Introduction to TESA and PESA
TESA (testicular sperm aspiration) and PESA (percutaneous epididymal sperm aspiration) are two methods of retrieving sperm that can be used in the treatment of male infertility. They are essentially sperm extraction methods from the male reproductive system, and as such, they are the methods of last resort. Usually, doctors only recommend these techniques when sperm output is nil or insignificant, i.e., there is no sperm in the semen sample or the amount is inadequate, while sexual function is normal or unprotected sexual intercourse is possible.
Thereby, TESA and PESA help biological fatherhood through assisted reproductive techniques by retrieving sperm directly from the male reproductive system.
At Zemya IVF & Fertility Clinics, we recognise that these are very sensitive procedures. Hence, to make sure that the sperm retrieval technique will not only be successful but will also address the root cause of infertility, we only resort to these procedures after a detailed evaluation of a man’s fertility.
Understanding male infertility and sperm transport issues
Male infertility could be due to any of three issues: sperm production, sperm transport, or ejaculation. Sometimes, although the testicles produce normal sperm, there is a blockage somewhere in the reproductive tract, which results in sperm not being able to mix with the semen. At other times, various reasons such as genetic disorders, hormonal imbalances, or testicular damage may lead to sperm production being affected.
In cases where the integrity or functionality of the vas deferens, epididymis, sperm duct, or testicular tissue has been compromised, the male is likely to be infertile even if he can have sexual intercourse and ejaculate normally.
What is testicular sperm aspiration (TESA)?
Testicular sperm aspiration is a minor surgery for sperm retrieval directly from the testis. In the testicular sperm aspiration TESA procedure, a very thin needle is used to puncture the testicle so that the tissue containing the sperm can be recovered. If sperm are produced but are not found in the semen assay, this method is very helpful.
Usually, TESA is recommended for males who are diagnosed with infertility due to obstructive causes or in cases where the sperm count is so low that ejaculated sperm are not sufficient for fertility treatment in these patients.
What is percutaneous epididymal sperm aspiration (PESA)?
Percutaneous epididymal sperm aspiration means getting sperm from the epididymis, which is a coiled tube behind the testicles where sperm mature and get stored. This method is mainly advisable for men who have azoospermia due to a blockage, i.e,. sperm production is fine, but the sperm can’t get through because of the block.
With PESA, a doctor can collect sperm suitable for fertilization without cutting the skin; it is quite quick, and the patients don’t usually have complaints about it afterwards.
Key differences between TESA and PESA
While both procedures aim to obtain sperm, TESA sperm is extracted directly from the testicular tissue, while PESA sperm is taken from the epididymis. The determination of which method to employ is based on a semen analysis, the status of sperm production, and whether there is a blockage in the reproductive tract.
At Zemya IVF & Fertility Clinics, whether to choose TESA or PESA is determined by comprehensive diagnostic testing and the individual circumstances of the patient.
Conditions that may require TESA or PESA
TESA and PESA are two of the options recommended for several male infertility conditions, such as:
- Obstructive azoospermia
- Congenital bilateral absence of the vas deferens
- Failed vasectomy reversal
- Retrograde ejaculation
- Low sperm count or total sperm count
- Undescended testicles
- Poor sperm production
- Male infertility diagnosed after semen analysis
In addition, these surgical methods can be used along with other reproductive technologies when the ejaculation of sperm may not provide enough sperm for obtaining fertilization.
Importance of semen analysis in male infertility evaluation
Semen analysis is an important test that helps to determine sperm count, sperm motility, and sperm morphology. A man may have a normal ejaculate volume, but no sperm can be measured, whereas another man may have drastically reduced sperm numbers, which interfere with fertilisation.
Usually, if the semen analysis results are abnormal, it will be necessary for the doctor to conduct a more detailed analysis and consider the possibility of sperm retrieval.
Pre-procedure evaluation and diagnostic testing
Before a TESA or PESA procedure, patients usually come to a fertility clinic where they get a full workup. This work-up will include a physical exam, blood tests to check hormone levels, and imaging studies like a testicular ultrasound.
Genetic investigations might be suggested if there is an absence of the vas deferens from birth, a case of cystic fibrosis, or suspicion of chromosomal abnormalities. Such examinations are aimed at figuring out if sperm retrieval can be carried out and is safe.
Step-by-step explanation of the TESA procedure
TESA is performed under local anesthesia. A thin needle is used to penetrate the testicles to aspirate a tissue sample that contains sperm cells. The biopsy is promptly checked under a microscope to confirm the presence of live sperm.
Many patients worry about the level of pain and wonder if TESA hurts. The majority of men report only minor pain, and aftercare is generally simple, with the pain going away quickly.
Step-by-step explanation of the PESA procedure
PESA consists of inserting a needle into the epididymis, where the fluid rich in sperm is aspirated. The procedure is without cuts and is usually very quick to perform. PESA is most effective when the production of sperm is normal, but the sperm cannot be transported due to a blockage.
Microsurgical epididymal sperm aspiration can be used in selected cases for enhanced accuracy.
Advanced sperm retrieval techniques for complex cases
Advanced procedures could be performed if regular sperm collection methods fail to produce enough sperm. These are, for example, microscopic testicular sperm extraction, microdissection testicular sperm extraction, and diagnostic testicular biopsy.
With these techniques, fertility experts can locate small areas of sperm production, even in cases of very severe male factor infertility.
Sperm quality, maturity, and viability
The success of fertility treatment depends not only on obtaining sperm but also on the quality of sperm. Retrieved sperm are analyzed for maturity, motility, and genetic integrity. Even a few healthy sperm can be sufficient when advanced assisted reproductive techniques are used.
High-quality sperm increases the chances of fertilisation and healthy embryo development.
Use of retrieved sperm in fertility treatments
Sperm obtained through TESA or PESA are mostly used in in vitro fertilization (IVF), especially with intracytoplasmic sperm injection. In ICSI, a single sperm is injected directly into the female partner’s egg after egg retrieval.
This approach bypasses natural fertilisation barriers and is especially helpful when sperm numbers are insignificant.
TESA, PESA and assisted reproductive techniques
TESA and PESA are important methods that have helped male infertility through reproductive techniques.
Sperm obtained can be used for immediate treatment or frozen for later treatment cycles, thus giving the couples the freedom of planning their family.
Note: There are many other factors that influence success rates. Some of them are sperm quality, the female partner’s eggs, embryo development, and overall reproductive health.
Lifestyle factors influencing male fertility
Various lifestyle habits can have a considerable influence on sperm production and male fertility in general. Some of these are smoking, heavy drinking, poor diet, and exposure to harmful substances in the environment.
Along with medical intervention, taking up good lifestyle habits can help enhance sperm quality.
Medical conditions associated with male infertility
Various health issues can result in male infertility and require sperm retrieval. Some of them are:
- Testicular cancer
- Erectile dysfunction
- Premature ejaculation
- Anti, sperm antibodies
- Sexually transmitted infections
Getting diagnosed at the earliest time allows one to plan appropriate treatment.
Hormonal and genetic influences on sperm production
Hormonal imbalances, including testosterone or pituitary gland dysfunction, may impact sperm production. Genetic disorders, including chromosomal abnormalities and cystic fibrosis-related conditions, may also reduce fertility.
Genetic testing helps guide treatment decisions and reproductive counselling.
Expectations and success considerations
TESA and PESA have become a blessing for many men who were infertile and helped them to have biological children after the natural way was impossible.
Disclaimer: Fertility results are influenced by a variety of factors, such as the ability to retrieve sperm, the age of the female partner, the quality of the eggs, and how well embryos can be implanted.
Frequently Asked Questions
TESA (testicular sperm aspiration) and PESA (percutaneous epididymal sperm aspiration) are used to retrieve sperm directly from the male reproductive system when sperm are absent or insufficient in the semen. These procedures help men with male infertility achieve pregnancy through assisted reproductive techniques.
TESA or PESA may be recommended if semen analysis shows very low sperm count or no sperm at all. These procedures are commonly advised in cases of obstructive azoospermia, failed vasectomy reversal, congenital absence of the vas deferens, retrograde ejaculation, or poor sperm production.
TESA retrieves sperm from the testicular tissue, while PESA collects sperm from the epididymis. The choice of procedure depends on whether sperm production is normal and if there is a blockage in the reproductive tract.
The TESA procedure is performed under local anesthesia, and most men experience minimal discomfort. Mild soreness may occur after the procedure but usually resolves within a short period.
PESA is a minimally invasive procedure that does not require surgical incisions. A fine needle is used to aspirate sperm from the epididymis, making recovery quick and uncomplicated.
Both TESA and PESA are relatively short procedures and are usually completed within a brief clinical visit. The exact duration may vary depending on individual anatomy and clinical findings.
Yes, sperm collected through TESA or PESA can be frozen and stored for future use. This allows flexibility in fertility treatment planning and reduces the need for repeated procedures.
Natural pregnancy is unlikely after TESA or PESA, as these procedures are typically performed when sperm cannot reach the semen. Retrieved sperm are usually used with in vitro fertilization and intracytoplasmic sperm injection.
Sperm retrieved through TESA or PESA are most commonly used in IVF with ICSI. This technique allows fertilisation even when only a small number of viable sperm are available.
Both procedures are generally safe when performed by experienced fertility specialists. Minor risks may include temporary discomfort, swelling, or bruising. Serious complications are rare.
Success depends on the underlying cause of male infertility, sperm quality, female partner’s age, egg quality, and embryo development.
Disclaimer: Fertility outcomes vary based on multiple individual and clinical factors.
Yes, smoking, excessive alcohol consumption, poor diet, and stress can affect sperm health. Adopting healthy lifestyle habits can support better sperm quality alongside medical treatment.
Genetic testing may be recommended, especially in cases of congenital absence of the vas deferens, cystic fibrosis, or suspected chromosomal abnormalities. This helps guide treatment and reproductive planning.
You should consult a fertility specialist if semen analysis shows low or zero sperm count, or if pregnancy has not occurred despite regular unprotected sexual intercourse. Early evaluation improves treatment options and outcomes.
TESA and PESA are performed at Zemya IVF & Fertility Clinics, where experienced fertility specialists provide advanced sperm retrieval procedures with personalised care and ethical treatment planning.