PESA (Percutaneous Epididymal Sperm Aspiration) and TESA (Testicular Sperm Aspiration) are methods used for surgical sperm aspiration. PESA is a method wherein sperm is collected from epididymis using a syringe and fine needle. TESA is a method wherein sperm is retrieved directly from the testicles. This is commonly used for men with azoospermia due to primary testicular disease (Very low sperm production in testis). In these men usually, there will be no sperm in the epididymis and testicular sperm retrieval is needed.
If these procedures fail to retrieve sperm, then testicular sperm extraction (TESE) or micro TESE, which are open testicular biopsies, are performed to retrieve sperm.