PESA & TESE, Epididymis

TESE (Testicular Sperm Extraction) & PESA (Percutaneous Epididymal Sperm Aspiration)

Men diagnosed with Azoospermia often need to undergo a minor surgical procedure to retrieve the sperm from the epididymis. If you have a blockage in any part of your reproductive system, tests called PESA (Percutaneous Epididymal Sperm Aspiration) and TESE (Testicular Sperm Extraction are your best chances at collecting semen samples.
These tests are commonly used to retrieve healthy and mature sperm in the case of male infertility. These sperm are then united with the eggs in an outside environment (a petri dish), fertilized, and implanted into the woman’s uterus for a healthy pregnancy. Keep reading to learn more about PESA, TESE, and the connection of epididymis in male fertility.

Understanding Azoospermia and Epididymis-Related Causes

Azoospermia refers to the male’s infertility, a condition where your testicles are unable to produce sufficient semen. It can have obstructive and nonobstructive causes. In the former, the part of your reproductive organs is blocked, which makes it difficult for the healthy sperm cells to pass through your ejaculate. 

Non-obstructive Azoospermia occurs when there is not enough sperm. In some cases, the testicles stop producing sperm altogether. 

Sperm is produced in your testicles, which are connected to the epididymis. This coiled tube stores, trains, and matures sperm before it passes through your vas deferens and eventually through the urethra. Obstructive Azoospermia happens when sperm is produced in the testis but can’t be released in your ejaculate due to a blockage in the epididymis or vas deferens.

Percutaneous Epididymal Sperm Aspiration (PESA)

Men facing infertility issues due to obstructive Azoospermia undergo PESA, a test that collects the semen sample directly from the epididymis. The testing procedure is quite effective in patients diagnosed with Azoospermia, in which the vas deferens or the epididymis are blocked. 

As a result, the sperm can’t be released in the man’s ejaculation. It’s also advised in men with retrograde ejaculation, a condition where the ejaculation goes into the bladder rather than releasing from the urethra.

The success rate of PESA is 83%. Another study that focused on CBAVD (congenital bilateral absence of the vas deferens) patients showed a 96.8% success rate. The procedure can be repeated until your healthcare provider collects enough sperm for lab testing or Intra Cytoplasmic Sperm Injection

Testicular Sperm Extraction (TESE)

Testicular Sperm Extraction, or TESE, is recommended for men with a very low or zero sperm count in ejaculation. The procedure involves extracting sperm from your testicles to determine the presence of healthy sperm production in your testis. 

If no sperm is found in the epididymis, your healthcare provider will schedule TESE to retrieve healthy and motile sperm directly from the testicles. The semen sample is then sent to the lab to detect the sperm count, quality of the sperm, and the problem in your reproductive tract. TESE is widely used in men with a congenital absence or those with no sperm in the epididymis. 

TESE is used in men diagnosed with obstructive Azoospermia. Micro TESE is another effective testing procedure for those with nonobstructive Azoospermia and other fertility-related issues in men. 

Comparison between PESA and TESE

Both PESA and TESE are performed in men with azoospermia-related infertility. However, these are different procedures and involve the extraction of sperm from different parts. As mentioned previously, PESA is a minimally invasive procedure that requires sperm retrieval from your epididymis. 

TESE, on the other hand, is reserved for men who do not have enough sperm reserve in the epididymis. In such cases, the sperm sample is extracted from the testicles. MicroTese is scheduled the same day or a day after the egg retrieval. 

Although the sperm collected in the procedure is far less than the sperm produced in ejaculation, the procedure is considered effective in azoospermic men.

Procedure and Outcomes: A Focus on Epididymis Relevance


PESA is a minimally invasive procedure performed under local anesthesia, mostly in an outpatient setting. A fine needle is inserted into your epididymis to retrieve the fluid. Your healthcare provider will extract healthy sperm from this liquid and store it. 


TESE can be performed under local anesthesia or general anesthesia, depending on where you take the test. If PESA has failed or there’s no sperm trace found in your semen, the doctor will schedule TESE to collect sperm from the testicles. A thin needle is inserted into your testis to collect sperm samples.

Benefits and Considerations

PESA and TESE help collect healthy sperm for infertility screening. These are viable options for men who can’t release sperm in their ejaculation due to Azoospermia or other causes of obstruction in their reproductive system. 

These sperm cells are stored for future IVF cycles. The procedures are mostly scheduled with the egg retrieval process, as it helps fertilize women’s eggs. Sperm and eggs collected are kept in the petri dish for fertilization, and the resulting embryo is transferred into the woman’s uterus. Simply put, parents who can’t conceive naturally due to man’s infertility can consider PESA or TESE.

Although the procedures are considered safe, they involve the insertion of the needle into your epididymis and testis. This presents the risk of hematoma. Some rare side effects of the procedure involve heavy bleeding, permanent damage to your epididymis, and the inability to collect sperm from the testis or epididymis. 

Make sure you discuss the risk factors with your doctor before proceeding with these procedures. Your healthcare provider will consider your age, prior fertility tests, and conception goals to recommend the most suitable sperm extraction procedure.


Genetic factors, infection or inflammation of the reproductive organs, or a previous surgery cause testicular problems in men. TESE and PESA can help detect the cause of infertility and the sperm count in men. The procedures are also used to determine the sperm quality in the semen. 

Men with congenital absence, i.e., missing vas deferens from birth, can undergo TESE to retrieve sperm directly from the testicles. Talk to your healthcare provider to learn more about sperm extraction procedures, their safety score, risk factors, and whether you are a good candidate.

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