TESA and PESA : When Are These Sperm Retrieval Techniques Right for You?

In this recent video, Dr. Malpani, an IVF specialist, sheds light on a growing concern in the realm of fertility treatments: the misuse of testicular sperm extraction (TESE). This procedure, often recommended for men with male factor infertility, is increasingly being used unnecessarily, leading to higher costs and added risks for patients without improving pregnancy outcomes. Dr. Malpani provides a detailed critique of this practice, emphasising the importance of evidence-based treatment.
What is Testicular Sperm Extraction (TESE)?
Testicular Sperm Extraction, commonly known as TESE, is a surgical procedure used to extract sperm directly from the testicles. It is typically considered for men with severe male factor infertility, such as azoospermia (no sperm in the ejaculate) or high sperm DNA fragmentation. In theory, extracting sperm directly from the testes can provide healthier sperm for use in procedures like intracytoplasmic sperm injection (ICSI), where a single sperm is injected into an egg to achieve fertilisation.
The Misuse of TESE
Dr. Malpani points out that TESE is often recommended unnecessarily for men who have sperm present in their ejaculate. Many doctors suggest TESE when an ICSI cycle fails, blaming the failure on the quality of the ejaculated sperm. They argue that sperm from the ejaculate may have higher DNA fragmentation due to exposure to oxidative stress in the seminal fluid, and claim that using sperm directly from the testes can improve pregnancy rates.
However, Dr. Malpani asserts that this rationale is flawed. Studies and clinical experience show that once sperm is injected into an egg during ICSI, the source of the sperm-whether from the ejaculate or directly from the testes-does not significantly affect the success rates of the procedure. In other words, TESE does not provide any added benefit over using ejaculated sperm for ICSI.
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Also watch -
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