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The commonest technique is called as testicular aspiration, wherein we put a tiny needle after giving the anaesthesia to the patient and then a small amount of testicular tissue is removed and then looked under the microscope. There we identify the sperms and use those sperms for IVF or ICSI procedure. This is done in conditions where a man has no sperms in his ejaculate, but assumption is that this is due to obstructive case. Also it is done when the man is unable to produce the sample or if his sperm DNA fragmentation rates are very high. The other kind of Surgical sperm retrieval is called as PESA or percutaneous epididymal sperm aspiration. Here it is done only if he has an obstructive azoospermia and we take sperms directly from a structure behind the testis called as epididymis. Again a small tiny needle is used for the procedure. It is also again a day care procedure and we get better quality sperms than from the testis because sperms in the epididymis tend to be a little motile and we get better quality sperms. This is PESA or percutaneous epididymal sperm aspiration. The third kind of sperm retrieval procedure is called as a testicular biopsy also called as TESA. Testicular sperm extraction or TESA is done where we have a condition called as non-obstructive azoospermia where we think the cause of not having sperm in the semen is caused due to reduced production in the testis. Here we open up the testicle and then take a bit of tissue little more than what we get in a TESA or a PESA and then look at this tissue under the microscope to identify sperms and the most recent or the most modern way of doing this procedure is called as Microdissection TESA.
