Male Infertility::

. Percutaneous Epidiymal Sperm Aspiration (PESA) for assisted fertilization (ICSI)

In Vitro-Fertilization (IVF) using Intra cytoplasmic Sperm Injection (ICSI) has become the treatment of choice for couples with severe male factor infertility. It has also proved propitious for patients who have had failed vasectomy reversal.

However and regardless of the presence of ASAB and other complications whereby ejaculation is prohibited (a blocked out flow tract), the testes continue to produce sperm which collects in the epididymis, located on the side of the testes leading into the vas.

In order to obtain the sperm directly from the epididymis a new technique has been developed - Percutaneous Epididymal Sperm Aspiration (PESA). The procedure is not a complicated one and is usually carried out under local anaesthesia with a light sedation. The majority of patients resume full activities after a couple of hours. The sperm collected with PESA can be injected individually into the eggs previously recovered from the female partner using the technique of Intra cytoplasmic Sperm Injection (ICSI).

In circumstances where PESA is unsuccessful, it may be possible to retrieve sperm directly from the testes. It has recently been reported that sperm obtained in this way achieved fertilization for one man who had gross distorted anatomy due to several previous operations carried out due to an absent vas. This is a very promising result, highly applicable to men who have had several attempts at vasectomy reversal.

PESA / ICSI can achieve a fertilization rate of over 60%. Actual pregnancy outcome however, relates to other factors such as (i) the age of the woman producing the eggs (ii) how many embryos were generated and (iii) how many embryos transferred. To date our overall success rate for ICSI is 40%.

To summarise, PESA / ICSI is of value for (i) men with congenital absence of the vas (ii) those with failed vasectomy reversal and (iii) those with other irremedial obstructions of the genital tract.

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