Percutaneous Epididymal Sperm Aspiration

Men with obstructive azoospermia, in whom sperm are produced but unable to exit the reproductive system because of a blockage, undergo the minimally invasive treatment known as percutaneous epididymal sperm aspiration (PESA). The epididymis, a coiled tube that sits on the back of the testicle and oversees storing and delivering sperm from the testes to the vas deferens, can be retrieved with PESA.

Causes of Obstructive azoospermia

There are several causes of obstructive azoospermia, including

  • Congenital abnormalities: Some men are born with abnormalities in the reproductive system that can cause blockages.
  • Infections: Certain infections, such as sexually transmitted infections, can cause scarring and blockages in the reproductive system.
  • Previous surgeries: Surgeries, such as vasectomy, can cause blockages that prevent the release of sperm.
  • Trauma: Trauma to the reproductive system can cause damage to the tubes that transport sperm and lead to blockages.

Diagnosis & Treatment

Several procedures, including a physical examination, semen analysis, and imaging tests like ultrasound or magnetic resonance imaging, are commonly used to diagnose obstructive azoospermia (MRI). A good physical exam by an experienced andrologist to identify a turgid full epididymis is the most important guide to successful PESA.

Surgery is frequently used as a form of treatment for obstructive azoospermia to remove or bypass the obstruction and allow sperm to be discharged during ejaculation. Percutaneous Epididymal Sperm Aspiration (PESA), a minimally invasive method, can occasionally be performed to extract sperm directly from the epididymis for use in reproductive treatments.

Obstructive azoospermia can be a discouraging diagnosis for couples who are having a difficult time getting pregnant, but there are several treatment options that are available. It's crucial to consult a trained healthcare professional if you or your spouse are exhibiting signs of obstructive azoospermia to identify the underlying cause and consider your treatment choices.


Under local anesthesia, PESA is normally carried out as an outpatient surgery. A tiny needle is used during the surgery to enter the epididymis through the scrotum. The needle is subsequently subjected to suction, which extracts a small volume of fluid containing sperm. The sperm is then checked for quality and viability using a microscope.


PESA is a reasonably short operation, usually finishing in under 30 minutes. The recovery period is similarly brief; most patients can return to their regular activities in a day or two. PESA normally has few side effects, with the most frequent ones being minor pain, bruising, or swelling where the needle was inserted.


To assist couples who are battling infertility, PESA is frequently used in conjunction with in vitro fertilization (IVF). The eggs of the female partner are fertilized with the recovered sperm in a lab, and the resulting embryos are subsequently implanted in the uterus.

The minimally invasive PESA process is a safe and efficient substitute for conventional surgical techniques for sperm extraction from epididymis. While it might not be appropriate for all men with obstructive azoospermia, it is a fantastic alternative for individuals who want to establish a family but are having trouble getting pregnant because of a blockage in the reproductive tract. Consult with a trained reproductive doctor if you or your partner are experiencing infertility to find out if PESA is the best course of action for you. Also, please check out if the centre is equipped with further procedures for sperm retrieval such as testicular sperm retrieval and microTESE.

Yes. With modern andrological practice and expertise, it is possible to do it very safely.

You can resume your daily activities on the same evening, except if done under spinal anesthesia where you need to take bed rest for 48 hours.

The chances of infection are very minimal because it is a percutaneous procedure

If your job involves only desk work and very light activity, you may typically return 1 or 2 days after the surgery. It is likely that you will have some discomfort for the first few days after surgery. Avoid exercise (no running, heavy lifting, long walks, straining, etc.) for one to two weeks.

You can have sex 1 month after surgery

Complete the preoperative tests and anesthesia check by the Consultant Anesthetist. Shave the scrotal area and lower abdomen including upper thighs. You need to be fasting (including fluids or water) for at least 8-10 hours prior to surgery and make sure you get this information from the team.

The complication rate is certainly less. You may have bruising, swelling and pain which usually resolve in 5-7 days. Watch for pain or swelling in the scrotum.