We had an email recently from James, a male reader who was diagnosed with azoospermia earlier this year. His diagnosis left him feeling incredibly overwhelmed and low. He felt as though he had let his partner down by not being a ‘real man’. A few months later though, and he has had a procedure which involves sperm extraction, called TESA and James’s dream of fatherhood is now no longer just a dream as he and his wife are about to embark on an ivf round.  

He wrote to us to ask if we would reach out to other men, to let them know that azoospermia doesn’t automatically mean the end. It also doesn’t mean that you are any less of a man. He asked if we could let our male readers know more about TESA, the procedure he had, and so we turned to Dr. Sergio Rogel, gynaecologist and fertility specialist from IVF Spain to explain the procedure. 

Firstly, can you explain what azoospermia is? 

Azoospermia means that the man’s semen (the white fluid) contains no sperm. It can be broken down into two categories:: 

1) obstructive azoospermia, which means you make sperm but there is a blockage in the male genital system.. 

2) non obstructive azoospermia, which means there is not enough sperm production to be seen in the semen.  

Can azoospermia be cured?

Men with azoospermia do not have to give up their hopes of conceiving a child. Depending on the type of azoospermia, it may be surgically treatable with sperm retrieval and assisted reproduction to achieve pregnancy.

Can you explain the difference between TESE and TESA, the two procedures that help extract the sperm? 

Yes of course. TESA is the process of sperm  aspiration, whereby sperm is extracted through a needle in the testis and aspirating fluid and tissue with negative pressure.

TESE is the process of sperm extraction whereby the testicle is cut open. TESE only allows you to search for spermatozoa (the reproductive cell or gamete of the male) in one area of the testicule, TESA allows you to explore the entire area.

Could you please explain what happens during the procedure whereby sperm is extracted from the testicles? 

First we proceed to a local anesthesia. Then we do the puncture or punctures depending on the case. The good thing about this technique is that we can check the sample instantly under the microscope so, if needed we can do several punctures on several areas of the testicles or even what we call a mapping of them with a puncture on every area. The last part is then the microscope observation and selection of the sperm.

Who is this procedure for? 

This procedure is usually indicated for men suffering from azoospermia or with high DNA fragmentation. In some cases we also do TESA when we are having trouble getting the embryos to the blastocyst stage and we suspect a male factor.  

If the sperm isn’t produced normally, is it healthy? Is it not stale?

In sperm production, the ejaculation is where the sperm matures. This means that the sperm we find directly in the testicles are immature and usually don’t  move. 

But we fix this part through a simple stimulation and they are completely healthy. In a way, they are even healthier because they didn’t go through the ejaculation process that can actually damage them.

It’s like getting a product directly out of the factory, and not from the shop, avoiding the risk of damage that can happen during the shipping!

Are there any risks involved?

Not at all. They must not worry about it at all. As always there are a few like risks such as haemorrhages or testicular fibrosis but honestly I have not seen these in my entire career. 

What is the success rate in terms of percentage, for finding a healthy sperm?

If the man is not suffering from azoospermia, the chances are almost 100%. For those with  azoospermia, it really does depend on the case. Until we do the puncture, it’s difficult to tell its origin. 


Have you been diagnosed with azoospermia? Have you had the TESA  procedure? If you would like to share your story, drop us a line at [email protected]