PESA can be used for men with congenital absence of the vas and in lieu of vasectomy reversal. This procedure involves insertion of a small needle, under local anesthesia, directly into the epididymis for aspiration of a fewer number of sperm than would be necessary for fertilization by conventional IVF. However, in most cases there are more than enough sperm to fertilize all oocytes by ICSI. With newer cryopreservation techniques, there may even be sufficient numbers of sperm for freezing so that additional ICSI procedures could be performed in the future without the need to obtain more fresh sperm.
The advantages to this technique are that it can be performed without surgical scrotal exploration, it can be repeated easily and at low cost, and it does not require an operating microscope or expertise in microsurgery.
The procedure is performed under local or general anesthesia. After induction of anesthesia, the testis is stabilized and the epididymis is held between the surgeon’s thumb and forefinger.
PESA has the main benefits of being successful in most of the cases, while avoiding a skin incision. Costs are lower because an operating microscope, the skills of a micro-surgeon and the possibility of a general anesthetic are not necessary or likely. The most significant drawback is the blind nature of the procedure, often requiring multiple, potentially damaging needle insertions. The delicate, coiled anatomy of the epididymal tubules are easily damaged with such maneuvers. While PESA may be successful for a person’s first ICSI cycle, future cycles will require repeated procedures and the increased likelihood of progressive epididymal damage.
Thailand, Malaysia, Singapore, Turkey and India are the most cost effective locations that offer up to almost 80% savings in comparison to the US.
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