TESA (Testicular Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration), and Micro-TESE (Microsurgical Testicular Sperm Extraction) are surgical procedures to retrieve sperm directly from the testes or epididymis in men with azoospermia (zero sperm in ejaculate). The retrieved sperm is used with ICSI for IVF. Available at Mother Hospitals, Boduppal, Hyderabad. Call 97059 93366.
Zero sperm count does not mean zero hope. TESA, PESA, and Micro-TESE retrieve sperm directly from the testes or epididymis — giving men with azoospermia the chance to father biological children through ICSI IVF. Led by Dr. E. Prashanthi Reddy at Mother Hospitals, Boduppal.
MBBS, DGO, PG Diploma in ART – Kiel University, Germany | 20+ Years Experience | TGMC Reg: 50624
Azoospermia means a complete absence of sperm in the ejaculate — diagnosed when two separate semen analyses find zero sperm. It affects approximately 1% of all men and is present in about 10–15% of men seeking fertility treatment. Crucially, azoospermia does not always mean a man cannot father a child — the distinction between obstructive and non-obstructive azoospermia is vital.
In obstructive azoospermia, the testes produce sperm normally — but a blockage somewhere in the reproductive tract (vas deferens, epididymis, or ejaculatory ducts) prevents sperm from appearing in the ejaculate. Common causes include vasectomy, previous infections (epididymitis), congenital bilateral absence of the vas deferens (CBAVD) seen in cystic fibrosis carriers, and previous groin or hernia surgery. Because sperm production is normal, retrieval success rates are very high (typically 90–100%).
In non-obstructive azoospermia, the testes themselves produce very little or no sperm due to impaired spermatogenesis (sperm production). Causes include Klinefelter syndrome (47,XXY), Y-chromosome microdeletions (AZF region), chemotherapy or radiation exposure, hormonal disorders, and testicular failure (Sertoli-cell-only syndrome). Retrieval is more challenging, requiring micro-TESE to locate the tiny pockets of sperm production. Success rates vary from 30–60% depending on the underlying cause.
A thorough workup is essential before choosing the right retrieval procedure. This includes: two semen analyses, FSH / LH / testosterone / prolactin blood tests, testicular ultrasound with Doppler, karyotype testing, Y-chromosome microdeletion analysis (AZFa, AZFb, AZFc regions), and clinical examination by a urologist-andrologist. Dr. Prashanthi will review all results and coordinate the treatment plan.
These are three different minimally invasive or microsurgical techniques for retrieving sperm from the male reproductive tract. The choice of procedure depends on the cause and type of azoospermia — your doctor will recommend the most appropriate option after full assessment.
TESA is a needle-based technique where a fine needle is passed through the scrotal skin directly into the testicular tissue. A small amount of tissue is aspirated (suctioned out) and examined in the embryology laboratory for the presence of sperm. It is performed under local anaesthesia or light sedation and takes approximately 15–20 minutes as an outpatient procedure. TESA is most suitable for obstructive azoospermia, though it may occasionally find sperm in non-obstructive cases too. The procedure is simple, quick, and associated with minimal downtime — most men return to normal activities within 1–2 days.
Best for: Obstructive azoospermia | Vasectomy | CBAVD
PESA retrieves sperm from the epididymis — the coiled tube that sits behind the testis where sperm mature and are stored before ejaculation. A fine needle is passed percutaneously (through the skin) into the epididymis, and fluid containing mature sperm is aspirated. PESA yields mature sperm with better motility compared to testicular sperm from TESA, which can improve fertilisation rates in ICSI. It is performed under local anaesthesia as a quick outpatient procedure. PESA is particularly effective for men with a blockage in the epididymis — for example, after vasectomy or due to infection-related scarring. If the epididymis has too much scarring, TESA may be needed instead.
Best for: Epididymal blockage | Post-infection | Post-vasectomy
Micro-TESE is the most sophisticated sperm retrieval technique and represents the gold standard for non-obstructive azoospermia. The procedure is performed under general anaesthesia, and an operating microscope (at 16–25x magnification) is used to identify dilated seminiferous tubules — the areas within the testis most likely to contain active sperm production. Only tissue from these specific areas is removed, preserving the rest of the testicular tissue and minimising damage. The extracted tissue is processed in the embryology lab in real time by a senior embryologist. Micro-TESE achieves sperm retrieval in 30–60% of men with non-obstructive azoospermia who would find nothing with conventional TESA — making it the most powerful tool for this condition. The procedure takes 1.5–3 hours and requires a day-care hospital admission.
Best for: Non-obstructive azoospermia | Klinefelter syndrome | Testicular failure
The choice between TESA, PESA, and Micro-TESE is guided by the type of azoospermia and its underlying cause. This table summarises the key decision points — your doctor will confirm the right approach after full evaluation.
✦ AZFa and AZFb deletions are generally associated with very low or no sperm retrieval even with micro-TESE. Genetic counselling is essential before proceeding.
Prior to any sperm retrieval procedure, a complete andrological evaluation is performed. Blood hormone tests (FSH, LH, testosterone) and a testicular ultrasound confirm testicular function and anatomy. Genetic testing (karyotype, Y-chromosome microdeletion analysis) is recommended for all non-obstructive cases to guide prognosis and genetic counselling. A semen cryopreservation assessment determines whether any residual sperm can be frozen beforehand as a backup. The female partner's IVF cycle is planned in coordination, so egg retrieval and sperm retrieval happen at the right time for ICSI. You will be asked to abstain from sexual activity for 2–3 days before the procedure.
The scrotal area is cleaned and local anaesthesia or light sedation is administered. A fine butterfly needle (21–23 gauge) is inserted through the scrotal skin into the epididymis under palpation guidance. Gentle suction is applied and epididymal fluid is aspirated into a heparinised syringe. The fluid is immediately examined under a microscope in the adjacent embryology lab. If motile sperm are found, the sample is processed for ICSI. If needed, the procedure is repeated at multiple epididymal sites (head, body, tail). Total time: 10–15 minutes.
Local anaesthesia or light sedation is given. A wide-bore needle (18–19 gauge) is inserted through the scrotal skin into the testis. Negative pressure is applied using a syringe and the needle is moved in and out gently to aspirate testicular tissue fragments. The tissue is placed in culture medium and handed to the embryologist who processes it to release sperm. Multiple passes may be made from different testicular sites. If TESA does not yield sufficient sperm, a small open biopsy (TESE) may be performed in the same sitting. Total time: 15–25 minutes.
Performed under general anaesthesia in the operating theatre. A single midline incision is made in the scrotum to expose the testis. The tunica albuginea (the testicular covering) is opened and the testicular parenchyma is examined under an operating microscope at 16–25x magnification. The surgeon identifies dilated seminiferous tubules — which appear larger and more opaque and are most likely to contain sperm — and selectively removes small tissue fragments from these areas only. The tissue is immediately processed by the embryologist. After retrieval, the testis is closed carefully to preserve as much tissue as possible. Total time: 1.5–3 hours. Requires day-care admission.
PESA and TESA are outpatient procedures — men typically go home within 2–4 hours. There may be mild scrotal discomfort and bruising for 2–4 days. A scrotal support (underwear) and simple analgesics manage any discomfort. Heavy lifting and strenuous activity should be avoided for 5–7 days. Micro-TESE requires slightly longer recovery — 5–7 days of rest is recommended, with most men returning to desk work within a week. Sexual activity can resume after 2–3 weeks. Follow-up with repeat hormone tests is arranged 3 months later to assess testicular function.
Surgical sperm retrieval procedures are only the first half of the treatment. The retrieved sperm — whether from PESA, TESA, or micro-TESE — must be used with ICSI (Intracytoplasmic Sperm Injection) to achieve fertilisation, because surgically retrieved sperm are typically too few in number and may have limited motility for conventional IVF insemination.
In ICSI, a single sperm — retrieved from the testis or epididymis — is selected under a high-power microscope and injected directly into a mature egg. The embryologist evaluates sperm morphology and any residual motility to select the best candidate. Even immotile sperm (which are common in testicular retrieval) can be used — viability is assessed using special tests. After ICSI, fertilisation is confirmed at 16–18 hours. Embryos are cultured to Day 3 or Day 5 (blastocyst stage) before transfer or vitrification (freezing).
The female partner undergoes standard ovarian stimulation (injections for 10–12 days) to produce multiple mature eggs. Sperm retrieval is timed to coincide with egg collection (OPU) so fresh sperm can be used for ICSI on the same day. Alternatively, sperm retrieved in advance can be vitrified (cryopreserved) and used in a future IVF cycle — useful when the female partner is not yet ready to start, or when sperm yields are uncertain and a test retrieval is done first.
Success rates depend on the female partner's age and ovarian reserve, the type and cause of azoospermia, the number and quality of embryos obtained, and whether fresh or frozen sperm is used. Overall clinical pregnancy rates per IVF cycle using surgically retrieved sperm (TESA/PESA/micro-TESE + ICSI) are comparable to those seen in standard male factor IVF — demonstrating that surgical sperm retrieval is a highly effective solution for zero sperm count. Individual outcomes are discussed during consultation based on your specific profile.
When sperm are successfully retrieved during TESA or PESA, any sperm not used immediately for ICSI can be vitrified (rapidly frozen) and stored for future use. This is strongly recommended because:
If the first IVF cycle does not result in pregnancy, frozen sperm means the male partner does not need to undergo another retrieval procedure for the next cycle — reducing stress, cost, and risk.
For men with non-obstructive azoospermia, a test micro-TESE may be done before starting the female partner's IVF cycle. If sperm are found and frozen, the couple can then proceed with IVF knowing sperm is available — avoiding a failed synchronised cycle.
Testicular sperm can be stored for many years. Vitrified sperm maintains good viability, and fertilisation rates with frozen-thawed testicular sperm are comparable to fresh sperm in experienced labs.
For more information about sperm freezing at Mother Hospitals, see our dedicated Sperm Freezing in Hyderabad page.
The cost of TESA, PESA, and micro-TESE at Mother Hospitals depends on the specific procedure chosen, whether it is done as a standalone test retrieval or synchronised with an IVF cycle, the requirement for anaesthesia, and whether sperm cryopreservation is included. PESA and TESA are typically lower in cost than micro-TESE, which requires an operating theatre, general anaesthesia, and a specialist microsurgical team. We provide a transparent, all-inclusive quotation during your consultation so there are no hidden costs. For an estimate, call 97059 93366 or WhatsApp us. We also offer EMI options and guidance for insurance claims where applicable.
We offer a complete male infertility service — from semen analysis and hormonal evaluation to surgical sperm retrieval and ICSI IVF. Our team coordinates all aspects of male factor treatment under one roof at Boduppal, Hyderabad.
Dr. E. Prashanthi Reddy completed her PG Diploma in ART at Kiel University, Germany — one of Europe's leading reproductive medicine centres. Her training includes advanced techniques for male factor infertility management.
Our embryology laboratory maintains strict protocols for handling testicular sperm. Experienced embryologists process TESA/PESA specimens in real time during procedures to maximise sperm recovery and quality.
For men with Y-chromosome microdeletions or chromosomal abnormalities, we integrate genetic counselling into the care plan — discussing implications for the child and guiding decisions on whether to proceed with retrieved sperm.
All sperm retrieval and IVF procedures at Mother Hospitals comply fully with the ART Act 2021 and ICMR guidelines. We are a certified ART clinic — giving couples complete legal and medical protection throughout treatment.
With over two decades of experience and more than 10,000 families helped, Mother Hospitals brings proven expertise to every case — including the most complex male infertility presentations involving azoospermia.
Yes. TESA can be performed in cases of cryptozoospermia (extremely low sperm count, typically fewer than 100,000 per mL in the ejaculate). In these cases, TESA may yield additional sperm for ICSI or serve as a backup if the ejaculate on the day of egg collection is insufficient. Your doctor will advise whether TESA alongside ejaculate collection is the right strategy for your situation.
TESA is performed under local anaesthesia or light sedation, so there is no pain during the procedure. Afterwards, men may experience mild scrotal discomfort, aching, or tenderness for 2–4 days, which is managed well with simple over-the-counter painkillers such as paracetamol and ibuprofen. Most men find the procedure far less uncomfortable than they anticipated. Micro-TESE involves a small scrotal incision under general anaesthesia — recovery is slightly longer but still well-tolerated.
If TESA does not yield sperm, the procedure may be extended to a conventional open testicular biopsy (TESE) in the same sitting, or the team may recommend micro-TESE as a next step — particularly if non-obstructive azoospermia is suspected. In cases where no sperm can be found even with micro-TESE (which occurs primarily with AZFa/AZFb deletions or complete Sertoli-cell-only syndrome), donor sperm is discussed as an alternative pathway — always with full counselling and patient consent under the ART Act.
If TESA is synchronised with the female partner's egg collection, ICSI happens on the same day — so IVF is already underway. If sperm is frozen in a test retrieval first, the female partner can start her IVF stimulation cycle in the very next menstrual cycle, typically 4–6 weeks later. There is no required waiting period after TESA before starting IVF, though full recovery (scrotal comfort, etc.) takes 1–2 weeks.
Yes — and this is strongly recommended. Any surplus sperm retrieved during TESA, PESA, or micro-TESE that is not used for the current ICSI cycle can be vitrified and stored at our cryopreservation facility. Frozen testicular sperm maintains good viability and fertilisation rates. This means that if the first IVF cycle does not succeed, no further surgical retrieval is needed for subsequent cycles.
TESA and PESA are very safe, minimally invasive procedures with a low complication rate. Potential risks include minor bleeding, bruising, infection (rare), or temporary swelling — all of which resolve quickly. Micro-TESE carries slightly more risk due to general anaesthesia and the surgical incision, but in experienced hands, the risk of significant testicular damage is very low. Testosterone levels may dip slightly in the weeks after micro-TESE but usually recover within 3 months.
TESA uses a needle to blindly aspirate testicular tissue — it is quick, done under local anaesthesia, and suitable for obstructive azoospermia where sperm production is normal throughout the testis. Micro-TESE uses an operating microscope to visually identify and selectively remove the specific tubules most likely to contain sperm — it is necessary when sperm production is patchy or severely impaired (non-obstructive azoospermia), as blind needle aspiration would likely miss those areas. Micro-TESE has a significantly higher sperm retrieval rate in non-obstructive cases.
Genetic testing is strongly recommended before TESA, especially for non-obstructive azoospermia. Karyotype testing identifies chromosomal conditions like Klinefelter syndrome (47,XXY). Y-chromosome microdeletion analysis (AZFa, AZFb, AZFc) helps predict sperm retrieval success and has important implications — AZFc deletions are compatible with TESE success, while AZFa and AZFb deletions almost always mean no sperm will be found. Additionally, Y deletions are passed to male children, which requires genetic counselling. For CBAVD (congenital bilateral absence of vas deferens), CFTR gene mutation testing is recommended as it may indicate cystic fibrosis carrier status.
Dr. E. Prashanthi Reddy · TGMC Reg: 50624