Sperm Retrieval Procedures: What You Need to Know About TESE, PESA, and Micro-TESE

Key Takeaways

• Sperm retrieval procedures help patients with little or no sperm in the ejaculate build their families through assisted reproductive technologies (ART).
• The right approach depends on the cause of infertility, such as obstruction, failed vasectomy reversal, or non-obstructive azoospermia.
• Retrieved sperm can be used for IVF or ICSI, which have strong success rates for male factor infertility.

Understanding Sperm Retrieval Procedures

Sperm retrieval procedures are an important treatment option for male factor infertility. They are used when sperm count, motility, or structure are insufficient for natural conception, or when no sperm are present in the ejaculate. In these cases, sperm can often still be retrieved directly from the testicles or surrounding structures and used in assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Types of Sperm Retrieval Techniques

There are several ways sperm can be retrieved, depending on each patient’s diagnosis and reproductive goals.

Testicular Sperm Extraction (TESE)

TESE involves retrieving sperm directly from the testicular tissue, either under local anesthesia or sedation. It is often recommended when no sperm are found in the semen. The procedure is usually timed with the egg retrieval for the female partner.

Microdissection Testicular Sperm Extraction (Micro-TESE)

Micro-TESE is a more advanced form of TESE that uses a surgical microscope to locate areas of the testes most likely to contain sperm. It is performed under sedation, typically one day before egg retrieval. This approach allows for optimal sperm retrieval while minimizing tissue damage.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is used when sperm production is normal but a blockage prevents sperm from reaching the ejaculate. A fine needle is inserted into the epididymis to collect sperm. This procedure is often coordinated with the egg retrieval process.

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA is similar to PESA but uses a surgical microscope for more precise retrieval. It is typically performed under sedation and is particularly effective for patients with blockages or congenital absence of the vas deferens, the duct that transports sperm to the urethra.

Who Needs Sperm Retrieval?

Sperm retrieval is recommended for patients who produce little or no sperm in their semen. The underlying causes can include:

Azoospermia

• Non-obstructive azoospermia: The reproductive tract and testicles are intact, but sperm production is reduced or absent due to hormonal or developmental issues.
• Obstructive azoospermia: The testicles produce sperm normally, but a blockage in the reproductive tract prevents sperm from being ejaculated. This can be caused by infection, prior surgery, or vasectomy.

Failed Vasectomy Reversal

If a vasectomy reversal does not successfully restore sperm flow, sperm retrieval can provide an alternative path to conception.

Genetic Conditions

Certain genetic abnormalities can lead to azoospermia or poor sperm development. Genetic testing is often recommended to identify causes and reduce the risk of passing genetic disorders to offspring.

How the Procedure Works and Recovery Time

Before sperm retrieval, a process called sperm mapping may be used to locate areas with the highest likelihood of sperm production. Sperm can be retrieved from the vas deferens, epididymis, or testicular tissue.

The goal is to collect viable sperm while minimizing damage to the surrounding tissue. Recovery usually takes a few days to a week. Mild bruising, swelling, or discomfort are common but temporary. Patients are typically advised to rest and avoid strenuous activity during recovery.

Success Rates with IVF and ICSI

With conventional IVF, eggs and sperm are combined in a lab dish where fertilization occurs naturally. ICSI takes a more direct approach by injecting a single sperm directly into an egg. ICSI tends to offer higher success rates for male factor infertility, since it bypasses many sperm-related barriers. Success rates vary and depend on a number of factors; we recommend discussing your specific circumstances with your provider.

If you’d like to discuss your options with a fertility specialist, contact Dallas IVF to schedule a consultation.

FAQs

What foods improve sperm health?

Foods rich in antioxidants, omega-3s, zinc, and folic acid—such as nuts, fish, leafy greens, and citrus fruits—can help improve sperm health.

Do smoking and alcohol affect sperm?

Yes. Smoking can lower sperm count and motility, and excessive alcohol use can reduce testosterone levels and sperm production.

Does heat exposure affect sperm?

Prolonged heat exposure, including time in saunas or hot tubs or placing laptops directly on the lap, can reduce sperm production.

Can stress impact fertility?

Chronic stress can raise cortisol levels, which may lower testosterone and negatively affect sperm production.

What vitamins and supplements support sperm health?

Vitamin C, Vitamin D, Zinc, Coenzyme Q10, and Folate have all been shown to support sperm concentration and quality.

Clinically reviewed by James Weinberger, MD