Testicular Sperm Aspiration (TESA)
TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI.
The procedure was accomplished through local anesthesia (5 ml of lidocaine for blocking the spermatic cord). The testicle was firmly held and a 16 G needle adapted to a 20 ml syringe filled with approximately 0.5 ml of culture medium (modified HTF -Irvine Scientific) was introduced in the superior pole of the testicle. The aspiration was accomplished along the longitudinal axis, avoiding the epididymis head. When the needle was inside the testicular parenchyma, a negative pressure was applied to the syringe, by pulling the embolus up to 20 ml. The material collected was analyzed under optical microscope, and dissected with the help of 2 bistouries to liberate the spermatozoa from the tissue. Counting of spermatozoa was not accomplished due to the small quantity of material available. Each testicle was punctured just once. TESA has been accomplished in 11 patients, for whom motile spermatozoa were not found with PESA.