Santiago Brugo Olmedo M.D.
Medical Director
Seremas Medicine for men and women
Seremas Home Seremas Surgery Seremas Epididymis Punction

Epididymis Punction

CIRUGIA | Punción de Epidimios

PESA: percutaneous epididymal sperm aspiration technique

Obstructive azoospermia
The most common case is the one of the patient who has suffered an inflammation of the epididymis at some point in his life and, therefore, they became obstructed.
These patients have totally healthy testis, they have good size and consistency, evidently, the problem is not in production but in the emission, from the testis to the penis.

What should we do?
In the first place, we must know if the testicular function is in good state. In order to do so, we will ask for a hormone analysis in blood, especially FSH and LH and, if necessary, B inhibin.

In general, we must make sure that the obstruction takes place in all the epididymis, because in case it occurs in only one part of it, we will be able to try surgical correction. This surgery consists of opening the epididymal tube and connecting it to the vas deferens; in this way, we will make the spermatozoa go through it freely on their way out. When all the epididymis is harmed, then we will have to use “percutaneous punction”, which means we will use light local anaesthesia and with a very thin needle, make an incision in the epididymis and at the same time aspire with a very small syringe connected to that needle. In this way, we will get the necessary spermatozoa to be used in In Vitro fertilization with ICSI.

But there are cases of obstructive azoospermia which are due to the lack or absence of the ducts which take the spermatozoa from the testis, in other words, vas deferens.

Why does absence of vas deferens occur?
It is a congenital disease, this means, previous to birth. There was a mistake in the patient’s development when he was in his mother’s uterus and those ducts were not formed. Actually, this absence of vas deferens is part of a much more important disease with bad prognosis, which is cystic fibrosis. These patients only suffer from the minimal expression of that disease, which causes the absence of deferens. Cystic fibrosis is a genetic disease, in other words, in these men there is a mutated ill gene causing the pathology.

Is it dangerous for the patient?
No, it is not. These men have no life risk because they have this genetic mutation of cystic fibrosis.

Can patients who do not have spermatozoa because of non-obstructive azoospermia, and have a genetic mutation for cystic fibrosis have children?
Yes, they can. We simply have to collect spermatozoa from the epididymis or from the testis and we will be able to use them in order to inject the woman’s oocytes, with an ICSI, and in this way we can achieve pregnancy.

Can it be risky for their descendants?
Yes, it can. It is relevant to carry out a genetic test of the couple in order to know if the female partner “shares the allele”, this means, if she has a gene modification which is similar to that of her husband’s. In that case, this couple has a high risk of having children who will suffer from cystic fibrosis disease, but complete. When this is the case, these children’s life prognosis is really compromised. Because of this reason it becomes essential to carry out the analysis of the woman’s potential genetic mutations in order to discard the possibility of transmitting cystic fibrosis disease to their descendants.

Results of pregnancy using this type of spermatozoa, are usually more successful than those we get when using testicular spermatozoa in patients with non-obstructive azoospermia. However, it is very important to remember the need of studying the patient’s female partner genetically in order to discard mutation coincidence of the same gen.

This genetic analysis is called PCR for cystic fibrosis mutations and is carried out in several laboratories in the country.

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