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Sperm Extraction (TESA, TESE, PESA, MESA) to Treat Male Infertility

Infertility can occur in men for various reasons. Little to no motile sperm may be present in their ejaculate, blockages may prevent the delivery of sperm, or ejaculation may not be possible. Potential reasons for these issues include a previous vasectomy, being born without a vas deferens, and having a low sperm count due to lifestyle factors or genetics.

Sperm extraction procedures can help men suffering from these conditions improve their fertility despite these causes. The sperm (spermatozoa) can be harvested directly from in or near the testes, and the healthiest, most viable sperm can be isolated. The sperm can then be used with other fertility treatments to achieve fertilization.

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“Anna and Michel D.

We just celebrated our son’s first birthday, and thought we should send out warm wishes to Dr. Saadat and his team as well. Without them this would not have been possible. We had “unexplained” infertility issues and the first clinic we went to was not very friendly and we felt like we were just another “cycle”. Dr. Saadat was always willing to answer questions and the nurses there were terrific. I felt like everyone in the office was on our side, and that makes a huge difference. So thank you to everyone from Anna, Michael and Alex”

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What Are TESA, TESE, PESA, and MESA?

TESA: Testicular Sperm Aspiration

Testicular sperm aspiration involves using a small needle to extract sperm directly from the testis (testicle).

While this is generally done under local anesthesia, it can be done under general anesthesia if you are anxious or nervous and prefer to be asleep during the procedure.

TESE: Testicular Sperm Extraction

Testicular sperm extraction is a surgical procedure that uses a small incision in the testis (testicle). A small portion of testicular tissue that contains sperm is removed.

This procedure is performed with the patient under general anesthesia.

PESA: Percutaneous Epididymal Sperm Aspiration

The epididymis is a tube behind the testis that joins the testicle to the vas deferens. PESA involves using a small needle to extract sperm from the epididymis.

This can be performed with the patient under local or general anesthesia based on their preference.

MESA: Microsurgical Epididymal Sperm Aspiration

Microsurgical epididymal sperm aspiration uses a small incision in the testicle to access the epididymis (the tube behind the testicle). A small needle is then used to aspirate sperm from the epididymal tubule.

MESA is performed with the patient under general anesthesia.

Which Fertility Treatments Is Sperm Extraction Used With?

IVF (In Vitro Fertilization)

Healthy eggs are retrieved from the female partner’s ovaries or an egg donor. The extracted sperm and eggs are combined to achieve fertilization.

Once a healthy embryo has developed, it is transferred into the uterus (embryo transfer).

IVF With ICSI (Intracytoplasmic Sperm Injection)

ICSI is used in nearly all IVF cycles (roughly 99 percent).

Intracytoplasmic sperm injection (ICSI) increases the likelihood of healthy embryos developing during the embryo culture process. A healthy sperm obtained from the extraction is injected into the cytoplasm of an egg.

If a viable embryo develops, it can then be transferred into the uterus.


Extracted sperm can be frozen (cryopreserved) and stored at the Reproductive Fertility Center cryobank for use in subsequent fertility treatments if needed. This prevents the need for multiple sperm extraction procedures.

Frequently Asked Questions About Sperm Extraction

Who performs these sperm extraction procedures?

These services are provided by a urologist who is not affiliated with our office.

How much does sperm extraction cost?

The cost of sperm extraction will vary depending on the technique used and several factors unique to each procedure.

How successful is sperm extraction?

Sperm extraction generally has a high chance of success. Dr. Saadat can review your individual likelihood of success based on the technique chosen and specific infertility concerns.

Is sperm extraction painful?

TESA, TESE, MESA, and PESA are performed using the necessary anesthesia to ensure the procedure is painless.

What is recovery like after sperm extraction?

These procedures will have a recovery period that can include moderate discomfort. Patients can manage these side effects with prescription or over-the-counter medication.

How do I know if I need TESE, TESA, PESA, or MESA?

Dr. Saadat will usually make a recommendation for you based on tests he performs and suspected causes of infertility. TESA is most often used when the testes produce viable sperm that can’t be ejaculated. TESE is more commonly used when there is an issue with the production of healthy sperm within the testicles.

Do I need to know the cause of my infertility before undergoing sperm extraction?

Sperm extraction procedures can be used to overcome a wide variety of male infertility concerns. Therefore, knowing the specific infertility concern is not always critical. However, knowing the cause of your infertility may be beneficial in determining which procedure is best for you.

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