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Surgical Sperm Extraction

Men who don’t have sperms in the ejaculate may undergo a direct sperm aspiration from the epididymis and testes. These are different procedures to retrieve sperms from the male testes and epididymis if no sperms are found in the semen sample. These retrieved sperms are used for ICSI. Both of these procedures should be coordinated with their females. 

There various methods to recover sperms from the testes.

  • P.E.S.A: (Percutaneous Epididymal Sperm Aspiration)
  • T.E.S.A: (Testicular sperm aspiration) or TSA

P.E.S.A: (Percutaneous Epididymal Sperm Aspiration):

P.E.S.A is a procedure performed for men who have obstructive azoospermia from either a prior vasectomy or infection. In this procedure, a needle is inserted into the epididymis, and sperms are withdrawn. It is done under local or general anesthesia in the OT.

T.E.S.A: (Testicular sperm aspiration):

If sperm cannot be found in the epididymis ( PESA), TESA is used to extract sperm from testicular tissue, and the needle is inserted directly into the testis. This procedure is performed on the male under local anesthesia or general anesthesia in the OT. In this procedure, a needle is inserted directly into the testicles and the tissue or sperms are aspirated from there. TESA is performed for men with obstructive azoospermia. TESA at times may not provide enough tissue or sperms and an open testis biopsy may be required.



Microsurgical testicular sperm extraction (microTESE) is done under a high microscope when a man has no sperm in his semen (non-obstructive ) and there is no obstruction. The sperms are extracted using a high power microscope localizing the area in the testes where at least some sperms are present.