When would my husband need an epididymal sperm aspiration as opposed to a testicular sperm extraction?

The epididymal sperm aspiration, ESA, is a useful technique to retrieve sperm from men with obstructions and the sperm can be used for assisted reproduction (ART). Sperm retrieved in this manner is most commonly used in conjunction with IVF, as opposed to IUI, or artificial insemination. This is because standard IVF uses as few as 10,000 sperm and ICSI uses only 1 sperm, compared to 1 million, at least, that are required for IUI. Therefore, a couple can have multiple IVF attempts with 1 ESA, but only 1 IUI attempt.

The testicular sperm extraction (TESE) is a terrific technique to retrieve sperm from men that have either a sperm duct obstruction disorder or a sperm production failure disorder. The TESE enables a urologist skilled in the procedure to locate tiny pockets of sperm production with as little as 1-2 sperm. This small number of sperm can then be used for IVF or ICSI. I recently did such a procedure in which I--and the embryologist--found 9 sperm (Normal is millions!). After ICSI, the woman is pregnant with twins.

The most important determination of ESA vs TESE is the man's diagnosis as well as the preference of the embyologist and reproductive specialist. In this area, most embryologists prefer epididymal sperm, but can work easily with sperm retrived with the TESE.

Dr S.