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Advanced Solutions for Male Factor Infertility: PESA, TESA, TESE

Authored and medically reviewed by Dr. Eli Reshef

Dr. Eli Reshef is a reproductive endocrinologist and fertility specialist who sees patients in Chicago and the greater Chicagoland area.

Male factor infertility alone accounts for 25-30% of infertility and contributes to nearly 50% of all infertility cases, yet it’s often overlooked in conversations about reproductive health. While many men assume fertility challenges only involve their partner, the reality is that issues like low sperm count, poor motility, poor morphology, and infection or blockages in the reproductive tract can significantly impact a couple’s ability to conceive.

When sperm cannot be obtained through ejaculation—a condition known as azoospermia—advanced techniques like PESA, TESA, and TESE provide hope. These procedures allow reproductive urologists to retrieve sperm directly from the male reproductive system, making parenthood possible even in complex cases. At Advanced Fertility Center of Chicago (AFCC), we partner with trusted urologists to perform these procedures safely and effectively, ensuring patients receive comprehensive, coordinated care.

What Are PESA, TESA, and TESE?

These are sperm retrieval techniques used when sperm cannot be obtained through ejaculation—a condition called azoospermia. They allow fertility specialists to collect sperm directly from the male reproductive tract for use in assisted reproductive technologies.

• PESA (Percutaneous Epididymal Sperm Aspiration): A minimally invasive procedure where a fine needle is inserted into the epididymis (the tube behind the testicle where sperm matures) to aspirate fluid containing sperm. It’s typically recommended for obstructive azoospermia, such as after a vasectomy or due to congenital absence of the vas deferens. Performed under local anesthesia, PESA usually takes 15–20 minutes and involves minimal discomfort.

• TESA (Testicular Sperm Aspiration): Involves inserting a needle directly into the testicle to extract tissue that contains sperm. This is often used for non-obstructive azoospermia, where sperm production is limited but present. TESA is also minimally invasive, performed under local anesthesia, and timed to coincide with the female partner’s egg retrieval.

• TESE (Testicular Sperm Extraction): A more invasive surgical procedure where a small incision is made in the scrotum to remove a sample of testicular tissue. TESE is typically reserved for severe cases of non-obstructive azoospermia or when other methods fail. It allows for a more thorough search for sperm within the testicular tissue. Recovery may take a few days longer than PESA or TESA.

Illustration of the male reproductive system

How Does a Reproductive Endocrinologist Decide If These Procedures Are Needed?

Before recommending PESA, TESA, or TESE, your reproductive endocrinologist will:

• Review your medical history and any prior fertility evaluations.

• Order advanced diagnostic tests, such as semen analysis, hormonal panels, and genetic screening.

• Determine the underlying cause of azoospermia—whether obstructive (blockage) or non-obstructive (production issue).

• Collaborate with a urologist to select the most appropriate retrieval technique based on your diagnosis and treatment plan.

This personalized approach ensures that every patient receives the right intervention for their unique situation. Donor sperm also remains a viable option for couples when sperm retrieval is unsuccessful or not recommended, providing an alternative path to parenthood.

How Do They Work With ICSI and IVF?

The number of sperm retrieved through PESA, TESA, or TESE is usually very small—often not enough for conventional in vitro fertilization (IVF) or for intrauterine insemination (IUI). That’s where ICSI (Intracytoplasmic Sperm Injection) comes in:

• ICSI Process: A single sperm is injected directly into an egg under a microscope. This technique dramatically improves fertilization chances when sperm count or motility is low.

• Integration with IVF: Eggs are retrieved from the female partner, fertilized using ICSI with the surgically retrieved sperm, and resulting embryos are cultured and transferred to the uterus.

• Timing: These procedures are often scheduled on the same day as egg retrieval, though sperm can also be frozen for later use.

Ready to Take the Next Step?

Our team combines cutting-edge technology with compassionate care. By working closely with experienced urologists, we provide seamless coordination between surgical sperm retrieval and advanced reproductive treatments like IVF and ICSI. If you’ve been diagnosed with male factor infertility or are struggling to conceive, schedule a consultation today. Our specialists will guide you through every option and help you build the family you’ve been dreaming of.

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