PESA (Percutaneous Epididymal Sperm Aspiration)
Where production is normal and only the plumbing is blocked, retrieval rates are excellent.
Understanding PESA (Percutaneous Epididymal Sperm Aspiration)
PESA — percutaneous epididymal sperm aspiration — retrieves sperm from the epididymis, the coiled tube behind the testis where sperm mature and are stored. A fine needle is passed through the scrotal skin directly into the epididymis and sperm are aspirated.
It is used specifically in obstructive azoospermia, where sperm production within the testis is normal but a blockage prevents sperm from reaching the ejaculate. Common scenarios include previous vasectomy, congenital absence of the vas deferens, and obstruction following infection or hernia surgery.
Because the obstruction lies downstream of normal production, epididymal sperm are usually present in good numbers and reasonable quality. Retrieval success in properly selected men is high, and the procedure is quick, needs no incision, and is performed as day care.
Symptoms
- Azoospermia with normal testicular volume and normal FSH
- Previous vasectomy with a wish to father children
- Absent vas deferens on clinical examination
- Previous epididymitis, tuberculosis or scrotal infection
- Obstruction following childhood hernia repair
- Normal sexual function and normal secondary sexual characteristics
- Dilated epididymis on ultrasound
If you recognise several of these, an assessment is worthwhile. Early evaluation usually means simpler treatment.
Causes & Risk Factors
Previous vasectomy
A frequent indication, where the couple later wishes to conceive and reversal is not chosen or has failed.
Congenital bilateral absence of the vas deferens
Associated with cystic fibrosis gene mutations; genetic counselling is offered to the couple before proceeding.
Post-infective obstruction
Scarring of the epididymis after epididymitis, tuberculosis or sexually transmitted infection.
Iatrogenic obstruction
Injury to the vas during hernia repair or other groin surgery, particularly in childhood.
Ejaculatory duct obstruction
Blockage at the level of the ejaculatory ducts, often with low ejaculate volume.
Failed vasectomy reversal
Where reconstruction has not restored sperm to the ejaculate.
Young syndrome and related conditions
Rare causes of epididymal obstruction.
Diagnosis at RAMS
We diagnose before we treat. Each step below is chosen for what it will actually change about your management.
Confirmed azoospermia
Two centrifuged semen samples examined carefully, with volume and pH recorded as these help localise the level of obstruction.
Hormone profile
A normal FSH with normal testicular volume strongly suggests obstruction rather than production failure — the pattern that predicts PESA success.
Clinical examination
Palpation of the vas deferens, which may be absent, and assessment of epididymal fullness.
Scrotal ultrasound
Confirming testicular structure and demonstrating epididymal dilatation.
Transrectal ultrasound
Where ejaculatory duct obstruction is suspected, particularly with low ejaculate volume.
Genetic assessment
Cystic fibrosis gene testing where the vas is absent, with counselling for both partners.
Treatment Options
Treatment is matched to the cause and to your circumstances. Every option, including doing nothing for now, is explained before you decide.
PESA procedure
A fine needle aspirates fluid from the epididymis under local anaesthesia. It takes only a few minutes, requires no incision, and no stitches are needed.
Immediate laboratory examination
Aspirated fluid is assessed at once for sperm presence, count and motility.
Cryopreservation
Surplus sperm are frozen for later cycles, avoiding repeat retrieval.
Conversion to TESA
Where epididymal aspiration does not yield adequate sperm, testicular aspiration can be performed in the same sitting, planned in advance.
Microsurgical reconstruction as an alternative
In selected men, surgical correction of the obstruction may allow natural conception, and this option is discussed before committing to retrieval.
Coordination with the assisted reproduction cycle
Timing retrieval with the partner's treatment cycle, or freezing sperm ahead of time.
Aftercare
Scrotal support, simple analgesia and avoidance of strenuous activity for several days.
Benefits of Treatment
- High sperm retrieval rates in obstructive azoospermia
- Quick procedure with no incision or stitches
- Performed under local anaesthesia as day care
- Good quality mature sperm from the epididymis
- Freezing avoids the need for repeat procedures
- An option after failed or declined vasectomy reversal
Why Choose RAMS
A dedicated men's health centre in Hanamkonda — built so that sensitive concerns meet genuine specialist expertise.
20+ Years of Experience
Two decades of andrology and urology practice, including complex and revision cases.
Fellowship-Trained Andrologist
Formal sub-specialty training in andrology and men's health — uncommon in the region.
Everything Under One Roof
Consultation, diagnostics, day-care procedures and surgery at a single address.
Modern Surgical Equipment
Dedicated theatre with an operating microscope, endoscopy and uroflowmetry.
Complete Confidentiality
Private consulting rooms and access-controlled records, always.
Open 24 Hours
Urological emergencies attended round the clock, all seven days.
Dr. Rammohan Thatipamula
MBBS, MS, MCh Urology · Fellowship in Andrology & Men's Health
With more than 20 years in clinical practice, Dr. Rammohan is among the few specialists in the Warangal region with formal fellowship training in andrology alongside an MCh in urology. That combination means male sexual health, fertility and urological surgery are handled by one specialist, rather than split across departments.
PESA (Percutaneous Epididymal Sperm Aspiration) FAQs
How is PESA different from TESA?
PESA takes sperm from the epididymis, where mature sperm are stored, and suits obstructive azoospermia. TESA takes tissue from the testis itself and is used when epididymal retrieval is unsuitable or unsuccessful, including in some non-obstructive cases.
Should I have a vasectomy reversal instead?
It depends on the time since vasectomy, your partner's age and fertility, and your preferences. Reversal can allow natural conception without assisted reproduction; retrieval avoids major surgery. We discuss both properly rather than defaulting to one.
Is the procedure painful?
Local anaesthesia keeps discomfort minimal during the procedure. Mild scrotal aching for a few days afterwards is usual and responds to simple painkillers and support.
Can the sperm be frozen?
Yes, and it is routinely done where the yield allows. Frozen sperm can be used for subsequent cycles without repeating the procedure.
Will my children inherit the cause of my infertility?
Where the obstruction relates to a genetic condition such as absent vas deferens, there are inheritance implications. This is exactly why genetic testing and counselling for both partners are offered before proceeding.
Talk to a specialist about pesa (percutaneous epididymal sperm aspiration)
Consultations are private, unhurried and completely confidential. We are open 24 hours, all seven days, in Hanamkonda.
Hospital Street, Hanamkonda, Telangana 506001 · Open 24 hours, all days