PESA/MESA/TESA/TESE Sperm Processing

  • Sidney VerzaJr.
  • Sandro C. EstevesEmail author


In men with azoospermia, spermatozoa can be retrieved from the epididymis or testis using different surgical methods such as PESA, TESA, TESE, and micro-TESE. After collecting the epididymal fluid or testicular tissue, laboratory techniques are used to remove contaminants, cellular debris, harmful microorganisms, and red blood cells. Processed spermatozoa can be utilized immediately for intracytoplasmic sperm injection or cryopreserved for future use. The surgically retrieved gametes are more fragile than the ejaculated ones. As such, sperm processing techniques should be used with care to avoid jeopardizing the sperm fertilizing potential. In this chapter, we describe the methods for optimal processing of surgically retrieved specimens and present our clinical experience with ICSI using testicular and epididymal sperm in azoospermic men. Additionally, we provide essential tips about how to optimally handle surgically retrieved sperm.


Azoospermia Sperm processing techniques Intracytoplasmic sperm injection Epididymal sperm Testicular sperm 




Absence of spermatozoa in the microscopic examination of the seminal fluid after centrifugation on at least two separate occasions.


The freezing process for storage of gametes or gonadal tissue at ultra-low temperature.


Intracytoplasmic Sperm Injection: a procedure in which a single spermatozoon is injected into the oocyte cytoplasm.


Microsurgical Epididymal Sperm Aspiration: a microsurgical procedure used to aspirate spermatozoa directly from the epididymal tubules for use in an ICSI procedure.


Microdissection Testicular Sperm Extraction: a microsurgical procedure used to dissect the seminiferous tubules within the testis in an attempt to identify areas of sperm production and extract spermatozoa for use in an ICSI procedure.


Percutaneous Epididymal Sperm Aspiration: a procedure in which a needle is inserted into the epididymis to retrieve spermatozoa for use in an ICSI procedure.

Sperm Processing

Laboratory techniques used to remove contaminants (cellular debris, microorganisms, red blood cells, etc.) and to select the best-quality spermatozoa to be used in conjunction to assisted reproduction technology.


Testicular Sperm Aspiration: a procedure in which a needle is inserted into the testis in order to retrieve spermatozoa for use in an ICSI procedure.


Testicular Sperm Extraction: operative removal of testicular tissue in an attempt to collect sperm for use in an ICSI procedure.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.ANDROFERT, Andrology & Human Reproduction Clinic, Referral Center for Male InfertilityCampinasBrazil
  2. 2.ANDROFERT, Andrology and Human Reproduction ClinicCampinasBrazil

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