TESA and PESA: Sperm Retrieval Procedures Explained

TESA and PESA are two ways of collecting sperm directly from the male reproductive tract when there is no sperm in the ejaculate, a condition called azoospermia. PESA draws fluid from the epididymis, the tube where sperm matures and is stored. TESA takes a sample from the testicle itself. Both use a fine needle rather than an incision, both are day procedures, and the sperm collected is used with ICSI, where a single sperm is injected into an egg. Which one is appropriate depends on why there is no sperm in the semen.

Why are TESA and PESA needed?

Both procedures exist to solve the same problem: sperm is not reaching the ejaculate, so it has to be collected further upstream. Infertility frequently involves a male factor, and azoospermia is one of its more significant forms. There are two kinds, and the distinction determines which procedure is used.

• Obstructive azoospermia. Sperm production is normal but a blockage prevents it reaching the ejaculate. Causes include a previous vasectomy, congenital absence of the vas deferens, or scarring from past infection.
• Non-obstructive azoospermia. The testes are producing little or no sperm, usually for hormonal or genetic reasons. There is no blockage to bypass.

In obstructive cases, mature sperm is usually waiting behind the blockage and can be aspirated. In non-obstructive cases, sperm may be present only in small pockets within the testicular tissue, which is why a different approach is needed and why success is less certain.

What is PESA?

PESA stands for percutaneous epididymal sperm aspiration. A fine needle is passed through the skin into the epididymis and fluid containing sperm is drawn off. There is no incision and no stitches, and it is a day procedure.

PESA is generally used for obstructive azoospermia, where sperm production is normal and the problem is purely mechanical. It is usually attempted before more invasive options because it is quicker and carries less risk.

What is TESA?

TESA stands for testicular sperm aspiration. Rather than drawing from the epididymis, a fine needle takes a sample of tissue or fluid directly from the testicle. It is used where PESA is not suitable or has not produced sperm, including in non-obstructive azoospermia where sperm has to be found within the testicular tissue itself.

Where TESA does not retrieve sperm in non-obstructive cases, a more extensive surgical approach such as TESE or micro-TESE may be considered. Our TESA, PESA and TESE page covers how these relate to one another.

What happens before, during and after?

Before

Assessment usually includes hormone testing such as FSH, LH and testosterone to gauge sperm production, a physical examination, and genetic testing where no sperm is present in the semen. These results guide which procedure is most likely to succeed.

During

Both are outpatient procedures using a fine needle. PESA is commonly performed under local anesthesia, sometimes with sedation, and TESA may use either, so ask us to confirm what applies in your case and how long it takes in our hands.

After

• Mild soreness or swelling is usual and generally settles within a day or two.
• Rest for the remainder of the day, and avoid strenuous activity for the period your clinic advises.
• Supportive underwear is often recommended for comfort.
• Report worsening pain, significant swelling, fever or bleeding to the clinic rather than waiting.

The sample is assessed in the laboratory immediately after retrieval. Depending on the plan and on what is found, sperm may be used in an IVF cycle straight away or frozen for later use. Published comparisons have found outcomes similar whether surgically retrieved sperm is used fresh or after freezing, which is covered in our article on frozen sperm versus fresh.

TESA or PESA: which applies?

	PESA	TESA
Sperm collected from	Epididymis	Testicle
Main indication	Obstructive azoospermia	Where PESA is unsuitable or unsuccessful, including non-obstructive cases
Method	Fine needle, no incision	Fine needle, no incision
Used with	ICSI	ICSI

The choice follows the diagnosis rather than preference. We at Millennium IVF Clinic carry out surgical sperm retrieval alongside ICSI, and you can arrange a consultation with our team to discuss which applies in your case.

Frequently asked questions

Will TESA or PESA definitely find sperm?

No. In obstructive azoospermia the chance is good because production is normal and the sperm is behind a blockage. In non-obstructive azoospermia it is less certain, because sperm may be present only in limited areas of the testicle or not at all. Your specialist should tell you what the realistic chance is in your case before you consent.

Can sperm retrieved this way be used for normal conception?

No. Sperm collected by TESA or PESA is used with ICSI in the laboratory, because the numbers retrieved are small and the sperm has not gone through the full maturation route.

Does a previous vasectomy rule this out?

No. A vasectomy is a common cause of obstructive azoospermia, and it is one of the situations PESA is designed for.

Is the procedure painful?

Anesthesia is used, commonly local anesthesia with or without sedation, and most men report mild soreness afterwards rather than significant pain. Ask us to confirm what will be used for you.