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Assisted reproductive treatments

Microscopic Epididymal Sperm Aspiration (MESA)

Epididymal sperm aspiration is performed when the vas deferens is either absent, such as with a congenital defect or is scarred from prior trauma, infection or surgery.

The Microscopic Epididymal Sperm Aspiration (MESA) procedure is performed either through the skin (percutaneous) or through a small opening made in the skin (about 1/2-inch long). In this microsurgical technique, sperm is gathered from the epididymis, a sperm-rich "tube" at the back of the testis.

This procedure is done under local anesthesia, either with or without intravenous sedation. 

Recovery after this same-day procedure is approximately 24 hours.

Percutaneous Epididymal Sperm Aspiration (PESA)

This procedure uses a needle to penetrate the scrotal skin to draw a small amount of sperm from the epididymis. The Percutaneous Testicular Biopsy (PTBX) technique removes small cores of testis tissue.

Testicular sperm retrieval (TESA, TESE, MICROTESE)


TESA recovers sperm directly from a man's testes, bypassing his reproductive tract. 
Men who may benefit from the TESA procedure may have:

  • Had a vasectomy
  • Had unsuccessful vasectomy reversal
  • No sperm in the ejaculate
  • An absence of the vas deferens
  • Scarring of the vas deferens or ejaculatory duct

Some men who produce low levels of sperm due to problems in the testicles may also benefit from TESA.

TESA is usually performed under sedation in a doctor's office or outpatient facility. The patient may briefly experience a small amount of discomfort, but he is usually able to return to normal activities the day following the procedure.


Testicular Sperm Extraction (TESE) is performed on patients whose sperm production is normal, but there is a blockage in the epididymis or other location ("obstructive azoospermia"). 

The procedure is also useful for men whose sperm production within the testes is so low that very few sperm are produced and they do not reach the ejaculate.

TESE entails removing small samples of testis tissue for processing and extraction of sperm.

Microscopic TESE (MicroTESE), which is used in cases of extremely low sperm production, is a very detailed, precise search for sperm under high magnification. The procedure is done in a day clinic setting under local anesthesia, either with or without intravenous sedation.

Treatments for men

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