Male infertility is one of the common reasons why many couples cannot conceive.
Poor quality or an insufficient number of sperms is one of the causes of male infertility. Sometimes the men may have adequate quality and quantity of sperms, but the inability to effectively ejaculate may cause failure to conceive. TESA and PESA IVF treatments can be procedures of choice for couples with male infertility due to azoospermia, vasectomy, and testicular tube blockages. TESA stands for Testicular Sperm Aspiration, whereas PESA stands for Percutaneous Epididymal Sperm Aspiration. Both PESA and TESA are minimally invasive procedures used for sperm retrieval from a man’s testes.

What is PESA or Percutaneous Epididymal Sperm Aspiration?

PESA is less complicated when compared to TESA. During PESA, the doctor directly inserts a needle into a man’s epididymis.

What is TESA or Testicular Sperm Aspiration?

During TESA, the doctor injects a needle through the man’s scrotum. This needle has a syringe attached to retrieve a part of testicular tissue
TESA IVF treatment is more complex as compared to PESA IVF treatment. Your doctor may perform PESA when sperm retrieval from epididymis is not possible

What are the indications of PESA and TESA?

Some of the conditions when the doctor may perform TESA or PESA in the male partner are:


Azoospermia is a condition when the male partner’s ejaculate contains no sperm. It accounts for 10% and 15% of the total cause of male infertility. Azoospermia can be of two types

  1. Obstructive: When there is a blockage preventing the release of the sperm
  2. Non-Obstructive: When there is decreased sperm quantity in testes.

For both obstructive and non-obstructive azoospermia, a doctor can perform PESA or TESA depending on the severity

Testicular failure

Testicular failure happens when the testes fail to produce and store a sufficient number of healthy sperms that can go into a woman’s uterus during sexual intercourse. This condition may occur due to abnormalities such as Klinefelter’s syndrome. In such cases, PESA or TESA can be the procedure of choice.


Varicoceles are benign testicular cysts. A mass of varicose veins forming within the epididymis can give rise to varicocele. A varicocele may obstruct the flow of sperms out of the epididymis and testicles

What are the steps involved in TESA and PESA?

Step 1: Administration of Anesthesia

The doctor generally injects a local anesthetic agent directly into the scrotum. Local anesthesia reduces the pain sensation in the male partner.

Step 2: Testes Examination

The doctor then will do the antiseptic swabbing of the scrotum to disinfect the area. Then the doctor does the physical examination. By palpating the scrotum, the doctor examines the testes and locates the vas deferens.

Step 3: Sperm Extraction

Upon reaching the vas deferens, the doctor inserts a small needle into the vas deferens or epididymis. Using a syringe, the doctor aspirates seminal fluid from the epididymis.

Step 4: Sperm examination

The embryologist examines the retrieved seminal fluid for sperm’s health and motility. A doctor can repeat PESA until the sperms aren’t adequate.