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Surgical sperm retrieval - PESA vs TESA vs TESE vs micro-TESE.

Four techniques, four different indications, four different success rates. A side-by-side comparison so you know which one belongs in your consent form - and why the technique is decided by the cause of your azoospermia, not by the clinic offering the operation.

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Indicative pricing

What each retrieval technique costs in the UK.

Indicative ranges across our partner andrology units.

In short

Technique-matched retrieval in an HFEA-licensed unit: £2,600–£9,500, home day-case in every case.

Procedure Indicative range
PESA (percutaneous epididymal) £2,600–£3,800
MESA (microsurgical epididymal) £3,800–£5,500
TESA (testicular aspiration) £2,800–£4,200
Open TESE (testicular extraction) £3,500–£5,200
Micro-TESE (microdissection TESE) £6,500–£9,500
HFEA embryology lab handling and freeze £950–£1,800
Andrology consultation only £280–£450

Prices vary by hospital, consultant and approach.

The problem

Four techniques, one right answer - for your cause of azoospermia.

This page is the comparison every andrology clinic should have written - but rarely does. Which technique, why, what yield, what recovery, what to ask for.

  • Obstructive vs non-obstructive is the whole question

    Obstructive azoospermia does not need a microscope. Non-obstructive azoospermia almost always does. The paperwork trail (FSH, testis volume, karyotype) settles it before theatre.

  • Yield varies by technique - and by the surgeon

    Micro-TESE in a high-volume surgeon’s hands finds sperm in up to 60 percent of non-obstructive cases. In a general urologist’s hands, the figure is closer to 20–30 percent.

  • Retrieval is a fertility operation, not a urology operation

    Book the technique that matches the cause and the lab, not the technique the clinic already knows.

When it helps

When each technique fits.

Match the cause of azoospermia to the technique - plus the red flag that stops the pathway.

  • Obstructive azoospermia - needle technique fits

    Normal FSH, normal testicular volume, palpable epididymal fullness - PESA or TESA gives sperm in nearly all cases.

  • Non-obstructive azoospermia - microscope fits

    Raised FSH, small testicular volume, low testosterone - micro-TESE is the right operation.

  • Post-vasectomy - PESA/TESA

    Confirmed vasectomy with no wish to reverse - PESA or TESA on the day of the partner’s cycle.

  • CBAVD - PESA or MESA

    Congenital bilateral absence of vas - PESA or MESA under microscope, with CFTR genetic counselling.

  • Failed prior TESA - step up to micro-TESE

    Where TESA failed to find sperm in a suspected non-obstructive case, micro-TESE is the next step.

  • Klinefelter (47,XXY)

    Micro-TESE in the specific setting of Klinefelter, with hormone optimisation before surgery.

  • Y-microdeletion - genetic counselling first

    AZFc microdeletion carriers can still be candidates for micro-TESE; AZFa and AZFb rarely yield sperm.

  • Red flag: unexplained testicular mass

    A testicular lump on ultrasound is a urology emergency - cancer excluded first, sperm retrieval second.

Procedure options

Four techniques, side by side.

The distinct anatomy, indication, yield and recovery of each - so the recommendation you get is one you can compare.

  • PESA

    Percutaneous epididymal sperm aspiration. Fine needle, local anaesthetic, 15–30 minutes. Best for obstructive azoospermia. High yield when the cause is right.

  • MESA

    Microsurgical epididymal sperm aspiration. Small incision under operating microscope. Higher-quality sample than PESA - used when yield or freezing matters.

  • TESA

    Testicular sperm aspiration. Fine needle into the testis under local. Fast - but lower yield in non-obstructive cases than open TESE.

  • Open TESE

    Small incision, small piece of testis excised, examined in the lab. Good yield in intermediate cases where TESA fails.

  • Micro-TESE

    Microdissection TESE - testis opened under the operating microscope; dilated tubules identified and excised. Best yield in non-obstructive azoospermia.

  • Freeze vs fresh

    Fresh timed to your partner’s egg pickup for the highest oocyte–sperm coordination; frozen for flexibility, or where micro-TESE is planned ahead of cycle.

  • Local vs GA

    PESA and TESA under local anaesthetic. TESE and micro-TESE need regional block or GA, with a longer theatre slot.

  • Repeat retrievals

    Repeat retrievals are possible, but always the last recourse - repeated micro-TESE in a small testis risks atrophy.

Safety and recovery

What to expect afterwards - honestly.

All four techniques are well-established. The things worth planning are the technique match, the yield honesty and the cycle timing.

  • Short anaesthetic

    Local for PESA and TESA; regional or GA for TESE and micro-TESE. Same-day discharge in almost all cases.

  • Scrotal haematoma

    The main early risk. Ice, support and rest for 48 hours reduce it.

  • Infection

    Under 2 percent. Same-day team for spreading redness or fever.

  • Testicular atrophy

    Rare (2–5 percent) after micro-TESE. Higher with repeated retrievals in a small testis.

  • Testosterone dip after micro-TESE

    Common in the first six months; usually recovers. Endocrine follow-up if symptoms.

  • Yield honesty

    Sperm found in 40–60 percent of non-obstructive cases at micro-TESE, versus 20–30 percent in lower-volume hands. The number is the surgeon.

  • Genetic risk pass-through

    Y-microdeletion, Klinefelter, CFTR mutations - inheritable via ICSI. Genetic counselling is not optional.

  • Cycle pressure

    Retrieval on the day of egg pickup carries emotional pressure. Freezing ahead removes it - often the kinder option.

  • Red flags after retrieval

    Fever, spreading redness, unrelenting pain, expanding scrotal swelling - same-day team, or A&E.

Reading your operation note

Your retrieval operation note in four parts. Read the last one first.

Whichever technique was used, the note the andrologist sends you keeps to the same shape.

A UK andrologist reviewing an operation note and lab report

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the histology before your review, just ask.

  1. 01 Header

    Technique, side and anaesthetic

    Which technique was used, which side, and the anaesthetic.

  2. 02 Technique

    Microscope and biopsy notes

    For TESE and micro-TESE, the operative microscope findings and number of biopsies taken.

  3. 03 Findings

    Yield, motility, freeze count

    Same-day lab report - sperm found or not, motility, and number of vials frozen.

  4. 04 Impression

    Cycle plan and follow-up

    Read this first: fresh use or freeze count, next steps if no sperm found, and endocrine follow-up.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Surgical sperm retrieval is not usually covered by private medical insurance - it sits under fertility treatment, which is often self-pay or funded via employer benefits.

Frequently asked

Everything we get asked about the four retrieval techniques.

Quick answers on yield, cost, recovery and no-sperm outcomes across PESA, TESA, TESE and micro-TESE.

  • PESA or micro-TESE - how do I know which one I need?

    The cause of azoospermia decides. Obstructive azoospermia (post-vasectomy, post-infection, CBAVD) - where FSH and testicular volume are normal - usually only needs PESA or TESA. Non-obstructive azoospermia (raised FSH, small testes) needs TESE or ideally micro-TESE, which gives the best yield.

  • What is the actual yield of micro-TESE?

    In experienced hands, sperm is found in 40–60 percent of non-obstructive azoospermia cases at micro-TESE. In lower-volume hands, the figure is closer to 20–30 percent. Yield depends on the underlying cause - Klinefelter, Y-microdeletion, cryptorchidism history - and on the surgeon. Volume matters.

  • How much does each technique cost in the UK privately?

    PESA £2,600–£3,800, MESA £3,800–£5,500, TESA £2,800–£4,200, open TESE £3,500–£5,200, micro-TESE £6,500–£9,500. HFEA embryology handling and freezing (£950–£1,800) is charged separately unless bundled.

  • How long is recovery for each technique?

    PESA and TESA: back to office work in 24–48 hours. TESE: 3–5 days. Micro-TESE: 5–7 days. Scrotal support and no heavy lifting or cycling for 2 weeks in all cases.

  • What if micro-TESE finds no sperm - is that the end of the road?

    No. Options include a repeat micro-TESE after 6–12 months (particularly if hormone optimisation is possible), donor sperm ICSI, or fertility preservation for future medical options. The conversation is honest and starts before, not after, the procedure.

  • Should I have genetic testing before retrieval?

    Yes - karyotype and Y-chromosome microdeletion testing are standard before micro-TESE, and CFTR mutation testing where CBAVD is suspected. Findings guide the technique, the yield expectations, and the genetic counselling your partner will want before ICSI.

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