Testicular Biopsy and Percutaneous Epididymal Sperm Aspiration (PESA)


In the past, fatherhood was not an option for men who had severe azoospermia (no sperm in their ejaculate), or have had a vasectomy. With the advent of Intracytoplasmic Sperm Injection (ICSI), these men now have the chance to become fathers if sperm can be found in their epidiymus or in their testicles.
A Percutaneous Epididymal Sperm Aspiration (PESA) is an in-office procedure in which a urologist uses very small gauge needles to aspirate fluid from the epididymus. The fluid is then viewed under a high powered microscope, by an embryologist, to see if sperm is present The patient is given lidocaine with a needle into the area near the epididymus to help reduce discomfort. When sperm are found they are used in ICSI. If no sperm are found during the PESA, then the urologist may feel that a testicular biopsy is the next best option.
A testicular biopsy can be performed as a core biopsy, where a punch gun is used to biopsy small samples of the testicle through a little cut in the testicle. Another option is an open biopsy, in which the testicle is fully opened and a sample is surgically removed. A patient is put under anesthesia for a testicular biopsy.
The embryologist minces the tissue and searches for sperm using a microtool. Sperm typically are not motile when found in the testicle and may be immature. However, testicular sperm can result in a pregnancy.
If you have severe male factor or no sperm in your ejaculate you could be a candidate for PESA or testicular biopsy at CNY Fertility Center. For more information call any of our three centers to schedule an appointment. Syracuse 1.800.539.9870, Albany 1.866.375.4589 or Rochester 585.244.1280.

6 replies
  1. Ray Lucero
    Ray Lucero says:

    How much does a procedure like this cost on average? I had a vesectomy 11 years ago and I want another child but do not know what chances I have.

  2. Amy
    Amy says:

    Hello Dr. Rob, So my partner has had a vesectomy and we have been looking into a PESA, so now we know, the ballpark price of that procedure,($700.)… what is the price for a IVF, or Intracytoplasmic sperm injection (ICSI)? We do want a ICSI, because we do want to to chose the sex of the child, or children. That brings me to my next question, is it possible to have 2 ICSI’s done and have twins?… and is it possible to have one of each sex, twins? (one female, one male)?

  3. Alma
    Alma says:

    My husband has a vasectomy, we would love to have another child. Do I have to have IVF done? I can still have children but unsure if I need to have any procedures done.

    • Editor
      Editor says:

      Hi Alma,
      We would like to discuss all of your options with you. To do this, we ask that you schedule a consultation appointment with us. Then, we will be able to look at your medical histories and create a few plan options for you to move forward with. To schedule a consultation, please complete the following form: https://cnyfertility.com/new-appointment-form/

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