TESA or TESE: It is the doctor's call

Since the medication prescribed for my DH was doing no good, his andrologist Dr. Vasan S S decided to introduce us to the term Testicular Sperm Aspiration (TESA). TESA involves anaesthetizing the scrotum, then a very tiny needle is passed into the testicle, and sperm along with a small amount of testicular tissue is aspirated out. As per his gut feel, this process will enable him to retrieve a few good quality sperms; TESA had been proven successful in cases where no sperm was found in the Semen Analysis but sperms would be available in the testicles or the epididymis. As that was our case, we went ahead with the "needle aspiration" procedure in Feb' 13.

Although information on the internet said TESA is done under local anaesthesia, we were asked to get my DH's Pre-Anaesthesia Check (PAC) to be completed two days prior to the TESA procedure. The procedure took time and after the minor surgery got over, Dr. Vasan informed me that he had to perform a Testicular Sperm Extraction (TESE) instead. TESE involves few small incisions and taking out some tissue from inside the testicle. As you are made to sign all sorts of consent forms before the hospital performs any procedure, it is then the doctor's decision to take necessary steps to try all possible ways to achieve the objective.

They informed us of cryopreserving two vials of sperms extracted during TESE. Since the incisions and sutures were at a very delicate part of my DH's body, he was advised to take a break from work for a week with restricted movements. It was a tough and painful phase of our lives.

Now, things were supposed to unravel the next month, after my Egg Retreival (ER) process.

                                                              

Decided to go with ART at Manipal Hospital

After running from pillar to post, visiting so many doctors within a month's time, we zeroed in on Manipal Hospital Bangalore (MHB) with high hopes. Actually, we heard about MHB on radio while driving on one of the "doctor hopping" days. They had a dedicated ART/ IVF Dept and talked about good success rates; plus they had Dr. Bina Vasan & Dr. Vasan S.S., Urologist-Andrologist as their Team Lead.

We first met with the Uro-Andrologist in Nov' 12 to discuss my DH's Severe Oligospermia and Bilateral Varicocele Grade III and see if his suggestion was any different. He gave us enough time to understand all the reports and our fears, then prescribed two medicines for one month time period, namely Paternia and Wysolone to boost the sperm production. He asked us to do a Semen Analysis (SA) test before starting the medicines and come back with a fresh SA test after taking a month's dose. He also asked us to discuss the way forward with his wife, Dr. Bina Vasan, ART Specialist.

We met Dr. Bina Vasan, asked about the IVF procedures, their costs, etc. We were given in-depth information about all of it by her Assistant, Dr. Manju Nair. As a norm, MHB asks all their new ART patients to do expensive tests of HIV, HCV, HBsAg, VDRL and ELISA for both the partners before going ahead with any treatment. In the next consultation, they wrote down few more tests like Inhibin B and CASA for the male partner and a procedure called Hysteroscopy for the female partner. 

After meeting the doctor couple, our dimming hopes got new flight. We felt that we are in safe hands, and this might be the positivity that we were looking for. Their enthusiasm and involvement gave us confidence.

DH reports of SA in Nov'12, were just the same as conducted in Sep and Oct' 12 in the previous few "doctor hopping" visits (all of them were reputed clinics, so scope of error wasn't much) although done in different lab. 

They planned my hysteroscopy procedure in Dec' 12. Later, many doctors confirmed that conducting a hysteroscopy even before starting with an ART treatment isn't the best thing to do; makes more sense to be done after a few failed IUI/IVF attempts.

More about hysteroscopy and our journey in my next post.