Surgical sperm retrieval (TESA and PESA)

TESA, PESA and the other methods

The UK fertility regulator, the HFEA, calls taking sperm directly from the testicles “surgical sperm extraction or retrieval (SSR)”. It says “Men who have no sperm in their semen and who want to have children may be able to have treatment to collect the sperm surgically. There are five different kinds of treatment:”

• “Percutaneous epididymal sperm aspiration (PESA)”
• “Microsurgical epididymal sperm aspiration (MESA)”
• “Testicular sperm aspiration (TESA)”
• “Testicular sperm extraction (TESE) - single or multi-site”
• “Microscope-assisted testicular sperm extraction (MicroTESE).”

This page is about the first and third of those, TESA and PESA, which the regulator describes together in one sentence. The microscope operation has its own page, micro-TESE, because it is used for a different problem and is done under general anaesthetic.

What TESA and PESA involve

The HFEA says “PESA and TESA involve a fine syringe being inserted into either the epididymis or the testicle to extract the sperm. It's a quick and relatively painless procedure that's usually performed under local anaesthetic.” The difference between the two is where the needle goes: PESA takes sperm from the epididymis, TESA from the testicle.

If a needle finds no sperm, there are larger procedures. The HFEA says “TESE involves making an incision into the testicle to take a small sample (biopsy) away from which sperm can hopefully be recovered. TESE can be performed under local or general anaesthetic.” And “MESA involves examining the epididymis under an operating microscope and taking fluid samples for further examination to see if there are any sperm.”

On what happens to the sperm, it says “If the sperm removed is of poor quality, your clinic may recommend you use them straight away rather than freeze them as poor quality sperm is less likely to survive the freezing process.”

When it is used

TESA and PESA are for a blockage, not for a problem making sperm. The HFEA says “You may have PESA, MESA, TESA or TESE if you have no sperm in your semen due to a blockage (obstructive azoospermia). This could be because:”

• “you've had a vasectomy”
• “you've had a sexually transmitted infection like chlamydia.”

And: “You may also have these treatments if you are unable to ejaculate (retrograde ejaculation or anejaculation).” Where the cause is sperm production instead, it says “You may have MicroTESE if you have no sperm in your semen due to a sperm production problem (non-obstructive azoospermia).” That is covered on the micro-TESE page.

After a vasectomy

For men who have had a vasectomy, the HFEA sets retrieval beside a reversal of the vasectomy. It says “Generally, if your vasectomy was less than 12 to 15 years ago, you want to have more than one child, and you have a female partner who's under 35, a vasectomy reversal is usually the preferred approach.” And “If your vasectomy was 15 to 20 years ago (or more) and you have an older female partner, you may be recommended to have sperm extracted surgically to use in a fertility treatment like ICSI.” It adds that “It may be sensible to consider extracting sperm for freezing from the testicles at the time of a vasectomy reversal as sometimes the operation may not be successful, or the vas can close up again.”

It is also clear who these treatments will not help: “Unfortunately these treatments wouldn't work for men with certain genetic conditions. Your clinic will explain if this applies to you.” Whether it is appropriate in a particular case is a clinical decision for the treating doctor. This directory does not make that judgement.

If no sperm is found

The HFEA says “If you've had surgical sperm extraction and it hasn't been successful, you may want to consider other options for having a family, such as using donor sperm in treatment or adopting.” Donor sperm is covered on the sperm donation page.

What the regulator says about risks

On side effects, the HFEA states: “Side effects tend to be rare, but bleeding and infection can occur.” It adds: “A small number of men experience a drop in their testosterone following surgical sperm retrieval, which may cause problems with sexual function, sleep, muscle weakness and anxiety. If you have any side effects at all, you should contact your clinic straight away.”

On the sperm itself, it says “There is no evidence that sperm collected surgically affects your chances of getting pregnant or that it poses a risk to the health and wellbeing of any children you might conceive.” and “Research has shown that sperm extracted surgically may not fertilise as well, although this could be due to the fact that some sperm is of lower quality.”

It is also clear that retrieval is not the end point: “Successfully extracting sperm doesn't guarantee you'll have a baby.” The sperm is used in ICSI, which carries its own risks, quoted on that page.

India’s ART (Regulation) Rules, 2022 set out two levels of clinic:

• A Level 1 clinic is one where “only IUI is carried out as part of treatment”.
• A Level 2 clinic is one where “all/advanced investigations, diagnostic and therapeutic procedures in ART are carried out”.

Because a Level 1 clinic may carry out only IUI, Surgical sperm retrieval is Level 2 work.

That is why each clinic below shows the level the national registry records for it. Of the listings below, 94 are registered as Level 2, 9 as Level 1, and 38 have no level in the registry extract. This directory does not know why a Level 1 clinic names Surgical sperm retrieval. A clinic may send patients to a partner Level 2 laboratory, or its website may describe services it does not provide on site. Ask the clinic where the Surgical sperm retrieval itself is done, and check its registration on the National ART & Surrogacy Registry.