PESA/TESE for ICSI

What is PESA/TESE?

PESA (Percutaneous Epididymal Sperm Aspiration)
and TESE (Testicular Sperm Extraction)
are methods used to retrieve sperm directly from the male reproductive organs. These procedures are typically indicated when no sperm is found in the ejaculate or when semen cannot be collected through normal ejaculation.

PESA involves the insertion of a fine needle through the scrotal skin to aspirate sperm directly from the epididymis.

TESE is a minor surgical procedure in which a small incision is made in the scrotum to access the testicle, allowing tissue to be collected from the seminiferous tubules for laboratory examination to identify the presence of sperm.

PESA/TESE for ICSI

Eligibility Criteria for PESA/TESE

These procedures are suitable for men with the following conditions:

  • Azoospermia (absence of sperm in the ejaculate), which is classified into:
  • Obstructive Azoospermia: Sperm production occurs in the testicles, but a blockage in the reproductive tract prevents sperm from being ejaculated. This may be caused by previous infections (e.g., gonorrhea, chlamydia), prior vasectomy, or genetic conditions such as CFTR mutation.
  • Non-obstructive Azoospermia: The testicles produce very few or no sperm. TESE is more commonly used in these cases.
  • Anejaculation or Retrograde Ejaculation: Inability to ejaculate or the backward flow of semen into the bladder. This condition may result in complete absence or significantly reduced volume of ejaculate and can be associated with neurological conditions such as poorly controlled diabetes, previous pelvic surgery, or spinal surgery, which may impair the nerves responsible for ejaculation.

Procedure Overview

  • The procedure is performed under sedation administered via intravenous injection, under the supervision of an anesthesiologist.
  • Local anesthesia is also given to minimize pain during and after the procedure.
  • PESA: A fine needle is inserted through the scrotal skin to aspirate fluid directly from the epididymis.
  • TESE: A small incision is made in the scrotum to access the testicle. A tissue sample is then taken from the seminiferous tubules, which appear yellowish, and is sent to the laboratory for sperm retrieval.
  • The procedure takes approximately 30–60 minutes.
  • Recovery is usually quick, and hospitalization is not required.

Possible Complications

  • Pain, swelling, or bruising in the scrotal area.
  • Hematoma (accumulated blood in the scrotum), though rare.
  • Wound infection or poor wound healing (rare).
  • Potential impact on testosterone production if multiple TESE procedures are performed.

Preparation Before the Procedure

  • Patients with chronic medical conditions or those taking regular medications should consult their physician prior to the procedure.
  • Fasting (no food or drink) is required for 6–8 hours prior to the procedure.
  • Abstinence from sexual activity and ejaculation is recommended for 2–5 days before the procedure.

Following PESA or TESE treatment, the collected sperm will be processed and used in intracytoplasmic sperm injection (ICSI), a form of in vitro fertilization.

Article by

SIRICHET  ANEKPORNWATTANA, M.D.

Obstetrician & Gynecologist, Reproductive Endocrinologist and Infertility Specialist

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