This method is indicated in cases where there is obstruction of the tubules responsible for conducting the sperm from the testicles during ejaculation, called vas deferens (VD). Patients in such cases might have inheritable conditions, responsible for the absence of VD, or previous history of infections or operations that have led to blockage of the tubes. Other indications could include urgent sperm retrieval when the male partner on the day of the egg collection cannot produce sperm, or if there is a background of erectile dysfunction.

​There are mainly 3 methods used for surgical sperm retrieval, which are performed under sedation and local anaesthetic.

Percutaneous Epididymal Sperm Aspiration (PESA)

A thin needle is passed into the epididymis, the area where sperm is found before it enters the VD. A vacuum is created in a syringe and sperm is drawn from the epididymis.

Testicular Sperm Aspiration (TESA)

This is similar to PESA as a technique with the needle is introduced in the testicle.

Testicular Sperm Extraction (TESE)

A biopsy is taken from the testicle and spermatozoa are harvested.

In situations where there is complete absence of spermatozoa (azoospermia), the Andrologists (Urology specialists) can perform a micro-TESE operation, where the testicles are dissected under a microscope and testicular tissue is biopsied for spermatozoa. These are subsequently frozen so that can be used for Intra-Cytoplasmic Sperm Injection (ICSI) treatment.