Percutaneous Epididymal Sperm Aspiration (PESA)



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 anaesthesia and the procedure takes around 10 minutes.



PESA is a sperm retrieval technique in which a needle is used to aspirate sperms out of epididymis. Men with obstructive azoospermia will need to undergo PESA treatment.


Obstructive azoospermia is a condition in which sperm are produced in the epididymis but are blocked by the tubes. If the male has medical conditions such as genital surgery, problems with sperm production and delivery, then there would be no sperm in ejaculation, or even would to be able to ejaculation.


Who should go for PESA?


  • If the couple or the man has unexplained/idiopathic infertility (infertility with undetectable reasons even after several medical diagnosis and treatment), PESA should be
  • Men has problem with semen analysis tests/ sperm culture test reports such as:
  1. Azoospermia- Zero sperm in ejaculation
  2. Oligospermia- Low concentration of sperms
  3. Asthenozoospermia- Sperms lacking the required motility
  4. Cryptozoospermia- Sperms with high casualty rate
  5. Necrozoospermia- A condition with dead and immobile sperms
  • 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.
  • If the man’s semen does not contain any active sperm, PESA is prescribed.
  • To obtain sperm for In-Vitro Fertilization-IVF (assisted reproductive technique where the ovarian egg/s get fertilised with the sperm outside the body in a laboratory set up)
  • Diagnosed the condition of lumps or injuries in testicles such as
  1. Varicocele- causing heavy testicles.
  2. Hydrocele- swelling of testicles with an abdominal pressure sensation.
  3. Epididymal- one testicle much heavier than the other one.
  4. Orchitis- inflammation in the testicles.
  5. Testicular torsion- twisted testicles due to injury or accident.
  6. Lumps with the possibility of testicular cancer.
  • 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 around 10 minutes. The procedure involves:


  • The patient lies on his back and his scrotum skin is sterilised with a germ killer/antiseptic medicine.
  • He is injected with local or general anaesthesia.
  • The surgeon extracts sperm from the epididymis using a needle.
  • 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 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:


  • Formation of Hematoma (swelling of clotted blood cells) or heavy internal bleeding.
  • Infection at the site of incision (swelling, itching, redness/rash etc.)
  • High Fever ranging up to 104 degrees Fahrenheit.
  • Severe pain in the scrotum or the incision site.
  • Swelling or discolouration in the scrotum.