The IVF technique involves taking sperm and eggs out of the body, fertilizing them by various means, forming embryos through in vitro culture, selecting quality embryos for transfer or freezing, and ultimately helping infertile couples to obtain a healthy baby. Therefore, good quality eggs and sperm are essential for a successful IVF. Normally, sperm acquisition can be accomplished through the masturbation method, however, some patients have sperm density equal to 0 in the semen obtained after masturbation and still cannot find sperm after centrifugation, this condition is called azoospermia, some patients only see a few motionless or slow moving sperm but with high malformation rate, and even some patients cannot complete masturbation for ejaculation. In these patients, other methods of sperm retrieval must be used, and percutaneous testicular/epidididymal aspiration (TESA/PESA) is a frequently used method. However, not every patient with azoospermia is suitable for TESA/PESA, and in general azoospermia is divided into obstructive azoospermia and non-obstructive azoospermia. Obstructive azoospermia is the absence of sperm in the semen due to obstruction of the vas deferens, and the patient has normal secondary sexual characteristics, libido, and sexual function. In this type of azoospermia, the testes are normally developed, and there is a certain amount of normally produced sperm stored in the testes and epididymis, but no sperm is discharged due to the obstruction of the vas deferens. Therefore, a certain amount of high quality sperm can be obtained by puncture and intracytoplasmic sperm injection (ICSI) can be performed. In contrast, non-obstructive azoospermia is usually due to testicular spermatogenic dysfunction, resulting in the absence of sperm in the semen due to the inability to produce sperm or the production of only a very small amount of sperm. This type of patient would be difficult to obtain sufficient quality sperm by puncture, but puncture can be very helpful in the diagnosis and treatment of such patients. The procedure of percutaneous testicular/epidididymal puncture for sperm extraction (TESA/PESA) roughly involves collecting sperm under local anesthesia through a needle and a very fine needle through the skin of the scrotum and extracting semen directly from the testes or epididymis. If sufficient quality sperm can be collected, the sperm is used for ICSI fertilization. This method is less invasive and less painful than the incisional method. However, percutaneous testicular/epidididymal aspiration treatment does not guarantee successful sperm retrieval, and there are many other factors that can affect the above process and make the treatment fail, including certain unpredictable factors. Percutaneous testicular/epidididymal sperm extraction (TESA/PESA) is a recently developed high-tech assisted reproductive technology that has enabled many infertile couples to have their own children. It is mainly applied to patients with obstructive azoospermia, some non-obstructive azoospermia, severe oligospermia and ejaculatory dysfunction, bringing hope to the majority of infertility patients.
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