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Sperm aspiration from the epididymis or testicle - PESA or TESA - and then ICSI and IVF

Sperm can be aspirated with a needle from the testicle or from the vas deferens (a structure right next to the testicle that also contains sperm). The man is given some drugs to sedate him and some local anesthesia is also used to numb the area. Then a small needle is inserted and sperm is aspirated from either the epididymis or the testicle. There should be no severe pain. The procedure generally takes about 30 minutes.

The different sperm aspiration and extraction procedures have long names and also short names (acronyms) : -
  • PESA - Percutaneous Epididymal Sperm Aspiration (can be done in the office)

  • TESA - Testicular Sperm Aspiration (can be done in the office)

  • TESE - Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle - often done in a hospital or free-standing surgicenter)


Male infertility can be a result of impaired sperm production or a blockage preventing ejaculation. Fertility specialists use the sperm retrieval methods of TESA (Testicular Sperm Aspiration) or TESE (Testicular Sperm Extraction) in such cases. TESE involves a surgical biopsy of the testis, while TESA uses a needle to extract fluid and tissue from the testis. Sperm is then retrieved from the tissue.

Nonobstructive Azoospermia - Microscopic testicular sperm retrieval

In clinical scenarios in which the testes are not producing adequate amounts of sperm (testicular atrophy, Y deletions, Kleinfelter's cases, post-chemotherapy/radiation) microsurgical testicular sperm extraction is performed. In this scenario, under general anesthesia an exhaustive search is performed under an operating microscope to search for testicular tubules that appear more developed and contain mature sperm. This procedure may take several hours and is done with direct input from the IVF embryology team. This procedure offers the most severe cases of male factor infertility the best chance of identifying sperm and proceeding with ICSI.

What are the indications for such a procedure?

There are many reasons why a TESA/E may need to be performed, but all involve an inability to produce an ejaculate with sperm sufficient for fertilization. Some examples are obstructive and non-obstructive azoospermia (NOA), CBAVD, and history of a vasectomy.

in cases of severe male factor infertility, genetic abnormalities may be present in the male partner. Such abnormalities might be transferred to any male offspring. Antenatal genetic testing is recommended in these cases. If there is absolutely no sperm in the ejaculate we can perform TESA to remove the few non-moving sperm available. Testicular Sperm Aspiration is performed under local or general anesthesia and there is only brief, minimal discomfort following the procedure. All discomfort should be gone within a few hours. A very fine needle is passed through the skin into the testicles where sperm will be located. These sperm recovered through TESA can then be used to fertilize an egg with the ICSI procedure.

To achieve ICSI fertilization a single washed sperm is located and its tail is crushed so it will be immobilized and not damage the egg after it is injected. It is then picked up with an injection micropipette, a specially prepared ultra-fine, glass needle. A single mature egg is held in place by a holding micropipette and the egg is rotated so that its polar body is at the 12 o'clock position. This insures that the egg is in the proper position so no damage will occur during the injection process. The injection micropipette then punctures the outer zona pellucida of the egg at the 3 o'clock position. It continues inward toward the pliable inner membrane of the egg that is then broken by suction from the injection micropipette. The sperm and a small amount of the egg material are quickly injected back into the egg and the micropipette is removed. Fertilization has been achieved and normal cell division can now take place.

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