In case masculine infertility is characterized by lack of spermatozoa in the ejaculate, the invasive spermatozoa obtaining methods are used. They are PESA, TESA and TESE.
The PESA and TESA methods are optimal for obtaining spermatozoa in the cases of obstructive azoospermia, while the TESE method – an ambilateral testicles biopsy with the use of microsurgical equipment – is used for non-obstructive azoospermia.
PESA is the needle biopsy of several areas of epipidymis. In case of obstructive azoospermia, the efficiency of the method is evaluated as 100%, however, this procedure can worsen the obstruction.
TESA is the needle biopsy of several areas of testicles. This method of obtaining spermatozoa involves the least invasion. In the cases of non-obstructive azoospermia, the method’s efficiency is limited by the disease itself (i.e., there can be no spermatogenesis focus) and by lack of visual control over the testicular tissue (there is a possibility that spermatogenesis focuses won’t be detected in the process of puncturing). If the spermatozoa are not found after 5 or 6 punctures of every testicle, then, after the patient’s consent, the microsurgical variant of puncturing, TESE, is performed.
TESE is the process of aspiration of testicular tissue for the subsequent search for spermatozoa. This method is one of the most effective for treating masculine infertility. In the case of TESE, testicular biopsy is performed, and the obtained tissue is used for extracting spermatozoa which are intended for subsequent fertilization of an oocyte. There are two ways of obtaining spermatozoa. The first one is a closed puncture with the help of a special gun (the high risks of complications and the efficiency of this method do not exceed those of PESA). The second way is the ambilateral microsurgical multifocal biopsy of testicles. This method is effective in the cases of non-obstructive azoospermia.