Male Fertility
No sperm in ejaculate doesn't mean no options. TESA, PESA & microTESE can retrieve sperm directly from the testis for ICSI even in non-obstructive azoospermia. Dr. Rajesh Modi, Nagpur.
A diagnosis of azoospermia, no sperm found in the ejaculate is one of the most devastating things a man can hear at a fertility clinic. It sounds absolute. But for many men, it isn't. TESA (testicular sperm aspiration) and PESA (percutaneous epididymal sperm aspiration) are minimally invasive procedures that retrieve sperm directly from the testis or epididymis and with those sperm, ICSI can be performed.
Both procedures retrieve sperm without needing it to appear in the ejaculate. The difference is where they retrieve it from — and which one your doctor recommends depends heavily on whether your azoospermia is obstructive or non-obstructive.
PESA draws sperm from the epididymis — the coiled tube next to the testis where sperm mature and are stored. It's typically used for obstructive azoospermia, where the epididymis is full of mature, healthy sperm that simply have nowhere to go. This is the basis of what's often searched as PESA IVF.
TESA draws a small sample of tissue directly from the testis using a fine needle, usually under local anaesthesia or light sedation. It's used for both obstructive and non-obstructive cases, and it's often the first step tried before more invasive surgical options.
Obstructive azoospermia occurs when sperm are produced normally but can't reach the ejaculate due to a blockage from a previous vasectomy, infection, or congenital absence of the vas deferens. In these cases, sperm retrieval success is high. PESA (retrieving sperm from the epididymis) or TESA IVF (from the testis itself) usually yields viable sperm for ICSI. Success rates with donor egg or partner egg IVF + ICSI in these cases are comparable to couples without male factor.
Non-obstructive azoospermia (NOA) is more complex it means sperm production in the testis is severely impaired. However, even in NOA, focal areas of sperm production may exist. Procedures like microTESE (microsurgical TESA) can find sperm in 40–60% of appropriately selected NOA patients. At Modi Pluro, Nagpur, Dr. Rajesh Modi performs a thorough genetic and hormonal workup before any retrieval attempt to give men the most accurate picture of their chances.
For men for whom retrieval is unsuccessful, donor sperm with IUI or IVF remains an option. Dr. Modi discusses all possibilities openly and sensitively recognising that this is an emotionally significant conversation, not just a clinical one.
Q: How long does a TESA procedure take?
A: TESA is typically a day-procedure performed under local anaesthesia or light sedation. The procedure itself takes 20–30 minutes. Recovery is usually 1–2 days of rest. Retrieved sperm can be used fresh in the same cycle or frozen for later use.
Q: What is the difference between TESA and MicroTESE?
A: Standard TESA uses a fine needle to aspirate testicular tissue. MicroTESE is a more sophisticated surgical procedure done under an operating microscope, identifying specific areas of the testis where sperm production may be occurring. MicroTESE is typically recommended for non-obstructive azoospermia.
Q: Does azoospermia mean no sperm at all?
A: Azoospermia means no sperm in the ejaculate — but sperm may still be present in the testis. This is why a specialist evaluation and retrieval attempt is always recommended before concluding that fathering a biological child is impossible.
TESA is typically a day-procedure performed under local anaesthesia or light sedation. The procedure itself takes 20–30 minutes. Recovery is usually 1–2 days of rest. Retrieved sperm can be used fresh in the same cycle or frozen for later use.
Standard TESA uses a fine needle to aspirate testicular tissue. MicroTESE is a more sophisticated surgical procedure done under an operating microscope, identifying specific areas of the testis where sperm production may be occurring. MicroTESE is typically recommended for non-obstructive azoospermia.
Azoospermia means no sperm in the ejaculate but sperm may still be present in the testis. This is why a specialist evaluation and retrieval attempt is always recommended before concluding that fathering a biological child is impossible.
