Surgical Sperm Retrieval: PESA, TESA & MESA


Surgical Sperm Retrieval is a technique used in men to collect the sperms directly from testis and epididymis.
This procedure is usually carried out as a day under anesthetic.
There are different methods to retrieve the sperm through surgically. They are TESA, PESA, TESE, MESA, Micro-TESE

This procedure is intended to help men who has the condition:
Azoospermia. There are 2 types of Azoospermia; Obstructive and Non-Obstructive Azoospermia
Obstructive Azoospermia: The testicles is able to form the sperm but there will be a block in the male reproductive tract.
Non- Obstructive Azoospermia: Sperms are not present in the semen as sperm production is impaired or abnormal.

Men who had suffered in Anejaculation & Retrograde ejaculation.
Men who had Vasectomy.
History of Undescended testis and any testicular surgery.
Men with congenital or acquired endocrine condition (Hormone producing condition for spermatogenesis)
Men with genetic condition like Klinefelter syndrome.

The goal of Surgical Sperm Retrieval :
To obtain the best quality sperm
To obtain enough sperm for immediate use and also for freezing.
To minimize the injury to the testicle and the reproductive tract

The Percutaneous Epididymal Sperm Aspiration technique is used in the condition of Obstructive Azoospermia.
The scrotum is cleansed with anti-septic and then saline to eliminate any residual antiseptic.
Under local anaesthesia, the head of the epididymis is palpated and stabilized between thumb and forefinger.
Using 26-G or 20-G butterfly needle is punctured through the scrotal skin.

The needle is attached to the tuberculin syringe. The needle is gently and slowly advanced into the epididymis.
After the needle is withdrawn from the epididymis .
The contents of the syringe are then gently flushed into a dish and examined for the presence of sperm.
If the motile sperm are seen it can be used for further procedures.

Advantages of PESA

It is a simple, quick procedure.
Avoids open surgery.
No surgical incision.
Less Invasive Method.
Requires only few instruments.
Minimal morbidity

Disadvantages of PESA:

It may cause epididymal obstruction at puncture sites.
Risk of hematoma formation.
Bleeding and infection can occurs.
In occasional cases, it had Vas aplasia where little epdidiymis was present and covered by fat, so the retrieval of sperms can be reduced.


The Testicular Sperm Aspiration technique is used in the condition of Azoospermia.
This procedure is done with local anaesthesia.
A fine needle is inserted into the testicle and aspirate small amount of tissue or sperm from the testicle.
If the motile sperm are observed, it can be used for further procedures

Advantages of TESA:

It is a simple and non- surgical procedure.
Required only few instruments.
No microsurgical expertise required.
Minimal or mild Postoperative discomfort.
Minimal recovery or morbidity

Disadvantages of TESA:

Risk of testicular atrophy
Testicular damage may occurs.
Bleeding and Infection.
There is a risk of puncturing a tunica vessel and causing a Hematocele.
Multiple passage of the needle through the testicular tissue it can damage a large number of seminiferous tubules and can cause intra- testicular hemmorhage.


Microsurgical Epididymal Sperm Aspiration is a procedure used in the condition of Obstructive Azoospermia and Vasectomy.
This technique is little more advanced technique for collecting the sperm Microsurgically.
The procedure is done under general anaesthesia.
Sperm is collected using surgical microscope to open the small tubes within the epididymis and aspirate it contents.
If motile sperm are observed, it can be used for further procedures.

Advantages of MESA:

Large number of sperms are retrieved.
High yield spermatozoa with good quality.
Decreased risk of Hematoma
Cryopreservation of sperms can also be done.
In micropuncture technique it limits the damage of Epididymal tube and also avoid potential blood cell contamination in the epididymal fluid.

Disadvantages of MESA:

Microsurgical instruments and expertise required.
Postoperative discomfort will occurs.
Surgical exploration required.
Increased anesthetic and operating time

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