PESA & TESA ( Infertility treatment )


PESA (percutaneous epidydimal sperm aspiration) and TESA (testicular sperm aspiration) are procedures that are performed to obtain sperm in certain cases of male Infertility. PESA or TESA can be performed on men that have zero sperm counts due to either a sperm production problem or a blockage in their reproductive tract, such as the result of a vasectomy, congenital absence of vas deferens, or infection.

Once a diagnosis of azoospermia (zero sperm count) has been made, we work closely with a urologist with specialized training in male infertility who will retrieve the sperm. The urologist will first perform an exam and further testing which may involve blood work and/or a testicular biopsy. The result of these studies determine which procedure is more appropriate and more likely to yield sperm.

While PESA is usually performed in our Center the morning of the egg retrieval, TESA may be done the day prior to the egg retrieval to allow in vitro maturation of immature sperm. With PESA, a small needle is placed into the epidydimis, which is a reservoir of sperm that sits atop each testicle, using local anesthesia. During TESA, sperm is obtained by means of a biopsy of the testicle. The sperm obtained from these procedures is then injected directly into the eggs (ICSI).
Success rates with PESA or TESA and IVF with ICSI

The success rate will depend very much on the IVF live birth success rates of the particular in vitro fertilization laboratory. IVF success rates are also dependent on the age of the female partner - even in these "male factor" cases after vasectomies.

We would generally expect the success rates to be about the same as (or somewhat higher) the rates for other couples with a female partner of the same age going through IVF.

The female partner's ovarian reserve, which is best measured by the antral follicle count is a good predictor of the chances for successful IVF outcome.

So which option is the best for fertility after a vasectomy?


For many couples with a relatively young female partner and a relatively short time since the vasectomy has been performed, vasectomy reversal surgery may be the best initial option. However, some young couples will choose sperm aspiration and ICSI over reversal surgery as their preferred option.

If the female partner is over 35 years of age, there should always be some evaluation of the fertility status of the female before proceeding with either reversal surgery or sperm aspiration.

•    This female evaluation would be best done by a Reproductive Endocrinology and Infertility specialist.

•    As the female age increases, there is less "fertile time" remaining to work with and at some point the best option will be sperm aspiration and IVF-ICSI.

If a vasectomy reversal has been performed and it has not been successful, a second surgery is of low yield and should be avoided.


•    Sperm aspiration and IVF is the best option in this scenario, unless the couple prefers Donor Insemination.
Couples should be fully informed of the pros and cons of these approaches prior to making their decision. In many cases it is advisable to consult with both a Reproductive Endocrinologist and an urologist before making the final decision.
General urologists are not well versed in discussing the options of IVF with ICSI since that is not part of their training or professional skills. Likewise, the reproductive endocrinologist does not perform vasectomy reversals and is not the best source for details about that.