Testicular Biopsy (PESA, TESA, TESE, MESA)

Normally, sperms are produced in the testes in the seminiferous tubules and are stored in the area called epididymis to mature. During ejaculation, they migrate to the vas deferens, where the prostate fluid, seminal vesicles’ fluid and the fluid of Cowper’s glands mix with them and become the semen fluid that comes out during ejaculation.

In some individuals, the sperm cannot reach the semen fluid, because there is an occlusion in the vas deferens or a missing region of the testis or it is abnormal. In these cases, sperms are not seen in the semen fluid analysis (spermiogram), this is called Azoospermia. In such cases, sperm cells have to be obtained from a biopsy method, i.e. a small surgical operation. The sperms found by this way are prepared for use in the ICSI method. Where sufficient numbers of sperms are present, some of the tissues obtained from the testicles are frozen for use in several ICSI trials.

In cases where sperms cannot be found (Azoospermia) we attempt to obtain them with various surgical techniques:

1. PESA-Percutaneous Epididymal Sperm Aspiration

In this method, sperm cells are obtained directly from the scrotum skin covering the male testicles by immersing the biopsy needle into the epididymis area and pulling a specimen out. The sperms obtained are used in the ICSI method.

2. TESA- Testicular Sperm Aspiration

It is preferred in cases where PESA is not possible or cannot be administered and sperms cannot be obtained. Here, a vacuum needle is inserted directly into the testicle tissue through the testicle skin and small tissue pieces are removed. They are used for ICSI if sperm cells are found in tissue pieces.

3. TESE- Testicular Sperm Extraction

If the first two methods are impossible to apply or sperms cannot be obtained, the TESE method is applied. In this method, skin tissue covering the testicles is opened and small pieces of biopsy are taken from the testis tissue and the presence of sperm cells is investigated. General anesthesia is generally preferred for this method. If the biopsy is performed under a microscope, this process is called Micro TESE and the chance of finding a sperm is higher.

4. MESA- Micro Epididymal Sperm Aspiration

In this method, open surgery is applied. The testis skin tissue is opened to try to remove the mature sperm cells with the needle from the epididymis. Generally, this procedure is preferred for patients who have obstructed or absent Vas Deferens. General anesthesia is required during the application of this method.

Sperm collection, use and storage

The sperm cells are used in the ICSI process to fertilize the egg cells after collection with one of the above-mentioned methods. They are washed with various laboratory methods and readied for ICSI. The remaining testicular tissues are directly frozen. After freezing, they are stored at -196 C for storage in the liquid nitrogen tank and, if necessary, for use in the next IVF. It can be stored for up to 10 years after obtaining them.

In cases of azoospermia where sperm cells cannot be found before PESA, TESA, TESE and MESA, some hormone tests such as FSH, Prolactin, Testosterone, karyotype analysis, and chromosome tests may be required.