PESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI who have obstructive azoospermia from either a prior vasectomy or infection. It is done with local anesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval.
PESA is a procedure that can be performed under local anesthesia without a microsurgical skill set. The procedure involves placing a butterfly needle in to the head of the epididymis after administration of local anesthetic. Negative pressure is applied until a milky white fluid is visualized. The tubing is then clamped and the system is flushed with sperm media in to a collection tube. The procedure can be repeated until sufficient yield is obtained. The percutaneous approach obviates the need to perform a skin incision therefore avoiding the associated morbidity such as infection and pain; however, a small risk of hematoma is still present. Percutaneous puncture can cause epididymal obstruction due to scarring which may preclude future reconstruction if this is pursued. PESA sperm yield is lower than MESA although usually sperm numbers are adequate for ICSI.