Matrushri
Fertility Centers Consultancy (Agencies)
TESA · TESE · Micro-TESE · PESA · MESA — Sperm Retrieval for Azoospermia
A testicular biopsy is the definitive procedure to retrieve sperm directly from the testes in men with azoospermia (no sperm in ejaculate) — enabling them to father biological children through IVF and ICSI.
A testicular biopsy is a surgical or needle-based procedure to remove a small sample of testicular tissue or fluid for two purposes: diagnostic (to determine whether sperm are being produced) and therapeutic (to retrieve sperm for use in IVF/ICSI).
💡 When is it needed? Azoospermia — the complete absence of sperm in semen — affects approximately 1% of men and 10–15% of infertile men. A testicular biopsy is the definitive test to determine whether sperm can be retrieved directly from the testes, and to characterise the type of azoospermia — guiding the most appropriate treatment approach.
There are several biopsy techniques — from minimally invasive needle aspiration (TESA, PESA) to microsurgical procedures (Micro-TESE, MESA) — each suited to different clinical situations. The choice depends on the type of azoospermia, prior investigations, and individual anatomy.
At Matrushri, all testicular biopsy procedures are performed by experienced urologists and andrologists under anaesthesia, with same-day discharge in most cases. Retrieved sperm can be used fresh or cryopreserved for future IVF/ICSI cycles.
The type of azoospermia determines which biopsy technique is most appropriate and the expected sperm retrieval success rate.
Each technique has specific indications, advantages, and success rates. Your specialist will recommend the most appropriate approach after full evaluation.
TESA is the least invasive testicular sperm retrieval technique. A fine needle is inserted through the skin of the scrotum directly into the testis, and fluid containing sperm and testicular cells is aspirated. The sample is immediately examined by the embryologist to confirm the presence of sperm.
TESA is most effective in obstructive azoospermia, where sperm are being produced normally but cannot exit through the ducts. In non-obstructive azoospermia, the yield is lower and less predictable.
TESA is performed by our experienced andrologists under ultrasound guidance for maximum precision. Retrieved sperm are immediately processed by our embryologists in the Class 1000 lab — either used fresh for ICSI or vitrified for future cycles.
TESE is an open surgical biopsy in which a small incision is made in the scrotum and testis, and a small piece of testicular tissue is removed. The tissue is processed in the laboratory to isolate any sperm present. TESE retrieves more tissue than TESA, making it more likely to find sperm in borderline or non-obstructive cases.
TESE can be performed as a diagnostic-only procedure (to assess sperm production before IVF) or as a combined therapeutic procedure (to retrieve sperm for immediate or future ICSI use).
TESE is preferred when TESA has previously failed or when a higher tissue volume is needed. Our surgeons take multiple small samples from different testicular locations, maximising the chances of finding sperm. All tissue is processed immediately in our Class 1000 embryology lab.
Micro-TESE is the gold standard sperm retrieval technique for non-obstructive azoospermia. Using an operating microscope at 20–25× magnification, the surgeon directly visualises the seminiferous tubules within the opened testis — identifying those that appear larger and more opaque, which are most likely to contain sperm.
This microscope-guided approach dramatically improves sperm retrieval rates compared to conventional TESE, while minimising damage to testicular tissue — crucial for preserving future hormonal function and testosterone production.
Our microsurgeons perform Micro-TESE using high-powered operating microscopes, giving men with non-obstructive azoospermia the best possible chance of sperm retrieval. Even in cases of Klinefelter syndrome or severe Y-chromosome deletions, Micro-TESE recovers sperm in a significant proportion of cases.
PESA retrieves sperm from the epididymis — the coiled tube behind the testis where sperm mature and are stored — using a fine needle aspiration. It is used when sperm are present in the epididymis but cannot reach the semen due to a blockage.
PESA is quick, minimally invasive, and can be repeated on multiple occasions. The retrieved sperm are mature and motile, making them well-suited for ICSI fertilisation.
PESA is our first-line approach for obstructive azoospermia caused by epididymal or ductal blockage. If the initial aspirate is insufficient, we can immediately escalate to MESA for a more targeted microsurgical approach — all under the same anaesthetic if needed.
MESA is the microsurgical version of PESA — performed under an operating microscope to directly visualise and aspirate individual epididymal tubules. It provides a larger and higher-quality sperm harvest than PESA, with enough surplus for multiple cryopreservation vials.
MESA is particularly valuable when PESA has failed or yielded insufficient sperm, and when maximum sperm banking is desired from a single procedure — reducing the need for future repeat procedures.
MESA is the preferred technique when maximum sperm banking is the goal — or when PESA has failed. Our microsurgeons harvest sufficient sperm to freeze multiple vials, giving couples several IVF/ICSI attempts from a single surgical episode, without the need for repeat biopsies.
From your first consultation to IVF with retrieved sperm — here is the complete journey at Matrushri.
Your andrologist reviews your semen analysis reports, medical history, previous investigations, and general health. The type of azoospermia is assessed clinically — and the most appropriate biopsy technique is recommended.
Day 1Hormonal profile (FSH, LH, Testosterone, Prolactin), scrotal ultrasound, genetic testing (Y-chromosome microdeletion analysis, karyotype), blood count, and clotting profile are completed to guide technique selection and pre-anaesthetic assessment.
Week 1–2You are admitted as a day case. Anaesthesia is administered (local, regional, or general depending on the technique). The scrotal area is cleaned and prepared. The embryology team is on standby to receive the retrieved sample immediately.
Procedure DayThe chosen technique (TESA, TESE, Micro-TESE, PESA, or MESA) is performed by our specialist. The sample is immediately handed to the embryologist in the adjacent laboratory, who processes it and confirms the presence of sperm within minutes.
15 min – 3 hoursRetrieved sperm are separated from testicular tissue under the microscope by our senior embryologist. Sperm quality, motility, and quantity are assessed. Sperm are either prepared for same-day ICSI (if coordinated with egg retrieval) or cryopreserved for future cycles.
Same Day — LabExcess sperm (or all sperm if not using fresh) are vitrified in multiple straws for future IVF/ICSI cycles. Cryopreserved testicular sperm can be stored for several years, giving couples multiple future attempts without repeat surgery.
Same DayMost men are discharged the same day or the following morning. You receive pain relief medication, scrotal support instructions, and a follow-up appointment. Return to light activity in 1–3 days depending on the technique used.
1–7 Days RecoveryYour partner proceeds with IVF ovarian stimulation and egg retrieval. Retrieved or thawed cryopreserved sperm are used for ICSI — injecting one sperm into each mature egg. Blastocysts are cultured and transferred to achieve pregnancy.
IVF Cycle — Next MonthA testicular biopsy is recommended for men with confirmed azoospermia or very severe oligospermia where ejaculation yields no or insufficient sperm.
The primary indication — confirmed on two separate semen analyses with centrifugation. Biopsy determines whether sperm can be retrieved directly from the testes for ICSI.
Primary IndicationMen who have had a vasectomy and now wish to father children. PESA or TESA retrieves sperm without reversal surgery — often simpler and more predictable than vasectomy reversal.
PESA / TESAMen born without the vas deferens — often CFTR gene mutation carriers. Sperm are produced normally but have no exit route. PESA or MESA successfully retrieves sperm in nearly all cases.
PESA / MESAMen with spinal cord injuries, diabetic autonomic neuropathy, or retrograde ejaculation where sperm cannot be retrieved from urine or via electro-ejaculation — TESA provides an alternative.
TESA AlternativeMen with blockages resulting from prior inguinal hernia repair, scrotal surgery, or sexually transmitted infections causing epididymal or ductal obstruction. PESA or MESA bypasses the blockage.
Obstructive AzoospermiaMen with Klinefelter syndrome have severely impaired sperm production. Micro-TESE by an expert microsurgeon retrieves sperm in 40–50% of cases, enabling biological fatherhood.
Micro-TESESperm retrieved from the testis or epididymis are structurally different from ejaculated sperm — they are immature and not yet capable of fertilising an egg naturally. However, ICSI (Intracytoplasmic Sperm Injection) bypasses this limitation entirely by injecting the sperm directly into the egg.
At Matrushri, our embryologists are expert in handling testicular and epididymal sperm — from the careful processing of the biopsy tissue to ICSI, blastocyst culture, and vitrification of resulting embryos in our Class 1000 lab.
Testicular biopsy demands surgical expertise, immediate embryology support, and a certified laboratory. Matrushri delivers all three.
Our dedicated andrologists and urologists are trained in all five sperm retrieval techniques — TESA, TESE, Micro-TESE, PESA, and MESA — selecting the most appropriate approach for each patient's individual anatomy and diagnosis.
Micro-TESE requires specialist microsurgical training and an operating microscope. Our surgeons are experienced in this gold-standard technique, offering men with NOA the highest possible retrieval rates.
Our embryology team is physically adjacent to the operating theatre — retrieved sperm are processed immediately, maintaining optimal viability. Our Class 1000 certified lab ensures the best possible conditions.
Excess sperm are vitrified in multiple straws with >95% post-thaw survival — giving couples multiple future IVF/ICSI attempts from one surgical procedure without repeat surgery.
We perform full pre-procedure evaluation including hormonal profile, scrotal ultrasound, Y-chromosome microdeletion analysis, and karyotyping — ensuring the right technique is chosen and genetic implications discussed.
Consultations across all 11 Matrushri centres. Testicular biopsy procedures are performed at our specialist IVF and surgical units — bringing expert care close to home.
If you have azoospermia or have been told sperm retrieval may be needed — speak with our andrologists first. Expert, compassionate, confidential care.
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