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What is PESA (Percutaneous Epididymal Sperm Aspiration) Treatment?

  • 4.8 (5 Votes)

PESA is a Surgical Sperm Retrieval method, used for male infertility treatments when there is no sperm in ejaculation. A needle is placed directly into the epididymis to extract seminal fluid containing sperms. PESA is performed under local anesthesia and the treatment takes 10 minutes.

PESA is a sperm retrieval technique in which a needle is used to aspirate sperms out of epididymis. Men with obstructive azoospermia need to for PESA treatment. Obstructive azoospermia is a condition in which sperms are produced in the epididymis but it is blocked by the tubes. If the male has some medical issues such as genital surgery, issues in sperm production and delivery, then there are no sperms in the ejaculation or no ejaculation happening.

Approximately 7% of the men are impacted by male infertility. You can read more about male infertility in our researched article on causes and treatments for male infertility.

How do sperm production (Spermatogenesis) and delivery take place?

To understand PESA or any other microsurgeries for sperm retrieval such as MESA, TESA, one needs to understand the male reproductive system of sperm production and delivery.

  • A male reproductive system including testicles and reproductive tubes are normally responsible for successful sperm production and delivery.
  • The very first production of sperm takes place in the seminiferous tubules, which are nothing but tightly coiled tubes within the testicles.
  • These tubules are again connected to a long primary tube called epididymis, which is again connected to a tube called vas deferens.
  • After production, sperm moves through epididymis to vas deferens when it needs to get ejaculated.
  • But due to some medical reasons such as Azoospermia (zero sperm in production) or genital surgeries such as vasectomy, penectomy etc. one can’t ejaculate naturally. Even if there is ejaculation, the sperm flow is found less in many cases.
  • Due to these conditions, one needs treatments such as PESA to treat infertility issues. PESA involves a method of injecting a needle in the epididymis and sperm extraction.

What test needs to be done prior to PESA?

FSH (Follicle Stimulating Hormone) test is a blood test used to measure the levels of FSH hormones produced by the pituitary gland. Males having normal FSH levels can produce sperms.

1- The normal value of FSH ranges from 1.5 to 12.4 IU/ml.

2- If FSH values are higher than 30 IU/ml, then it indicates that testes don’t produce sperms. Higher FSH levels are linked with male infertility. There will be no advantage in going for PESA or other testicular biopsies if FSH is high.

3- Lower FSH values indicate a problem with the pituitary gland.

Go for PESA treatment only if your FSH level is in the normal range or slightly elevated.

Who should go for PESA?

Your doctor or fertility specialist prescribes PESA after diagnosing the following conditions as given below -

1- If the couple or the man has unexplained/idiopathic infertility (infertility with reasons undetectable even after several medical diagnosis and treatment), PESA is prescribed.

2- Males facing problems in semen analysis tests/ sperm culture test reports such as

a- Azoospermia- Zero sperm in ejaculation


b- Oligospermia- Low concentration of sperms

c- Asthenozoospermia- Sperms lacking the required motility

d- Cryptozoospermia- Sperms with high casualty rate

e- Necrozoospermia- A condition with dead and immobile sperms

3- Men with abnormal ejaculation disorder such as Retrograde Ejaculation where the ejaculation goes backward to the urinary bladder instead of coming out of the urethra.

4- If the man’s semen does not contain any active sperm, PESA is prescribed.

5- To obtain sperm for In-Vitro Fertilization-IVF (assisted reproductive technique where the ovarian egg/s get fertilized with the sperm outside the body in a laboratory set up)

6- To diagnose the condition of lumps or injuries in testicles such as

  • Varicocele- causing heavy testicles.
  • Hydrocele- swelling of testicles with an abdominal pressure sensation.
  • Epididymal- one testicle much heavier than the other one.
  • Orchitis- inflammation in the testicles.
  • Testicular torsion- twisted testicles due to injury or accident.
  • Lumps with the possibility of testicular cancer.

7- When the man has lower Leutenizing hormones (LH) and Follicle-stimulating hormones which are essential for reproduction and testosterone production in men.

Procedure of PESA treatment

PESA is a very quick and simple surgical procedure performed by a surgeon or a Urologist. The entire procedure takes hardly 10 minutes. The procedure involves-

a- The patient lies on his back and his scrotum skin is sterilized with a germ killer/antiseptic medicine.

b- He is injected with local or general anesthesia.

local or general anesthesia

c- The surgeon extracts sperm from the epididymis using a needle.

d- The collected sperm is then sent to a laboratory to consider the possibility of finding sperm cells.

Benefits of PESA

PESA is a very successful sperm retrieval method to treat male infertility. The benefits of PESA can be summed up as-

  • PESA involves no complex surgical process involved in the scrotum area.
  • PESA is a treatment with minimum pain and discomfort. The risk and complications are very limited.
  • PESA does not involve open surgery.
  • PESA procedure is simple and quick. It takes 10 minutes to perform PESA treatment.
  • PESA can be repeated two to four times to get an adequate number of sperms.

Risks of PESA

Even if the PESA is considered a very mild surgery for sperm retrieval, there can be some possible side effects of this surgery from mild to severe. Some of them are-

1- Formation of Hematoma (swelling of clotted blood cells) or heavy internal bleeding.

clotted blood cells

2- Infection at the site of incision (swelling, itching, redness/rash etc.)

3- High Fever ranging up to 104 degrees Fahrenheit.

4- Severe pain in the scrotum or the incision site.

5- Swelling or discoloration in the scrotum.

What are the other testicular biopsy options if PESA treatment fails?

PESA is the first to go treatment for male infertility. If your infertility is severe, then there are chances that your PESA treatment will fail. In this case, you can go for an advanced technique of sperm aspiration or known as the testicular biopsy. It is always better to go for epididymis sperm extraction techniques such as PESA, MESA which provides mature and motile sperms.

1- MESA (Micro Epididymal Sperm Aspiration) is a technique in which a small incision is made in the scrotum. It is a microsurgery in which sperms are extracted from the tubules of the epididymis. Hence, a large number of sperms are extracted by this method. Sperms obtained are more motile.

2- TESA (Testicular Epididymis Sperm Aspiration) is a technique in which a needle is directly inserted into the testis to extract seminal fluid. There are higher chances of extracting more sperms with this process as compared to PESA, which only involves extraction from the skin of epididymis.

Certain tests are required to identify male infertility issues. Go through diagnostics to identify infertility in men.

3- Perc Biopsy is a technique that is similar to TESA but in this treatment a larger needle is used to extract small testicular tissue from which sperms are extracted.

4- TESE(Testicular Epididymal Sperm Extraction) is a technique in which large testicular tissue is extracted after cutting the scrotum. Under microscopy, sperms are identified. Sperms extracted by TESE procedure are always immature and immotile.

Microdissection TESE is a technique in which a microscope is used to extract the testicular tissue, which has number of sperms. Usage of microscope leads to less damage to the testis. Hence, it involves lesser risk as compared to TESE.

If none of the testicular biopsies work for you, then you have the only option of using a sperm donor. You can also try our curated list of useful tips to boost fertility in men. To know more, read our article on Useful tips that boost fertility in men.

Dr. Kavita Jaggi Agrawal

About The Author

Infertility Specialist, Obstetrician Dr. Kavita Jaggi Agrawal

Dr. Kavita Jaggi Agrawal is an obstetrician, gynecologist and infertility specialist who is providing her valuable expertise in the field of gynecology and infertility issues. She ensures that the patients receive the required fertility treatments well on time. Dr. Kavita specializes in the treatments like High Risk Pregnancy Care, In Vitro Fertilization (IVF) and Reproductive Medicine. Currently, she is practicing at Amit Jaggi Memorial Hospital, Vibhav Nagar, Agra.


  1. Male infertility and its causes and treatments causes and treatments for male infertility, Elawoman - 2017
  2. Five important things that optimize sperm quality sperm production, Elawoman - 2017
  3. How to boost male fertility and sperm count naturally sperm flow, Elawoman - 2017
  4. 4 lifestyle factors that affect fertility infertility issues, Elawoman - 2017
  5. About unexplained infertility and its treatment unexplained/idiopathic infertility, Elawoman - 2017
  6. Facts on semen color and semen health semen, Elawoman - 2017
  7. What is in-vitro fertilization (ivf) and its needs IVF, Elawoman - 2017



Sandhya Sengupta

Thanks for sharing this quality information. Now I have understood the treatment involved in treating male infertility problems.

Oct. 11, 2018, 2:44 p.m. 5.0


Suresh Manjur

My brother's PESA procedure proved to be useful for him. This blog has a lot of useful content for readers. Thanks for sharing with us!

Aug. 25, 2018, 5:42 p.m. 4.5


Maria Warren

PESA and IMSI are entirely different with no connection in between. PESA is used to retrieve sperms while IMSI is selecting the best sperm through high resolution microscope. Anyways both are used in infertility issues.

June 2, 2018, 6:51 p.m. 5.0


Keshav Mohanty

I think PESA looks a bit primitive when compared to IMSI. Nevermind these are all blessings for infertile males.

June 2, 2018, 4:47 p.m. 5.0


Vijay Mathur

This blog has cleared all our doubts on PESA procedure. It is indeed a useful blog.

May 27, 2018, 2:18 p.m. 4.5

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