PESA treatment explained : What preparations one should take

When couples are planning fertility treatment, male fertility should be considered as an important part of the overall evaluation. Semen analysis and other investigations can help the fertility specialist understand whether male-factor fertility concerns need further assessment.

For some men, semen analysis may show azoospermia, which means sperm is absent in the ejaculated semen. This does not always mean that sperm is absent from the body. In some cases, sperm may still be produced in the testes but may not reach the semen because of a blockage. In such situations, the fertility specialist may discuss sperm retrieval options such as PESA.

PESA, or Percutaneous Epididymal Sperm Aspiration, is a sperm retrieval technique in which sperm is collected from the epididymis. The epididymis is a small tube located close to the testicle, where sperm is stored and carried forward. Once retrieved, the sperm may be used in an IVF cycle with ICSI, depending on the couple's fertility diagnosis and treatment plan.

What is PESA treatment?

PESA may be recommended in selected cases where sperm is not seen in the semen because of an obstruction. In such situations, sperm production may still be taking place inside the testes, but a blockage may stop the sperm from passing into the ejaculated sample.

During the procedure, the fertility specialist collects sperm directly from the epididymis with the help of a fine needle. It is usually performed with anaesthesia and, in many cases, can be completed as a day-care procedure without the need for hospital admission.

After retrieval, the sample is checked in the laboratory. If usable sperm are found, they may be used during ICSI, where a selected sperm is injected into a mature egg to assist fertilisation.

Who may need PESA?

PESA may be discussed when sperm is absent in the semen because of a suspected blockage. It may be relevant for men with obstructive azoospermia or blocked sperm passage.

Possible situations where PESA may be considered

• Sperm absent in semen due to obstruction
• Previous vasectomy
• Congenital absence or blockage of reproductive ducts
• Ejaculatory duct obstruction
• Certain infection-related blockages
• Failed sperm release despite sperm production
• IVF planning where sperm retrieval is needed

PESA is not suitable for every male fertility concern. If azoospermia is related to very poor sperm production rather than a blockage, another sperm retrieval method, such as TESA or Micro TESE, may be discussed. This is why the correct diagnosis before the procedure is important.

How PESA connects with IVF and ICSI

PESA is usually not the final fertility treatment by itself. It is a sperm retrieval step that may support assisted reproductive treatment.

In many cases, sperm retrieved through PESA is used with ICSI during IVF. The number of sperm retrieved may be limited, and ICSI enables the embryology team to use selected sperm directly for fertilisation.

PESA helps retrieve sperm, while IVF with ICSI helps use that sperm for fertilisation.

Why preparation matters before PESA

PESA may be a relatively quick procedure, but preparation is still important. It helps the fertility team confirm whether the procedure is suitable, plan anaesthesia safely and coordinate sperm retrieval with the IVF cycle where required.

Preparation also gives patients a clearer understanding of what will happen before, during and after the procedure. It includes medical, practical and treatment-related planning.

Before PESA, the fertility specialist may recommend certain tests based on the man's medical history and semen analysis.

Common assessments may include

These assessments help the doctor decide whether PESA is appropriate or whether another sperm retrieval approach may be more suitable.

Medical preparations before PESA

Patients should follow the fertility specialist's instructions before the procedure. These may vary depending on the clinic protocol, anaesthesia plan and overall health condition.

General preparations may include

• Share the complete medical history with the doctor.
• Inform the clinic about diabetes, high blood pressure, heart disease, bleeding disorders or allergies.
• Mention previous surgeries, infections, vasectomy or testicular injury.
• Tell the doctor about all medicines, supplements and blood thinners.
• Complete all advised blood tests and scans before the procedure.
• Ask whether fasting is required before anaesthesia.
• Confirm whether any medicines should be paused or continued.
• Report fever, infection, swelling or severe pain before the procedure day.
• Ask whether sperm freezing is planned if sperm is retrieved.
• Clarify whether PESA timing is linked with the female partner's egg retrieval.

Patients should not stop prescribed medicines without medical advice. Any changes should be discussed with the treating doctor.

Practical preparations for the procedure day

Planning a few practical details in advance can help the procedure day run more smoothly.

Useful steps include

• Arrive at the clinic on time.
• Carry all required medical reports and identification documents.
• Wear comfortable clothing.
• Follow fasting instructions if anaesthesia is planned.
• Arrange for someone to accompany the patient if sedation or anaesthesia is used.
• Avoid planning work meetings or travel immediately after the procedure.
• Ask how long rest may be required before going home.
• Keep the clinic's contact details available.
• Clarify when the clinic will provide an update about sperm retrieval.
• Ask whether the retrieved sperm will be used fresh or frozen.

Clear information about these details can help patients know what to expect on the day of the procedure.

Understanding what to expect before PESA

Clear information can help men approach PESA with a better understanding of the procedure and its role in fertility treatment.

Before treatment, men may discuss

• How sperm retrieval is performed
• What happens if usable sperm is retrieved
• What the next step may be if sperm is not found
• Whether the sperm will be used fresh or frozen
• How PESA connects with IVF and ICSI
• Whether another retrieval method may be considered if needed

Partners may also attend consultations together so that both understand the treatment pathway and the next steps.

PESA is one part of a broader fertility plan. Knowing how it fits into the overall treatment can help couples prepare more effectively.

How Oval Fertility supports male fertility care

At Oval Fertility, male fertility is treated as an important part of the fertility journey. Our clinic's male fertility services include advanced diagnostics, surgical sperm retrieval and precise sperm selection for complex male-factor fertility cases.

For men with obstructive azoospermia, PESA may be considered to retrieve sperm from the epididymis when sperm is absent in semen. Depending on the couple's treatment plan, retrieved sperm may be used as part of IVF with ICSI.

Our clinic also offers other male fertility treatment services such as TESA, Micro TESE, PICSI, Microfluidics, MACS, SpermSlow and Male OncoFertility. This allows the fertility team to assess each case carefully and recommend a suitable path instead of using a one-size-fits-all approach.