PED

Pedal Mark 1

Percutaneous Epididymal Sperm Aspiration (PESA) is a medical procedure used in the field of andrology and reproductive medicine to address male infertility. This technique involves the direct aspiration of sperm from the epididymis using a fine needle. PESA is often employed when there is an obstruction in the male reproductive tract that prevents sperm from being ejaculated, such as in cases of vasectomy, congenital absence of the vas deferens, or other obstructions. It is also used when there is a failure to retrieve sperm via ejaculation due to other reasons.

Procedure

The PESA procedure is minimally invasive and can be performed under local anesthesia in an outpatient setting. During the procedure, a fine needle is inserted into the epididymis, which is a tightly coiled tube located at the back of the testicle that stores and carries sperm. Sperm is aspirated directly from the epididymis with minimal discomfort to the patient. The aspirated fluid is then examined in a laboratory to isolate viable sperm for use in assisted reproductive technologies (ART), such as In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI).

Indications

PESA is indicated for men with:

• Obstructive azoospermia, where there is no sperm in the ejaculate due to a blockage.
• Congenital absence of the vas deferens, often associated with Cystic Fibrosis gene mutations.
• Previous vasectomies where the patient now desires fertility.
• Ejaculatory dysfunction, including anejaculation or retrograde ejaculation.

Advantages

• Minimally invasive with few complications.
• Can be performed under local anesthesia.
• Does not require surgical incision, leading to quicker recovery times.
• Enables men with obstructive azoospermia to father biological children.

Risks and Complications

While PESA is generally safe, there are potential risks and complications, including:

• Pain or discomfort at the puncture site.
• Hematoma or bleeding.
• Infection.
• Rarely, damage to the epididymis, which could affect sperm production or cause further obstruction.

Comparison with Other Techniques

PESA is often compared with other sperm retrieval techniques such as Testicular Sperm Aspiration (TESA) and Microsurgical Epididymal Sperm Aspiration (MESA). While PESA is less invasive and requires less recovery time, MESA is known for yielding a higher quantity and quality of sperm, especially useful in cases of low sperm count or quality. However, MESA is more invasive and requires general anesthesia and microsurgical skills.

Conclusion

PESA represents a significant advancement in the treatment of male infertility, particularly for those with obstructive azoospermia. It offers a less invasive option with the potential for high success rates when combined with ART. As with any medical procedure, the decision to proceed with PESA should be made after a thorough discussion with a healthcare provider, considering the individual's specific medical history and fertility goals.