Surgical Sperm Retrieval (TESA / PESA / micro-TESE)

Medically reviewed by Dr Manjushree Boob, MD, DNB, FICMCH, FICOG - Infertility & IVF Consultant

What it is

Surgical sperm retrieval means collecting sperm directly from the male reproductive tract, rather than from the ejaculate, so that they can be used for intracytoplasmic sperm injection (ICSI). There are three common methods: percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA) and microdissection testicular sperm extraction (micro-TESE).

In PESA and TESA a fine needle is used to draw sperm from the epididymis or the testis. In micro-TESE a small incision is made and the surgeon uses an operating microscope to look for the particular tubules that are producing sperm. Because only a handful of sperm are needed for ICSI, even a very small number can be enough for the laboratory to work with.

Who needs it

A man may need sperm retrieval when a semen analysis shows no sperm at all (azoospermia), or sperm that cannot be used. This falls into two broad groups.

• Obstructive azoospermia. The testes make sperm normally, but a blockage stops them reaching the semen. Causes include a previous infection, a vasectomy, an absent or blocked vas deferens, or injury after hernia or other surgery. TESA or PESA usually finds sperm easily.
• Non-obstructive azoospermia. The testes make very little sperm, or make it only in small patches. Causes include hormonal problems, genetic conditions, past undescended testes, mumps, chemotherapy or unknown reasons. Here micro-TESE gives the best chance of finding sperm.

Retrieval may also help men who cannot ejaculate, or whose ejaculated sperm carry a high level of DNA damage. Our page on male infertility explains how we work out which group a man belongs to, using examination, hormone tests and sometimes genetic tests.

“Doctor, my report says zero sperm. Is that the end of the road?” Not necessarily, and I want you to hear that before you hear anything else. A zero on the report tells us sperm are not reaching the sample. It does not yet tell us whether the factory is shut or just the road is blocked. We find out by examining you, doing blood tests, and where needed searching directly. Some men find sperm, and some do not. I would rather tell you the honest odds for your case than offer false comfort.

How it is done

Assessment first. We take your history, examine the testes, and do a hormone profile and, when indicated, a scrotal ultrasound and genetic tests. The wife’s fertility is assessed in parallel, since the sperm will be used in an ICSI cycle. See our ICSI page for what happens next.

PESA. After numbing the skin, a fine needle is passed into the epididymis and fluid is drawn out. The laboratory looks at it at once under the microscope. If sperm are found, the procedure stops.

TESA. The same idea, but the needle goes into the testis and a small amount of tissue and fluid is aspirated. It is used when PESA finds nothing or when the epididymis is not the right target.

micro-TESE. A small cut is made in the scrotum and the testis is opened. Using an operating microscope, the surgeon identifies the larger, healthier-looking tubules, which are the most likely to hold sperm, and removes tiny samples only. The embryologist checks each sample in the theatre, so the surgeon can stop as soon as enough sperm is found and avoid removing more tissue than needed.

In the laboratory. Retrieved sperm are either used fresh for ICSI on the day or frozen for later use. Timing with the wife’s egg collection is planned in advance.

Anaesthesia, duration and hospital stay

PESA and TESA are usually done under local anaesthesia, sometimes with light sedation, and take 15 to 30 minutes. micro-TESE needs general or spinal anaesthesia and takes one to two hours, since the search can be painstaking.

All three are day-care procedures. Most men go home the same day, once they have passed urine and are comfortable.

Recovery

Day 1. Expect aching and some swelling of the scrotum. Wear a snug supporter, use ice packs wrapped in cloth for short periods, and take the painkillers prescribed.

First week. The bruising may spread and change colour, which looks alarming but is harmless. After TESA or PESA you can return to desk work within a day or two. After micro-TESE, rest for three to five days. Avoid lifting, running and cycling for a week or two.

Weeks 2-4. Soreness fades. Any stitches dissolve by themselves. Sexual activity can be resumed when it is comfortable, usually after one to two weeks.

By six weeks. Most men feel entirely normal. After micro-TESE we check hormone levels some months later, because a small number of men need testosterone support after extensive testicular surgery.

Call us for increasing pain, a rapidly enlarging scrotum, fever, or discharge from the wound.

Risks and complications

These are generally safe procedures, and you should still know what can happen.

• Pain, bruising and swelling. Common, and temporary.
• Bleeding or a collection of blood (haematoma). Uncommon, and occasionally needs drainage.
• Infection. Rare with sterile technique.
• Sperm may not be found. This is the most important one. In obstructive causes the chance of finding sperm is high. In non-obstructive azoospermia it is lower and depends on the cause. We discuss this openly in advance.
• Reduction in testosterone or testicular damage. Rare, mainly after micro-TESE, where the careful microscopic technique helps to keep tissue loss small.
• Genetic implications. Some causes of absent sperm are genetic and can be passed on, which is why genetic counselling matters.
• Anaesthesia risks, which are low in a healthy man and are reviewed beforehand.

Alternatives

Treating the cause, where possible. Hormone treatment helps some men with low gonadotropins, and surgery for a varicocele may bring sperm back into the ejaculate in selected men.

Surgical reconstruction of a blockage, such as a vasectomy reversal, in some obstructive cases. It can allow natural conception, though it is not suitable for everyone.

Donor sperm, a path some couples choose when sperm cannot be found or when they would rather not undergo surgery. It is a personal decision, and we will support you whichever way you go.

Adoption. A wonderful route, and a valid one.

You can see all the procedures we perform, and our IVF and fertility treatments department page explains the wider fertility pathway.

What it costs

Prices depend on which method is needed. The approved ranges are:

TESA / PESA: ₹25,000 – ₹45,000

micro-TESE: ₹30,000 – ₹60,000

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your treatment

• Bring all previous reports, including semen analyses, hormone tests and any scans or operation notes.
• Complete the planned tests - hormones, scrotal ultrasound and, if advised, genetic tests - before the date is fixed.
• Tell us about all medicines, especially blood thinners such as aspirin, which may need to be paused.
• Fast for six to eight hours if you are having general or spinal anaesthesia, as instructed.
• Shave the area lightly if asked, and wear loose clothing and a supportive underwear on the day.
• Arrange for someone to take you home, and plan a few days of lighter work.
• Talk with your wife about the plan: whether sperm will be used fresh or frozen, and when her cycle will be timed.
• Give yourselves emotional room. This is a hard conversation for many men. You are not alone in it, and the team will not rush you.

---

If your report has shown no sperm, or you are unsure what the next step should be, the fertility team at Shubham Hi-Tech Hospital and Test Tube Baby Centre, Amravati, will look at your case with you and give you an honest picture. Call +91-8668954915 or get in touch here.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.