Advanced Sperm Retrieval for Male Infertility

At SAFE Fertility Group, we provide advanced sperm retrieval procedures, including TESE and PESA, for men who have no sperm in their ejaculated semen or who are facing certain causes of male infertility.

These procedures are commonly used in combination with ICSI, allowing fertility specialists and embryologists to retrieve sperm directly from the testicle or epididymis and use selected sperm for fertilization in the laboratory.

TESE and PESA can provide an opportunity for men with azoospermia or sperm transport problems to have biological children.

What is Male Infertility?

Male infertility refers to a condition in which a man has difficulty contributing to pregnancy due to problems with sperm production, sperm quality, sperm movement, or sperm delivery.

One important cause of male infertility is azoospermia, a condition in which no sperm are found in a man’s ejaculated semen.

Azoospermia may occur for different reasons. In some men, sperm are produced in the testicles but cannot pass through the reproductive tract due to a blockage. In other men, sperm production inside the testicles may be very low or may not occur properly.

A proper evaluation by a fertility specialist is important to identify the cause and choose the most appropriate treatment approach.

Understanding Azoospermia

Sperm production and delivery involve several parts of the male reproductive system.

Sperm are produced in the testicles inside small tubes called seminiferous tubules. After production, sperm move into a larger coiled tube called the epididymis, where they are stored and mature for a period of time. The epididymis is connected to the vas deferens, which carries sperm toward the urethra during ejaculation.

For sperm to appear in semen, they must move through this system successfully.

Azoospermia may occur when this process is interrupted.

Types of Azoospermia

Obstructive Azoospermia

Obstructive azoospermia occurs when sperm are being produced in the testicles but cannot pass out through the reproductive tract because of a blockage.

The blockage may occur in the epididymis, vas deferens, or ejaculatory duct. In this case, sperm may still be retrieved directly from the epididymis or testicle and used for assisted reproductive treatment.

Non-Obstructive Azoospermia

Non-obstructive azoospermia occurs when sperm production in the testicles is impaired or extremely low.

In this condition, sperm may not be detectable in the ejaculated semen because production inside the seminiferous tubules is abnormal or insufficient.

Some cases may require further hormonal evaluation, genetic testing, medication, or surgical sperm retrieval depending on the cause and the doctor’s recommendation.

What are TESE and PESA?

TESE and PESA are sperm retrieval techniques used to obtain sperm directly from the male reproductive system when sperm are not present in the ejaculated semen or when ejaculation is not possible.

The retrieved sperm can then be used in assisted reproductive treatment, especially ICSI, where a single selected sperm is injected directly into a mature egg to support fertilization.

PESA: Percutaneous Epididymal Sperm Aspiration

PESA stands for Percutaneous Epididymal Sperm Aspiration.

This procedure involves placing a fine needle through the skin into the epididymis to gently aspirate fluid that may contain sperm.

PESA is often considered in cases of obstructive azoospermia, where sperm production is normal but sperm cannot pass through the reproductive tract due to a blockage.

The wound from PESA is usually very small, similar to a needle puncture.

TESE: Testicular Sperm Extraction

TESE stands for Testicular Sperm Extraction.

This is a surgical sperm retrieval procedure in which a small amount of testicular tissue is removed and examined in the laboratory to find sperm.

TESE may be recommended when sperm cannot be retrieved from the epididymis or when sperm production inside the testicle is very low.

The procedure usually involves a small incision, approximately 0.5 cm, depending on the surgical approach and individual case.

Other Sperm Retrieval Techniques

In addition to TESE and PESA, other sperm retrieval techniques may be used depending on the patient’s condition.

TESA: Testicular Sperm Aspiration

TESA stands for Testicular Sperm Aspiration.

This procedure involves placing a fine needle through the skin of the scrotum into the testicle to aspirate fluid or tissue that may contain sperm.

TESA is less invasive than open surgical extraction and may be used in selected cases.

MESA: Microsurgical Epididymal Sperm Aspiration

MESA stands for Microsurgical Epididymal Sperm Aspiration.

This is an open surgical sperm retrieval procedure performed using an operating microscope. The microscope helps the doctor locate the epididymal tubules precisely so that a larger number of sperm may be retrieved.

MESA may be considered in certain cases of obstructive azoospermia where sperm are present in the epididymis.

How Male Infertility is Treated

The first step in treating male infertility is to identify the cause. The doctor will assess whether the problem is related to sperm production, sperm transport, hormonal factors, obstruction, previous surgery, infection, genetic factors, or other medical conditions.

In some cases, medication may be used to support sperm production, depending on the cause. However, when sperm are not present in the semen due to blockage or severely reduced sperm production, sperm retrieval procedures such as TESE, PESA, TESA, or MESA may be recommended.

When sperm are successfully retrieved, they can be used together with ICSI. In ICSI, an embryologist selects a suitable sperm and injects it directly into a mature egg to achieve fertilization.

This combination allows some men with azoospermia or severe male infertility to pursue biological parenthood.

Who May Consider TESE or PESA?

TESE or PESA may be suitable for men with:

Azoospermia, or no sperm found in ejaculated semen
Obstructive azoospermia
Blockage in the epididymis, vas deferens, or ejaculatory duct
Previous vasectomy
Failed vasectomy reversal
Congenital absence of the vas deferens
Difficulty ejaculating or inability to provide a semen sample
Severe male factor infertility
Very low sperm production
Need for sperm retrieval before ICSI treatment
Cases where sperm cannot be obtained through normal ejaculation

The most suitable sperm retrieval method depends on the cause of infertility, semen analysis results, hormone levels, testicular function, and the doctor’s evaluation.

TESE / PESA Process

1. Consultation and Male Fertility Evaluation

The fertility specialist will review the patient’s medical history, semen analysis results, previous fertility treatment history, and possible causes of azoospermia.

Additional tests may be recommended, such as hormone testing, ultrasound, genetic testing, or further male fertility assessment.

2. Treatment Planning

The doctor will determine which sperm retrieval technique is most appropriate, such as PESA, TESA, TESE, or MESA.

The treatment plan is usually coordinated with the female partner’s IVF or ICSI cycle when applicable.

3. Sperm Retrieval Procedure

PESA or TESA is usually performed by an IVF specialist under anesthesia. The patient will not feel pain during the procedure.

For PESA, sperm are aspirated from the epididymis using a fine needle.

For TESA or TESE, sperm are retrieved from the testicle by aspiration or small tissue extraction.

4. Laboratory Examination

The retrieved fluid or tissue is immediately sent to the laboratory, where embryologists examine the sample to identify and prepare sperm.

5. Use with ICSI

If sperm are found, they may be used for ICSI. A single selected sperm is injected directly into a mature egg to support fertilization.

6. Recovery

After the procedure, the patient may rest in the recovery room for approximately 2 hours, where the nursing team will monitor the patient closely.

Most patients can return home on the same day.

After the Procedure

After TESE, PESA, TESA, or MESA, the doctor may provide specific instructions for recovery.

Patients are generally advised to:

Rest after the procedure
Avoid strenuous activity for approximately 1–2 weeks
Avoid impact or pressure to the scrotal area
Follow medication instructions if prescribed
Contact the clinic if there is unusual pain, swelling, bleeding, fever, or other concerns

For PESA or TESA, the wound is usually very small, similar to a needle hole.

For TESE or MESA, there may be a small incision of approximately 0.5 cm, depending on the procedure.

TESE / PESA and ICSI

TESE and PESA are often performed together with ICSI treatment.

This is because the number of retrieved sperm may be limited, and sperm may not be suitable for conventional IVF. With ICSI, only one suitable sperm is needed for each mature egg.

The embryologist carefully selects sperm and injects it directly into the egg. This technique can significantly improve the possibility of fertilization in cases of severe male infertility or azoospermia.

Why Choose SAFE Fertility Group for TESE / PESA?

SAFE Fertility Group provides sperm retrieval procedures with experienced fertility specialists, professional embryology support, and advanced assisted reproductive technology.

Experienced Fertility Specialists

Our doctors evaluate the cause of male infertility and recommend the most appropriate sperm retrieval approach for each patient.

Comprehensive Male Infertility Assessment

SAFE provides semen analysis, fertility evaluation, and treatment planning for men with azoospermia or severe male factor infertility.

Advanced Embryology Laboratory

Retrieved sperm are examined and prepared by trained embryologists under strict laboratory standards.

Integration with ICSI

TESE and PESA can be combined with ICSI to support fertilization when sperm are retrieved directly from the epididymis or testicle.

Personalized Treatment Planning

Each case is planned individually based on the patient’s diagnosis, sperm retrieval possibility, partner’s fertility condition, and reproductive goals.

Safe and Supportive Care

Our team provides clear guidance before, during, and after the procedure to help patients feel informed and supported throughout the treatment journey.

Take the Next Step with SAFE

TESE and PESA can offer new possibilities for men facing azoospermia or severe male infertility. With proper diagnosis, advanced sperm retrieval techniques, and ICSI treatment, some patients may still have the opportunity to achieve biological parenthood.

At SAFE Fertility Group, our specialists are ready to provide professional consultation, male fertility evaluation, sperm retrieval procedures, and advanced assisted reproductive treatment.

Contact SAFE Fertility Group today to schedule a personal consultation and learn whether TESE or PESA is suitable for your fertility treatment plan.