TESA (Testicular Sperm Aspiration)
No sperm in the ejaculate does not always mean no sperm in the testis.
Understanding TESA (Testicular Sperm Aspiration)
TESA — testicular sperm aspiration — retrieves sperm directly from the testicular tissue using a fine needle. It is performed for men with azoospermia, where no sperm are present in the ejaculate.
For many men, being told there is no sperm in their sample feels like a definitive end to the possibility of biological fatherhood. It very often is not. Sperm production may be occurring within the testis while an obstruction prevents it reaching the ejaculate, or production may be reduced but not absent.
TESA is a short day-care procedure performed under local anaesthesia or brief sedation. Retrieved sperm are used for assisted reproduction with the female partner, and surplus sperm can usually be frozen for future attempts, avoiding repeat procedures.
Symptoms
- No sperm found on two properly performed semen analyses
- Inability to conceive despite normal sexual function
- Previous vasectomy with a wish to father children
- Absent or blocked vas deferens on examination
- Small testicular volume with raised FSH
- Previous failed sperm retrieval elsewhere
- Ejaculatory failure due to spinal injury or diabetes
If you recognise several of these, an assessment is worthwhile. Early evaluation usually means simpler treatment.
Causes & Risk Factors
Obstructive azoospermia
Normal sperm production with blockage in the epididymis, vas or ejaculatory ducts. Retrieval rates in this group are very high.
Previous vasectomy
Where reversal is not chosen or has not succeeded, sperm are retrieved directly.
Congenital absence of the vas deferens
Often associated with cystic fibrosis gene mutations, warranting genetic counselling for the couple.
Non-obstructive azoospermia
Impaired production within the testis, where focal areas may still contain sperm.
Post-infective obstruction
Scarring following epididymitis or tuberculosis, which remains a relevant cause in this region.
Iatrogenic injury
Obstruction following childhood hernia repair or other scrotal surgery.
Ejaculatory dysfunction
Where sperm production is normal but ejaculation cannot be achieved.
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 separate semen samples, centrifuged and carefully examined, before any retrieval is planned.
Hormone profile
FSH, LH and testosterone, which help distinguish obstruction from impaired production and predict retrieval success.
Clinical examination
Testicular volume and consistency, and palpation of the vas deferens and epididymis.
Scrotal and transrectal ultrasound
Assessing testicular structure, epididymal dilatation and ejaculatory duct obstruction.
Genetic testing
Karyotype and Y-chromosome microdeletion analysis, plus cystic fibrosis gene testing where the vas is absent.
Coordination with the fertility team
Timing retrieval with the partner's cycle, or planning freezing in advance.
Treatment Options
Treatment is matched to the cause and to your circumstances. Every option, including doing nothing for now, is explained before you decide.
TESA procedure
A fine needle aspirates tissue from the testis under local anaesthesia or brief sedation. The procedure itself takes only a few minutes and requires no incision or stitches.
Immediate laboratory assessment
Aspirated tissue is examined at once to confirm the presence of sperm and assess quality.
Sperm cryopreservation
Surplus sperm are frozen for future cycles, sparing the man repeat procedures.
Progression to open retrieval
Where TESA does not yield sperm, open testicular biopsy or microdissection retrieval may be undertaken, discussed in advance as part of the plan.
Hormonal optimisation beforehand
In non-obstructive cases, correcting hormonal abnormalities before retrieval can improve yield.
Reconstructive alternative
Where obstruction is surgically correctable, microsurgical reconstruction may allow natural conception and is discussed as an option.
Recovery and aftercare
Scrotal support, simple analgesia and rest for a day or two. Most men resume normal activity within 48 hours.
Benefits of Treatment
- Biological fatherhood remains possible despite azoospermia
- Short day-care procedure with no incision or stitches
- Local anaesthesia rather than general anaesthesia in most cases
- Sperm can be frozen, avoiding repeat procedures
- Rapid recovery with minimal time off work
- Performed by a fellowship-trained andrologist
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.
TESA (Testicular Sperm Aspiration) FAQs
Is TESA painful?
Local anaesthesia means the procedure itself causes minimal discomfort. Some scrotal aching and tenderness for a few days afterwards is normal and settles with simple analgesia and scrotal support.
How successful is it?
Success depends heavily on the cause. Where azoospermia is obstructive, sperm are retrieved in the great majority of cases. In non-obstructive azoospermia rates are lower and more variable, which is why hormone levels and testicular findings are assessed beforehand to give you a realistic expectation.
Will it damage my testicles?
TESA is minimally invasive and serious complications are uncommon. Temporary swelling and discomfort are usual; significant injury is rare.
How long is recovery?
Most men resume normal activity within one to two days, avoiding heavy lifting and strenuous exercise for about a week.
What if no sperm are found?
We discuss this possibility fully beforehand. Options may include microdissection retrieval, hormonal treatment followed by a repeat attempt, or exploring donor sperm and adoption. You will not be left without a conversation about what comes next.
Talk to a specialist about tesa (testicular 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