usually resolve on their own within a short time. The healthcare providers recommended rest and there is the restriction of heavy activities for some time.
• Sperm Evaluation: The sperm that are obtained are evaluated for quality and quantity so that they can be used for assisted reproductive techniques like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to help with fertility treatment.

Cost of PESA Treatment in India

The cost of PESA treatment in India ranges from 220 USD to 290 USD. The cost can vary according to the facilities of each hospital in India and the skills of the surgeon performing the procedure. The cost can also vary if complications arise during or after the procedure.

PESA Treatment : 211 USD - 284 USD

Symptoms and Risk factors

Indications of PESA

Some of the indications of PESA treatment are as follows:

• When there is a blockage preventing sperm from coming out naturally.
• After a failure of vasectomy reversal surgery.
• If there is a blockage in the tubes that carries sperm.
• When someone is born without the tubes that carry sperm.
• When the tubes carrying sperm cannot be fixed.
• If previous attempts to collect sperm failed.
• To save sperm for future use, especially for cancer patients before their treatments.

Risk Factors of PESA Treatment

Some of the risks that are associated with PESA treatment are as follows:

Infection

There is a small risk of infection at the site of injection or where the needle is inserted into the epididymis.

Bleeding

Sometimes bleeding can occur during the procedure which can make the whole procedure unsuccessful.

Pain and Discomfort

It is common to experience some pain or discomfort in the area after the procedure but it can resolve with time.

Swelling

Swelling can occur after the procedure and can persist for some days but it can resolve without the need for additional treatment.

Bruising

Bruising of the scrotum may occur as a result of the needle insertion.

Failure to Retrieve Sperm

In some cases, PESA may not successfully perform and do not retrieve enough sperm, which can be disappointing for individuals or couples who need infertility treatment.

Rare Complications

Some of the time, more serious complications like injury to surrounding structures or damage to blood vessels can occur but these complications are rare and usually associated with the poor skill of the surgeon.