TESA vs PESA vs Micro-TESE: Sperm Retrieval Options for Azoospermia

Dr. Anshika Lekhi, MBBS, MS (Obstetrics & Gynecology), The Fertilife, Gurgaon

Being told there is no sperm in your sample sounds like the end of the conversation. For a large number of men it is not, because sperm may still be produced and simply unable to get out.

Which procedure you need depends entirely on which of those two situations applies, so that is where this starts.

First, Which Kind of Azoospermia

Obstructive

Production is normal and the pathway is blocked, whether by a previous vasectomy, infection, surgery or a congenital absence of the vas deferens. Testicular volume and FSH are usually normal.

Here sperm is almost always retrievable, because it is being made and is sitting somewhere accessible.

Non-obstructive

Production itself is impaired. FSH is often raised, testicular volume reduced, and the picture may involve a genetic cause such as Klinefelter syndrome or a Y chromosome microdeletion.

Retrieval is possible in a meaningful proportion of these men but not all, and the surgical approach has to differ. Male fertility assessment establishes which category you are in through hormone profiling, examination, scrotal ultrasound and genetic testing where indicated.

PESA

How it works

Percutaneous epididymal sperm aspiration. A fine needle draws fluid directly from the epididymis under local anaesthesia, with no incision.

When it is the right choice

Quick, short recovery, and suited to obstructive azoospermia where sperm has collected behind a blockage. It is not appropriate where production is the problem, because there will be nothing there to aspirate.

TESA

How it differs from PESA

Testicular sperm aspiration. A needle takes a small sample of tissue from the testis itself, again usually under local anaesthesia.

Its limitation

This is also principally an obstructive-azoospermia procedure, often used when PESA does not yield enough. It samples a small and essentially random area, which is exactly why it is the wrong tool for non-obstructive cases where production is patchy.

Micro-TESE

Why it exists

Microdissection testicular sperm extraction is a different operation. Under an operating microscope the surgeon opens the testis and examines the seminiferous tubules directly, looking for the fuller, more opaque tubules more likely to contain sperm.

In non-obstructive azoospermia, production can survive in isolated pockets while most of the testis produces none. A blind needle will miss those pockets. Magnification is what makes finding them possible.

What it costs you

It is a general anaesthetic procedure with a longer recovery than the needle techniques, and it needs a surgeon who does it regularly.

There is also a consequence men are rarely warned about. A 2025 systematic review examined testosterone levels following surgical sperm retrieval in men with non-obstructive azoospermia. That is a conversation to have beforehand rather than discover afterwards, so ask about your baseline testosterone and what follow-up monitoring is planned.

What Happens to the Sperm

It goes to ICSI

Whatever the route, retrieved sperm goes to ICSI, where a single sperm is injected directly into each mature egg. The HFEA notes that surgically retrieved sperm is a standard indication for the technique.

Fresh or frozen

Timing matters here. Retrieval can be synchronised with your partner's egg collection, or the sperm frozen in advance so her cycle does not hang on the surgical result that day. The second option removes a great deal of pressure from both of you and is worth raising.

What If Nothing Is Found

This has to be planned for, not improvised on the day.

Agree in advance what happens if the retrieval yields no sperm. Whether your partner's cycle proceeds with donor sperm already consented to and available, whether her eggs are frozen unfertilised instead, or whether the cycle is cancelled. Couples who have not had that conversation end up making it in a corridor on the worst morning of the process.

A good unit raises this before the surgery is booked. If yours has not, raise it yourself.

Recovery and What to Expect

Needle procedures generally mean a day or two of discomfort, with scrotal support and avoiding heavy lifting for a short period. Micro-TESE takes longer, with swelling and bruising that settle over a couple of weeks.

Expect to be told when you can return to work, when to resume exercise, and which signs warrant a call: fever, increasing pain, significant swelling or discharge from the wound.

Questions to Ask Before Consenting

Which type of azoospermia do my results indicate, and what established that. Which procedure is proposed and why that one. How many does the surgeon perform in a year. What happens if nothing is found. Will the sperm be frozen or used fresh. What are the implications for my testosterone.

A unit that answers those six clearly is one worth operating with.

To discuss male infertility treatment in Gurgaon or ICSI, call +91 73037 08364.

This article is for general information and is not a substitute for advice from your fertility specialist or andrologist, who can interpret your own hormone and genetic results.