TESE & PESA in Ahmedabad

That is no longer true. TESE (Testicular Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration) are surgical sperm retrieval techniques that bypass the ejaculate entirely — going directly to the source of sperm production in the testicles or epididymis. For men with obstructive azoospermia, sperm is retrieved in over 90% of cases. For many men with non-obstructive azoospermia, where the testes produce sperm in very small numbers, micro-TESE finds viable sperm in 40–60% of cases.

At Wellspring IVF & Women’s Hospital, Ahmedabad, surgical sperm retrieval is coordinated as a combined protocol with ICSI (Intracytoplasmic Sperm Injection) — the only fertilisation technique that can use the tiny quantities of surgically retrieved sperm. Under the direction of Dr. Pranay Shah, our team coordinates the complete male-surgical and IVF-laboratory pipeline — from sperm retrieval to embryo transfer — ensuring no step is lost.

If you or your partner has been told there is no sperm — this page is written for you. The diagnosis is not the end. In many cases, it is the beginning of a very specific treatment journey that ends with biological parenthood.

Conventional TESE – Testicular Biopsy

Step 1: Spinal or short general anaesthesia is administered. The patient is positioned comfortably on the procedure table.

Step 2: A small incision (approximately 1–2 cm) is made in the scrotal skin and the testicular covering (tunica albuginea). No major structures are cut.

Step 3: A small biopsy of testicular tissue (typically 2–3 mm) is excised from one or more areas of the testis. The tissue sample is immediately handed to our embryologist for processing.

Step 4: The embryologist minces the testicular tissue and examines it under high magnification to identify any sperm cells. In OA cases, sperm is found reliably. In NOA cases, the yield from conventional TESE is less predictable.

Step 5: The testicular incision is closed with absorbable sutures. Scrotal skin is closed with 1–2 absorbable sutures. A scrotal support is applied.

Micro-TESE — Microsurgical Retrieval for NOA

Micro-TESE is the gold-standard technique for Non-Obstructive Azoospermia. It uses an operating microscope at 16–25× magnification to visually identify the rare seminiferous tubules that contain active spermatogenesis within an otherwise non-producing testis.

In NOA, sperm production is not always absent — it may be severely reduced and geographically isolated to a few small foci. Conventional TESE takes random biopsies and hopes to hit a productive area. Micro-TESE instead targets the most promising tubules while preserving more tissue and blood supply.

Step 1: General or spinal anaesthesia. A larger testicular incision (approximately 3–4 cm) allows direct visualisation of the tubules.<

Step 2: Under 16–25× magnification, the surgeon systematically examines the tubules across both poles of the testis.

Step 3: Larger, opaque tubules indicating active spermatogenesis are selectively excised and processed in real time.

Step 4: The surgeon may excise additional tissue based on the embryologist’s feedback, then reconstructs and closes the testis carefully.

Step 5: Recovery is typically 3–5 days, with swelling and mild discomfort expected. Most men return to light work within a week.

Before the Procedure (1–7 Days Prior)

• Complete all blood tests: CBC, coagulation profile, blood group, HIV / HBsAg / HCV serology, and hormonal panel.
• Stop blood-thinning medications such as aspirin, NSAIDs, and warfarin 5–7 days before, after discussing with Dr. Shah.
• Purchase supportive scrotal underwear for post-procedure use.
• Fast from midnight if general or spinal anaesthesia is planned.
• Arrange transport — do not drive yourself home after the procedure if sedation is used.
• A short prophylactic antibiotic course is often prescribed 1–2 days before the procedure.

After the Procedure (Recovery)

• Apply an ice pack wrapped in cloth in 15-minute intervals for the first 24 hours.
• Wear supportive underwear continuously for 5–7 days.
• Mild discomfort is usually managed with oral paracetamol. Ibuprofen should be avoided because it can increase bleeding risk.
• Avoid heavy lifting, vigorous exercise, and sexual activity for 1 week after PESA or 2 weeks after TESE.
• Keep the area dry for 24–48 hours. Avoid swimming for 10–14 days.
• Call Wellspring immediately if you develop fever above 38°C, increasing pain after day 2, or significant swelling or bruising.