PESA / TESA / TESE in Delhi
Sperm is recovered directly from the epididymis or testis when none appears in the ejaculate.
What PESA / TESA / TESE involves
Azoospermia means no sperm in the semen sample. In obstructive cases the testis produces sperm normally but the passage is blocked, and sperm can be aspirated from the epididymis (PESA) or testis (TESA). In non-obstructive cases, production itself is impaired, and a micro-dissection biopsy (micro-TESE) searches for pockets of sperm production.
Retrieved sperm is always used with ICSI. Where retrieval is planned in advance, we freeze a sample so the egg retrieval is never wasted if nothing is found on the day.
Who this is for
- Obstructive azoospermia after infection, vasectomy or absent vas deferens
- Non-obstructive azoospermia with adequate testicular volume
- Failed ejaculation or retrograde ejaculation
- Very poor sample quality on the day of egg retrieval
Not everything on this list means you need this treatment. The workup comes first, and the recommendation follows from what it shows — not from what was booked before you arrived.
Step by step
Andrology assessment
Hormone profile, karyotype, Y-chromosome microdeletion screening and scrotal ultrasound.
Procedure selection
PESA or TESA for obstruction, micro-TESE where production is the problem.
Retrieval
A short day procedure under local or short general anaesthesia.
Freezing or immediate ICSI
Recovered sperm is frozen, or used the same day for injection.
Your results, in writing
Whatever the outcome of PESA / TESA / TESE, you leave each stage with the findings written down — what was done, what was found, what it means, and what the options are from here. Reports are issued the same day wherever the laboratory allows it.
Case study: Azoospermia after a childhood hernia repair
34, Munirka · azoospermia · normal hormones
What she came in with
No sperm in two semen samples, but normal testicular volume, normal FSH and normal testosterone — a pattern that points strongly to obstruction rather than a production failure.
What the workup showed
Scrotal ultrasound showed dilated epididymides bilaterally. A childhood bilateral inguinal hernia repair had almost certainly damaged the vas deferens. Production was intact; the passage was not.
What we did
PESA under local anaesthesia, coordinated with his wife's egg retrieval the same morning, with a backup sample frozen two weeks beforehand in case nothing was found on the day.
Outcome
Abundant motile sperm were aspirated. Twelve of fourteen mature eggs fertilised with ICSI, producing five blastocysts and an ongoing pregnancy from the first transfer.
The point of this case
Obstructive azoospermia has a sperm retrieval rate close to 100%. The hormone profile and ultrasound told us that before the procedure, which is why it was booked as a same-day case rather than a major operation.
Illustrative case. This is a composite of presentations commonly seen in this practice, written for explanation — it is not the record of an identifiable patient, and no individual's details are used. Outcomes vary, and nothing here is a prediction of what will happen in your case.
What is different about having this done here
Genetic screening before retrieval, so you know the odds beforehand
Sperm frozen in advance wherever possible
Coordinated with the female partner's cycle to avoid wasted retrievals
Realistic counselling about donor sperm if retrieval fails
Treated by the consultant, not by a rotating team
Dr. Tiwari performs the scans, the procedure and the follow-up herself, and looks after any pregnancy that results. Over a long treatment course that continuity is the difference between being known and being processed.
- MBBS, MS (Obstetrics & Gynaecology), FNB (Reproductive Medicine)
- Over ten years in reproductive medicine and gynaecological surgery
- Consultations and scans at Mother's Hope, Katwaria Sarai; theatre work at SHE Delhi Hospital, Greater Kailash II
- Itemised costs given in writing before anything begins
Areas we see patients from
Both locations are in South Delhi. Patients travelling from further out have appointments grouped to cut down the number of trips.
Questions about PESA / TESA / TESE
What are the chances of finding sperm?
Close to 100% in obstructive azoospermia. In non-obstructive cases, micro-TESE recovers sperm in roughly 40–50%, and hormone levels and genetic results help predict this beforehand.
Is the procedure painful?
PESA and TESA are brief and done under local or short anaesthesia with mild soreness for a day or two. Micro-TESE is more involved with about a week's recovery.
Talk it through before you commit
Consultations run for a full hour. Bring any previous reports — they are reviewed properly, not repeated.