# New to site - Failed PESA!



## LLM (Dec 9, 2004)

Hello Everyone.

Let me give you a quick summary:

Jan 04 - Initial investigations showed zero sperm count
Apr 04 - Testicular biopsy showed "signs of spermatogenesis in left testicle"
Nov 04 - Cancelled ivf due to failure to retrieve any sperm through pesa

Obviously we are completely devastated by what happened last week and I am in a complete state of shock. My DH is doing his best to remain positive but I think he's just being very brave.

What concerns me is that our consultant told us to now consider using the 3 embryos that are in the freezer (fertilised with donor sperm) and to give up on the idea of having my DH's biological child. When we had the biopsy in April we were given hope by the urologist that there was a good chance of finding enough sperm for icsi through tese, which is what we went for but on the day they only performed pesa and not tese which has been found to produce better results in severely azoospermic men.

Does anyone think that maybe we should have another go at another clinic or should we give up and consider the donor embryos?

Very very confused!

Lou x


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## Claudine (Jul 27, 2004)

It's hard to give advice out over these things as everyone has different circumstances to consider.  If you can afford it and you are still young enough to pursue your dream of having a child that is both genetically yours, then look for another clinic.

Most of us on the MF thread on the ICSI board are having to go through PESA or TESE.  It's interesting that your clinic said that PESA was more successful, we are all under the impression that in fact TESE is the more aggressive surgical retrieval option and that IT rather than PESA is the last recourse.  What your clinic is saying is completely at odds with everything we have found (and that's a fair amount of research as many of us have azoospermic DHs).

When they said better results, did they mean better chance of finding sperm or better chance of successful pregnancy

Fin's DH is looking to go to Peter Schlegal at Cornell in the US after an unsuccessful TESE at the Bridge.  Nathalie's DH has had an unsuccessful PESA and will be going for TESE in the New Year.

What clinic are you at?  Do you know why your dh is azoospermic?  (non-obstructive, obstructive?).  Sorry to bombard with questions, but more info can help us to help you!

Don't make any decisions until you are sure you have researched and exhausted all possible options.  Do not feel pressured by your consultant; yes, donor is more likely to be successful and more immediate but you need to be given full information in order to be able to make an informed decsion.

Take care of yourselves, this is a very upsetting and emotional time for you.  Sending you lots of support.


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## LLM (Dec 9, 2004)

Thanks for your reply!

I think I could have explained things a bit better as yes, I agree that tese is the best procedure as that is effectively what DH had when he had the testicular biopsy and they found some signs of life. 

Throughout all of our appointments with the consultant (Bupa Leicester and Leicester ACU) he talked about ivf/icsi/tese but then when it came to paying for the treatment on the day I was billed for ivf, pesa, etc. 

And another thing, when my DH had the biopsy he was cut open and had a couple of stitches for a week but with the pesa there was only a mini steristrip covering the puncture wound and it was alot less painful.

DH has been diagnosed with Non Obstructive Azoospermia but none of the tests (FSH/Testosterone/Karyotype/Cystic Fibrosis) have said what caused it which is another bone of contention as I know he would feel happier in himself if he was given a reason why!

The more I think about it the more I don't want to give up on our dream yet!

Lou (32 for 20 more days!)


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## Fin (Aug 23, 2004)

Hi Lou,

So sorry to hear of the failed Pesa all I can say is you have to try Tese as they are two totally different procedures.

Percutaneous epididymal sperm aspiration (PESA) and is recommended for men with obstructed or absent ejaculatory ducts (i.e. unsuccessful vasectomy reversal, congenital absence of the vas deferens). Sperm are aspirated directly from the epididymis (the tiny collecting tubules next to the testes) for use in the ICSI procedure. The few drops of fluid may contain sufficient sperm to be frozen for several ICSI procedures.

Testicular sperm extraction (TESE) is available for men with obstructions or ejaculatory problems that cannot be treated by any other method. Small samples of testicular tissue are obtained by needle biopsy and a few sperm are painstakingly dissected out of the tissue for use in the ICSI procedure.

As you can see from the above the Pesa locates sperm in the epididimus and Tese sperm from the testicles. If your DH does not have Obstructive Azoospermia Pesa was a waste of time to be honest.

Like Claudine has said my DH and I are going to New York next year for Microdisection Tese (a more advanced form of Tese) due to my DH having an unsuccessful Tese.

Can I ask what was your DH FSH levels?

At first it does seem like the end of the world but you will find that with research doors will be opened to you that you never knew were there.

Anytime you need advise or just to talk you know where I am.

Lol

Fin


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## Andy_N_Yil (Jun 27, 2003)

Lou - I've had SSR (TESE & MOST) and it might be helpful to give a bit more info as Fin says 
* FSH
* Ball size

Mine are about 1/3 the size of a normal mans and I have had SA's with 5 or 10 in them.  There is a condition called "Klinefelter's Syndrome" such a condition results in Small balls, long arms/legs etc.. usually due to a chromosone abnormality.  But the doctors don't even rank me in that, I'm an unknown as all my chromosones are ok.  
We'd all like a name for our issues but I think you need to concetrate on the solution.

My feeling is by questioning the donor embies you want a bit of you and your DH in the mix.  Which is a very loving stance to take as it's not your issue it seems.  My DW also understands why I become silient when someone uses the 'donor' word and I think Fin is amazing going to the lengths she is.  

Your only issue now is time and money...  Time for both treatment and yourselves and money for the rest.

Good luck
Andy


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## Claudine (Jul 27, 2004)

Lou, I'm not sure I should add fuel to the fire but...
when we had our diagnostic testicular biopsy which was done using TESE, they froze whatever sperm they could find.

Was this not done or discussed as an option with you back in April?  Or was it done and it did not thaw well (this happened to us on our first and third cycles, we managed to get 2 embryos but they were not very good).

My DH's FSH levels are around the 16 mark, well, they were at last testing anyway.  Like you we have had -ve for CF gene, Y chromosome microdeletion and normal karyotyping.  Like you we don't know why DH has NOA.  But as you can see, Andy and his DW are proof NOA men can be fathers (there's another guy called Zosh who was similarly lucky first time)... so there is hope!

Have posted links to sperm retrieval on the next post down to yours, someone else who has had an unsuccessful result.  Hope it's of help to you.


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## LLM (Dec 9, 2004)

Thanks for all your replies, it is soooooo nice to know we are not alone!

I don't know what the FSH level was but I know they said it was slightly high. DH does have small balls but the karyotype came back normal and I think it would have identified something like Kleinfelters.

We were told that sperm retrieved through tese does not freeze well so there was no point in that.

I guess I'm just feeling a bit miffed that what we thought we were getting (any paying for) we didn't get and now we are sat here completely dejected. 

I will try and get hold of a copy of DH's blood results and spend the next few months making enquires about having another go.

Thanks once again
Lou x


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## Flopsy (Sep 18, 2003)

Hi Lou,

My DH has had 2 successful TESE's and the sample froze and thawed really well.  Both the hospital who did the procedure and three IVF clincs we have spoke to were happy to use this procedure. They claimed that there was little difference between a fresh and frozen TESE. Weird or what?

In our case one clinic tried to push us into using donor sperm but that was because my DH is a cancer survivor and the TESE was done after cancer tx.

Sadly, even with wonderful embryos created we have been unsuccessful but that is probably due to a problem with my immune issues.

Good luck with the research.  Would suggest a second opinion and maybe a letter to the clinic querying their decision.  Don't blame you for feeling miffed!!

with warmest regards,


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## natalie34 (Jun 7, 2004)

Hi Lou,

Not much more to add than what everyone else has said.

My DH had <1million sperm back in June. In October, I started D/R and we decided for back up purposes to have some frozen.

All hormone tests were fine - FSH - 4.4.

Despite trying 3 times, all were NIL. We were advised to go for PESA. Unfortunately this failed in November and my tx was abandoned.

DH had further FSH test - 5.1 and scan of testicles - all fine. So now we are off to have TESE on 12/01/05.

Like Flopsy, our consultant does not have an issue regarding the sperm being frozen and he alos confirmed that in his opinion as the operation is so envasive, this is our best option, as they do not know what the problem is with my DH. In his words, if its there, with TESE he should be able to find it. As Fin and the others have said, PESA only goes into the epididymis.

Why not join us on the ICSI Male Factor. Its a great thread and there are lots of us in similar situations to you. See above!!

Best of luck,

Nat x x


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