TESA or TESE: Which Is Better for Sperm Extraction?

One of the most serious reasons of male infertility is the lack of sperm in the ejaculate – the so-called azoospermia. This violation affects the natural conception in the most dramatic way, since the absence of sperm makes it simply impossible. But still azoospermia is not an insurmountable barrier to paternity.

ART (assisted reproductive technology) can cure male infertility, even if sperm analysis has determined the absence of sperm in the ejaculate. Testicular biopsy is a method of ART, which is indicated for azoospermia.

Biopsy Techniques

  1. The Testicular Sperm Aspiration method, better known as TESA, is a procedure in which the testicles are aspirated (removed by vacuum). This method is the most widespread for the following reasons:
  • financial expenses are minimal;
  • it can be performed without suturing;
  • microsurgery methods are not used.

The TESA procedure takes about fifteen to twenty minutes; it is performed under short-term parenteral (intravenous) anesthesia. During the procedure, by means of a puncture testicular tissue is taken. About one hour after aspiration, a patient can go home.

  1. The Testicular Sperm Extraction or Testicular Biopsy procedure, commonly known as TESE, is a biopsy technique that extracts sperm from the testes. This is a more invasive procedure for sperm extraction from testicular tissue, during which it is taken in a larger volume than with TESA. A larger amount of material makes it possible to send part of the tissue for morphological study in order to clarify the further prognosis, and part – for cryopreservation for subsequent use in the in vitro fertilization program.

A TESE biopsy, like TESA IVF, is performed under parenteral anesthesia, takes the same amount of time (fifteen to twenty minutes), and about one hour after extraction the patient can go home. The results of a histological examination will be known in about five to seven days.

Biopsy preparation

Based on the preliminary examination and the data of the main diagnosis, the attending physician determines which method (TESE, TESA or micro-TESE) should be used. Like any other medical manipulation, a testicular biopsy requires some preparation:

  • Before the procedure, a patient undergoes an examination (usually it coincides with the preparation for the in vitro fertilization (IVF) procedure or artificial insertion of the sperm into the cytoplasm (ICSI);
  • To increase the number of germ cells, you should adhere to the following recommendations for one to two weeks before the procedure: to observe sexual abstinence and to exclude factors that can negatively affect spermatogenesis (alcohol consumption, exposure to heat, taking certain medications, etc.)