TESA (testicular sperm aspiration)

What TESA involves

The UK fertility regulator, the HFEA, lists “Testicular sperm aspiration (TESA)” among five ways of collecting sperm surgically. It describes TESA together with its epididymal counterpart, PESA: “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.”

A more extensive procedure, taking tissue rather than drawing it through a needle, is micro-TESE. On using the sperm, the HFEA 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

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).” It notes that “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.

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.”

It is also clear that retrieval is not the end point: “Successfully extracting sperm doesn't guarantee you'll have a baby.” and “You'll need to have a fertility treatment like ICSI to use your sperm.” See ICSI.

Questions

How is TESA different from PESA?

The HFEA says a fine syringe is inserted “into either the epididymis or the testicle”: PESA draws from the epididymis, TESA from the testicle.

Is it done under general anaesthetic?

The HFEA says PESA and TESA are “usually performed under local anaesthetic.”

What happens to the sperm afterwards?

The HFEA says “You'll need to have a fertility treatment like ICSI to use your sperm.”

Sources

• HFEA, Surgical sperm extraction, read 25 September 2026.
• The Assisted Reproductive Technology (Regulation) Rules, 2022, G.S.R. 419(E), 7 June 2022, para 10.1 (not changed by the Amendment Rules, 2026, G.S.R. 491(E)), read 25 September 2026.
• Clinic data: each clinic's own website, as read by this directory; registry level from the National ART & Surrogacy Registry extract.