fertility treatments

Treating male infertility with TESA - Procedure, Causes, Advantages, Disadvantages

  • 4.7   (7 Votes)
Medically Reviewed by Dr. Deepika Tiwari - MBBS on 29 Dec 2018 - Written by Dr. Neha Gupta - MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MBBS

TESA procedure is combined with IVF treatment in case of presence of obstructive and non-obstructive azoospermia for sperm retrieval process. TESA procedure is effective when cryopreservation was performed in the past. This infertility treatment is gaining excellent success rates for patients.

Let’s Discuss in More Details About Male Infertility Treatment With TESA:

TESA or Testicular sperm aspiration is a procedure in which a sample of sperm cells is removed from the testicle through a small needle attached to a syringe. Sperms are looked at under a microscope in the laboratory and separated from tissues. These sperms are then used to fertilize eggs or frozen for future infertility treatment. TESA (testicular sperm aspiration) may be useful for men with infertility problems caused by a blockage that keeps sperms from being ejaculated. Infertility problems may be associated with certain genetic conditions, ejaculation problems, infection, or caused by a previous vasectomy.

Cases where TESA is a requirement

TESA is beneficial in the following conditions:

  • For couples with severe male factor infertility.
  • Obstructive azoospermia: When there are problems with the release of semen, even if sperms are produced, due to an obstruction in the reproductive tract. Obstruction can be due to a blockage in vas deferens (tubes that transport semen from the testes to the ejaculatory duct), a genetic defect (absence of vas deferens) or injury to the vas deferens due to surgery. 
  • Non-obstructive azoospermia occurs when there is no sperm production or very low number of sperms.
  • Retrograde ejaculation when the semen travels back into the bladder instead of being released out from the urethra.
  • For men who have had a vasectomy or who have had a failed vasectomy reversal.

Test tube baby, IVF, IVF treatment

Causes of Male Infertility

The production of sperms is a complex process and requires normal functioning of testes as well as the hypothalamus and pituitary glands that cause sperm production. Some of the factors that cause infertility are:

  • Varicocele (swelling of the veins that drain the testicle) result in reduced quality of the sperms.
  • Infections such as inflammation of the epididymis, STDs (sexually transmitted diseases) can interfere with sperms production or sperms health or can cause scarring that blocks the passage of sperms. 
  • Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the penis. Ejaculation problems may happen due to lack of ejaculation, diabetes, spinal injuries and surgery of the bladder, prostate or urethra.
  • Cancers and nonmalignant tumors can affect the male fertility directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. 
  • Men with undescended testicles may also have infertility problems because sometimes both the testicles fail to descend from the abdomen into the sac (scrotum) that normally contains the testicles. 
  • Hormone imbalances when the hypothalamus, pituitary and testicles are altered.
  • When the tubules that transport sperms are blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development.
  • Certain surgeries such as testicular surgeries, prostate surgeries, and large abdominal surgeries might prevent sperm while ejaculation.
  • Overexposure to certain environmental elements, including industrial chemicals, heavy metal exposure, radiation or X-rays might temporarily impair sperm count.
  • Health, lifestyle factors such as drugs taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. 
  • Alcohol use can lower testosterone levels and cause decreased sperm production.
  • Men who smoke and consume tobacco may have a lower sperm count than that of those who do not smoke.

Process of TESA

Testicular Sperm Aspiration is a surgical procedure to find sperms when a male partner does not have sperms or does not have enough sperms in his ejaculate which is also known as azoospermia. TESA is slightly more complex then PESA (Percutaneous Epididymal Sperm Aspiration), patients may experience a little discomfort for a few days following the procedure. TESA treatment involves passing a fine needle straight into the testes in order to restore a small number of the seminiferous tubules. In most cases, sperms can be detached from the seminiferous tubules in a laboratory. Firstly, a detailed semen analysis is conducted, if the results indicate no sperm in the semen, the doctor may recommend surgical retrieval of sperms from the testicles. Sperm retrieval is generally performed in combination with IVF and ICSI. This allows the fertility doctor to select healthy sperms and use them to fertilize individual eggs from the female partner. The sperms obtained are separated from the fluid collected from the testes, specially prepared, and used for fertilization. Except in cases where the extracted sperm need to be frozen, for most of the couples, egg retrieval and sperm retrieval are performed on the same day. These surgical procedures can be performed under local anesthetic or even sedation that totally depends upon the preference of the patient as well as the IVF doctor. TESA is performed in advance of an IVF cycle and sperms are cryopreserved, or coordinated with the female partner’s egg retrieval. The cost for the sperm retrieval procedure depends on several factors, including fees for anesthesia, surgical fees of the physician, charges for sperm freezing and facility fees.

IVF procedure, IVF

Advantages of TESA

TESA can also be useful for men who want to have children after having treatment associated with infertility, such as certain cancer treatments. Nowadays, TESA is also a widely accepted technique in the treatment of men diagnosed with OA (obstructive azoospermia), or NOA (non-obstructive azoospermia) but requires ICSI due to immature fertilization potential of testicular sperms. Since testicular biopsy is an invasive procedure, TESA has the potential to reduce surgical aspirations to single sperm retrieval by including cryopreservation.

Disadvantages of TESA

The disadvantages of TESA are as follows:

  • Even though the surgery is successful and there are sperms in the ejaculate, the quality of those sperms parameters such as the numbers, motility and morphology may be so low that the couple has to do IVF (In-Vitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection) to achieve pregnancy. 

  • Although there are sperms in the ejaculate, overall pregnancy rates are low and In-Vitro Fertilization (IVF)-Intracytoplasmic Sperm Injection (ICSI) has to be done to achieve pregnancy. Poor sperm parameters may be caused by back pressure that develops in the testicle from preventing the sperms from getting out with ejaculation. With no way to get out, pressure builds up in the testicle and damages the factories or cells that produce sperm.
  • Studies have found that fertility medications such as Clomid, used for improving spermatogenesis in a man with low sperm counts, are generally ineffective and do not improve the sperm parameters. This is because the factories that produce sperms are damaged and cannot function properly to produce sperms. However, even though the sperm parameters are poor, the sperms that are available can be very successful in fertilizing an egg, when IVF (In-Vitro Fertilization) or ICSI is (Intracytoplasmic Sperm Injection) is done, with good pregnancy outcomes.

It is important to realize, that IVF (In vitro Fertilization) technology is required to achieve a pregnancy with the vast majority of these extraction procedures. The success rates are intimately tied to a complex and complementary program of assisted reproduction for both partners.

Learn more about home remedies and natural supplements for treating Male infertility at Elawoman blog. If you are looking for Doctors for Male infertility you can call us at +917899912611.

Dr. Neha Gupta

Written by

Infertility Specialist, IVF Specialist

Dr. Neha Gupta is an Obstetrician and Gynaecologist in Gurgaon. She has been practicing for many years now. Her rich experience in Normal Vaginal Delivery, Intrauterine Insemination (IUI), In-Vitro Fertilization (IVF), Hysterectomy and Tubectomy makes her the most preferred names in Gurgaon. She has acquired MBBS in 2004, DNB from National Board of Examinations in 2009 and MS - Obstetrics and Gynaecology from Maulana Azad Medical College in 2009. She is a member of the Royal College of Obstetricians and Gynaecologists, London. Dr. Neha Gupta has an expertise in Intrauterine Insemination and is practicing at Fortis Memorial Research Institute in Gurgaon. You can get the contact details of Dr. Neha Gupta at elawoman.com


  • Testicular epididymal sperm aspiration (tesa) - procedure, benefits, types, risks  TESA, Elawoman - 2018
  • Ejaculation failure causes, and treatment of different types of ejaculation disorders  ejaculation problems, Elawoman - 2018
  • Azoospermia - causes, diagnosis, and azoospermia treatment  azoospermia, Elawoman - 2018
  • Pesa procedure - best sperm retrieval procedures for conception  PESA, Elawoman - 2018




I am looking forward to opting TESA treatment. Please suggest some best place for TESA treatment in Gurgaon.

Oct. 13, 2018, 9:52 a.m. 4.5


Dipendra Chand

I never studied TESA deeply. It was an interesting read, one question though, can we perform TESA for abnormal sperm morphology?

Oct. 9, 2018, 7:49 p.m. 5.0


Deepika Chawdhary

TESA is a highly effective method. My doctor suggested it after failed IUI treatment. The method is really successful for males having major fertility issues.

Sept. 7, 2018, 2:59 p.m. 4.5


Sandhya Madan

One of the biggest advantages of using TESA treatment is that during TESA ICSI immature sperms are also capable of fertilizing female eggs.

Dec. 4, 2017, 3:41 p.m. 4.5


Laura Miller

When planning for a test tube baby, avoid all kinds of addictive drugs.

Aug. 31, 2017, 5:49 p.m. 5.0


Isabella Smith

A Healthy sperm count is the most essential part of the IVF procedure. More than 40 million sperm per ejaculation is the ideal range.

Aug. 31, 2017, 5:47 p.m. 4.5


Sanjeela Sharma

IVF treatment has a higher success rate with couples below the age of 40.

Aug. 31, 2017, 4:08 p.m. 5.0

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