Fertility Programs and Services

Testicular Sperm Aspiration (TESA)

When conception is the goal, most couples willingly agree to a full range of procedures that result in the birth of a child. But that doesn’t mean those procedures can’t be made as comfortable and cost effective as possible.

That’s the philosophy endorsed by specialists in the Reproductive Medicine Center at Froedtert & The Medical College of Wisconsin. One such treatment approach is a minimally invasive procedure for men called testicular sperm aspiration, or TESA.

The Reproductive Medicine Center at Froedtert & The Medical College is the only program of its kind in the Milwaukee area offering this procedure. It has been a treatment option for men who visit the Reproductive Medicine Center for eight years.

TESA is performed by a urologist using a local anesthetic, a small needle and a special syringe to extract sperm directly from the testicles to be used for diagnosis and/or sperm freezing. Unlike the traditional open testicular biopsy, TESA saves time, and ultimately, cost for the patient. It is well-tolerated, and the outcome — the most important consideration — is just as effective, according to Jay Sandlow, MD, Medical College of Wisconsin urologist and vice chairman of Urology at Froedtert & The Medical College.

Unlike an open testicular biopsy, which is a day surgical procedure requiring an operating room, an anesthesiologist and a recovery room, TESA is a clinic procedure that lasts approximately 20 to 30 minutes. Recovery is shorter and significantly less painful. While open testicular surgery may require a recovery period of nearly a week, TESA is often done on a Friday afternoon, allowing men to rest and heal over the weekend and return to work Monday.

“Our goal is to make these procedures as easy on the patient as possible, while gaining the information we need to proceed with further fertility treatment,” Dr. Sandlow said. “In the end, we are all aiming in the same direction — conception, and a new baby.”

Typical candidates for TESA are men who have had a vasectomy they choose not to reverse, men with blockages, or those who cannot produce sperm in the ejaculate, but are producing sperm in the testicles. In addition to vasectomy, causes for lack of sperm may include prior testicular trauma, a congenital condition, or previous infection.

Doctors can determine whether TESA is an option after obtaining specific medical information about the patient. TESA extracts as much sperm and tissue as an open testicular biopsy and results can be delivered immediately. Urologists view results right in the procedure room of the clinic, and determine whether further analysis is necessary.

If, as in rare cases, a testicular cancer is diagnosed, the urologist can perform a TESA procedure to extract the patient’s sperm from the non-cancerous testis and freeze it prior to cancer treatment if the patient cannot ejaculate on his own.

The treatment has been so successful that Dr. Sandlow and his colleagues recently published an article about it in the Journal of Urology. “Patient reaction has been remarkably positive,” Dr. Sandlow said. “While most men experience TESA as their first sperm retrieval procedure, those who have had previous open testicular biopsies cannot believe how easy TESA is. It has been a phenomenal success.”

Author: Eileen Wright