TESA and PESA: Solutions for Male Infertility

TESA and PESA are procedures that retrieve sperm directly from the testicle or epididymis when sperm are not available in the semen. For some men with infertility, retrieved sperm can be used with IVF and ICSI to help fertilise eggs, but the right approach depends on why sperm are absent.

Hearing that a semen sample contains no sperm can feel overwhelming. It does not always mean that biological parenthood is impossible. For couples exploring TESA PESA infertility treatment in Kanpur, understanding the diagnosis is the first step towards an informed, shared decision.

Why might sperm be absent from semen?

The medical term for no sperm being found in semen is azoospermia. This is different from a low sperm count. The finding usually needs confirmation with repeat semen testing and careful laboratory examination, including checking the concentrated sample after centrifugation.

There are two main types:

• Obstructive azoospermia: Sperm are being produced, but a blockage or missing reproductive duct prevents them from reaching the semen.
• Non-obstructive azoospermia: Sperm production is severely impaired. Small areas of the testicle may still produce sperm in some men.

Possible causes include previous surgery, infection-related scarring, conditions present from birth, hormonal problems or genetic factors. These require different approaches. A male infertility assessment helps identify whether sperm retrieval, medical treatment or another option is appropriate.

What is TESA?

TESA stands for testicular sperm aspiration. A doctor inserts a fine needle into the testicle to collect a small amount of tissue and fluid. An embryologist examines the sample to look for sperm that may be suitable for treatment.

TESA may be considered in selected men, especially when sperm production is expected to be preserved but sperm cannot reach the ejaculate. Local anaesthesia is often used, with additional pain relief or sedation depending on the clinical plan.

TESA is not the same as TESE, which involves surgically removing testicular tissue, or micro-TESE, which uses an operating microscope to help identify tissue likely to contain sperm.

What is PESA?

PESA stands for percutaneous epididymal sperm aspiration. The epididymis is a coiled tube behind each testicle where sperm mature and are stored. During PESA, a doctor uses a fine needle to withdraw fluid from this tube.

PESA is generally considered for obstructive azoospermia, when sperm production is functioning but the passage is blocked. It is not an appropriate solution for a sperm production problem alone.

If the sample does not contain enough suitable sperm, the team may consider another retrieval method. Any possible backup procedure should be discussed and consented to beforehand.

TESA versus PESA: which is suitable?

The main difference is where sperm are collected. PESA collects sperm from the epididymis, while TESA collects them from the testicle. Neither is automatically better for every patient.

When there is a blockage

PESA or testicular retrieval may be considered, depending on the cause, examination findings and treatment plan. For some men, surgery to repair the blockage is also an option. The choice depends on factors such as the partner’s fertility assessment, time considerations and the couple’s preferences.

When sperm production is impaired

Simple needle aspiration may miss small areas of sperm production. For men with non-obstructive azoospermia who proceed with surgical sperm retrieval, micro-TESE is generally the preferred approach. Some hormonal causes can instead be treated medically before retrieval is considered.

You can explore TESA and PESA treatment information before your consultation, but a procedure should be selected only after a personalised evaluation.

What tests are needed before sperm retrieval?

The assessment aims to understand the cause and avoid unnecessary procedures. Both partners should be evaluated, because planning also depends on the female partner’s age, ovarian reserve and reproductive health.

For the male partner, the evaluation may include:

• Repeat semen analysis at a laboratory experienced in fertility testing.
• A medical history covering previous surgery, infections, medicines and fertility treatment.
• A physical examination of the testicles and reproductive tract.
• Hormone tests, such as FSH and testosterone, when indicated.
• Genetic testing and counselling in selected cases.
• Imaging when a specific clinical finding needs investigation.

Some genetic findings affect the likelihood of retrieving sperm or may have implications for a child. Where relevant, counselling helps couples understand these issues before treatment.

How are retrieved sperm used with IVF and ICSI?

Sperm retrieved through TESA or PESA are usually used with intracytoplasmic sperm injection, or ICSI. This is a laboratory technique performed as part of IVF, in which an embryologist injects one sperm into a mature egg.

The female partner undergoes ovarian stimulation and egg collection. After ICSI, the laboratory monitors fertilisation and embryo development. An embryo may then be transferred to the uterus, or suitable embryos may be frozen according to the treatment plan.

Retrieved sperm may sometimes be frozen for later use. Whether this is practical depends on the quantity and quality of sperm and the laboratory assessment. Ask about the timing of retrieval and the backup plan before egg collection. Learn more about ICSI treatment and its role in IVF.

What happens on the procedure day?

Before the procedure, the team explains the plan, anaesthesia, possible risks and alternatives. Tell your doctor about allergies, regular medicines and any blood-thinning medication. Do not stop prescribed medicines without advice.

Fasting may be required if sedation or certain forms of anaesthesia are planned. Arrange an accompanying adult if advised, especially when sedation is used.

TESA and PESA are commonly day-care procedures. The laboratory checks the collected material for sperm, and the team explains the findings and next steps. Discharge depends on your recovery and the doctor’s assessment.

Recovery, discomfort and possible risks

Mild soreness, bruising or swelling can occur after retrieval. Follow the clinic’s instructions on pain relief, supportive underwear, wound care and returning to work, exercise and sexual activity.

Possible complications include bleeding, a collection of blood in the scrotum, infection and persistent discomfort. There is also a possibility that no usable sperm will be found.

Contact your treating team promptly for fever, worsening pain, increasing swelling, persistent bleeding or discharge from the procedure site. Avoid self-medicating with antibiotics or unprescribed painkillers.

What should couples expect emotionally and medically?

Finding sperm is one step, not a guarantee of pregnancy. Fertilisation, embryo development and implantation depend on several factors, including egg quality, sperm characteristics and the health of both partners.

Ask what the plan would be if retrieval is unsuccessful. Depending on the diagnosis, further evaluation, a different retrieval approach or donor sperm may be discussed. Every option requires thoughtful counselling and informed consent; you do not need to make every decision immediately.

Male infertility is a medical condition, not a measure of masculinity or personal worth. Avoid tobacco, anabolic steroids and unsupervised testosterone, which can suppress sperm production. Healthy habits support general health, but they cannot reliably reverse a blockage or replace specialist care.

Questions to bring to your consultation

• Is the problem a blockage, impaired sperm production or a hormonal condition?
• Why do you recommend this retrieval method for us?
• Do we need genetic testing or counselling?
• Will sperm be retrieved before or alongside egg collection?
• What is the agreed plan if no usable sperm are found?

If you are considering TESA or PESA, take the next step with a clear conversation. Book an appointment with PRAVI IVF & Fertility Centre, Kanpur, Uttar Pradesh, or message WhatsApp +91 80091 50040 to discuss an evaluation.