Scrotal, Penile & Fertility
Sperm Retrieval Procedures (TESE / PESA)
PESA / TESE are surgical techniques to recover sperm for IVF when none are present in the ejaculate. From simple needle aspiration (PESA) to a small biopsy of the testicle, this procedure will usually recover sperm which can be used for IVF with ICSI.
Key takeaways
- PESA / TESE are surgical techniques to recover sperm for IVF when none are present in the ejaculate. From simple needle aspiration (PESA) to a small biopsy of the testicle, this procedure will usually recover sperm which can be used for IVF with ICSI.
- Specialty: Scrotal, Penile & Fertility
>99
Retrieval in obstructive azoospermia%
10–20
Typical PESA timemin
No
PESA is needle-onlyincision
Treatment Overview
About Sperm Retrieval Procedures (TESE / PESA)
PESA / TESE is a way of collecting sperm directly from the male reproductive system when none are found in the semen (a condition called azoospermia), where the likely underlying problem is a blockage.
PESA (Percutaneous Epididymal Sperm Aspiration): A minor, 10 to 20-minute procedure where a very fine needle is used to collect sperm from the tube above the testicle (the epididymis). This is usually used if there is a blockage, such as from a previous vasectomy, or in patients who have congenital bilateral absence of the vas (CBAVD)
TESE (Testicular Sperm Extraction): An operation where your urologist makes a small incision in the scrotum, and then takes a small piece of tissue which can then be inspected to see if it contains sperm. Any sperm which are found are then frozen and used for IVF with ICSI, which is where individual sperm are injected into individual eggs which have been carefully removed from the female partner under ultrasound guidance.
Safety Information
Benefits, Risks & Side Effects
01
Benefits
For most men where there is a blockage to sperm delivery, sperm can be found enabling them to have a biological child. The alternative for some couples would be to consider a reconstructive operation, of this is possible, such as in the situation where there has been a previous vasectomy.
High Success: Because the testicle is normally working properly, it is normally possible to find sperm which can be used for IVF with ICSI. If an initial PESA does not work, then we would normally proceed to TESE under the same anaesthetic.
Sufficient sperm: Sperm are usually frozen in a number of different tubes, or ampoules. The embryologists would usually try and thaw out one ampoule for a single IVF cycle, so there would hopefully be enough sperm from a single operation for more than one cycle. This is not always the case, however.
Minimally invasive: PESA, which will usually retrieve sperm in 90% of patients, is minimally invasive, and does not require any incision, but only the passage of a needle through the skin into the epididymis.
02
Risks
While these procedures follow best-practice clinical standards, it is important to understand the potential risks. We categorise these by frequency to help you make an informed decision.
🟢 Common (More than 1 in 10 patients)
Worsening Obstruction: Between 5 and 9 out of 10 patients may experience worsening obstruction of the epididymis.
Bruising: There is a risk of a temporary bruise over the surface of the scrotal skin or within the scrotum after this operation.
🟡 Occasional (Between 1 in 10 and 1 in 50 patients)
No Sperm Found: Despite the surgeon's best efforts, no viable sperm are found in approximately 1 in 25 to 1 in 100 patients.
Infection: There is a small risk of an infection after this operation.
🔴 Rare (Between 1 in 50 and 1 in 250 patients)
Loss of the Testicle: There is a rare risk (between 1 in 100 and 1 in 250 patients) of complications severe enough to lead to the loss of a testicle.
Chronic Pain: A small number of patients may develop long-term or chronic pain in the testicle.
Significant Infection or Bleeding: Rare instances of infection or bleeding in the scrotum that are severe enough to require further surgical intervention.
Testicular Atrophy: Shrinkage of the testicle which may rarely require hormone replacement therapy.
General Medical Issues: Very rare complications related to anesthesia or the heart, such as blood clots or chest infections.
03
Side Effects
To help you prepare for your recovery, we use the following traffic light system to outline common after-effects. These are typically temporary and settle as the area heals.
🟢 Common (More than 1 in 10 patients)
Bruising and Swelling: It is very common to experience mild bruising and swelling of the scrotum following the procedure.
General Discomfort: Most men experience some swelling and a dull ache in the scrotum or groin for a few days.
Stitch Irritation: For TESE any incisions are closed with dissolvable stitches which can feel itchy or irritating for two to three weeks until they disappear.
What We Treat
How Sperm Retrieval Procedures (TESE / PESA) Can Help You
This treatment is effective for a wide range of health needs. Select a condition below to learn more about how we can support your recovery and improve your daily well-being.
Patient Journey
What to Expect
A step-by-step guide through your Sperm Retrieval Procedures (TESE / PESA) journey—from preparation and what happens during the procedure to recovery and aftercare.
01/ 03
Before Procedure
Before surgery, you will have a full "fertility work-up" including blood tests to check your hormones (FSH and Testosterone) and genetic screening.
Planning: You must be a patient registered with an IVF clinic.
Preparation: You must ensure that you have completed all of your consent forms for the clinic, and adhered to the travel guidelines on Zika. You must have had your blood tests done for virologies (HIV, Hep B and Hep C, or as advised by your individual clinic) within 3 months of your procedure.
Fasting: You must not eat or drink (nil by mouth) for 6 hours before your operation. You may be allowed to drink clear fluids like water up until closer to your surgery, but please follow the instructions given at pre-assessment.
02/ 03
During Procedure
PESA/TESE: This is usually done while you are asleep (general anaesthetic), but can be done while you are awake with local anaesthetic. The surgeon uses a small needle through the skin to try and suck out any sperm from the epididymis. Any samples taken are inspected by the embryologist to see if sperm have been found, and if they are then they are frozen.
If they are not found then the surgeon may try and same technique on the other epididymis, or make a small incision in the scrotum and testicle and take a small biopsy directly from the testicle. Again, any samples taken are inspected by the embryologist to see if sperm have been found, and if they are then they are frozen. Any bleeding is stopped, and the testicle is then closed with some stitches, and returned to the scrotum, which is then also stitched closed.
03/ 03
After Procedure
After the procedure, you should rest for 72 hours.
Support: Wear tight-fitting underwear or a jockstrap for support—this is very important for reducing pain and swelling.
Ice Packs: Packs: You will be given an ice pack at the time of your operation which will be removed before you go home. If helpful, you can apply a cold or ice pack inside the scrotal support for 15-20 minutes 2-3 times a day, but not directly in contact with the skin.
Activity: You can slowly get back to normal activity after 3 days.
Follow up: If sperms have been found your partner will be to book for IVF treatment. There is not usually the need for any follow up with your urologist.
Specialists
Specialists for Sperm Retrieval Procedures (TESE / PESA)
Leading experts for this treatment. View profiles to see clinical backgrounds and current availability.
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Patient Guidance
Frequently Asked Questions
Common questions about this treatment and what to expect.
3 questions
Obstructive means you are making sperm, but there is a 'blockage' (like a vasectomy or a missing tube) preventing them from getting out; PESA is usually very successful here. Non-obstructive means the testicles have a 'production' problem and are making very few, if any, sperm. mTESE is specifically designed for these more difficult cases because the microscope helps us find the few areas that are still working
Reviewed 2 Mar 2026
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Sperm retrieved directly from the testicle are often less 'mobile' (they haven't learned to swim yet). However, because we use ICSI (where a single sperm is injected directly into the egg), this overcomes this problem. The pregnancy rates using surgically retrieved sperm are very similar to those using ejaculated sperm.
Reviewed 2 Mar 2026
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It is possible, but we generally recommend that is not sperm is found at mTESE by a surgeon who undertakes this procedure regularly, then further attempts are not worthwhile. If however sperm were found, then a further retrieval to get more sperm should this be needed can be undertaken.
Reviewed 2 Mar 2026
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