Percutaneous technique for aspiration of sperm from the epididymis and testicle

Percutaneous sperm aspiration from the epididymis (PESA) or testicle (TESA) may be used as a diagnostic technique to confirm sperm production and as a method to harvest sperm for use in intracytoplasmic sperm injection (ICSI). We performed 43 PESA/TESA procedures in men considered to have nonreconstructible obstructive azoospermia. This short outpatient procedure was performed using a butterfly needle under intravenous i.v. sedation and local anesthesia. In 17 diagnostic aspirations, diagnoses of normal spermatogenesis, maturation arrest, and germ cell aplasia were established. In 26 therapeutic sperm aspirations for use with ICSI, adequate samples of sperm were obtained and residual sperm was cryopreserved. In the ICSI cycles, fertilization and pregnancy rates of 59% and 32%, respectively, were obtained. PESA/TESA is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive, costly, and technically more difficult. There have been no acute or chronic complications in this patient population, including nine men who underwent a second successful procedure.