No sperm in the sample is not always the end.

TESA is testicular sperm aspiration and PESA is percutaneous epididymal sperm aspiration: both use a fine needle through the skin to collect sperm for IVF.

PESA draws fluid from the epididymis, the coiled tube behind the testis where sperm collects. TESA draws a small amount of tissue and fluid from the testis itself. Neither treats the cause. They collect sperm for the lab, where one sperm is injected into each egg by ICSI.

The difference is where the sperm is taken from and whether a needle or a small cut is used.

The name on your plan matters, because recovery and the right use are not the same. If a report or estimate is vague about which one you are having, ask.

• PESA: needle into the epididymis. Least invasive. Used when a blockage is the problem.
• TESA: needle into the testis. Used when PESA finds nothing, or the epididymis is absent or scarred.
• TESE (testicular sperm extraction, also called testicular biopsy): a small cut and a small piece of tissue. Samples more tissue, and can answer a diagnostic question at the same time.
• Micro-TESE: TESE under an operating microscope, looking for the tubules most likely to hold sperm. Used when production is the problem. [CONFIRM: done at Jananam or arranged with a named surgeon]

It depends on whether you have obstructive or non-obstructive azoospermia, which is why the diagnosis comes before the procedure.

In obstructive azoospermia, sperm is made normally but blocked on the way out, so PESA is usually tried first with TESA ready in the same sitting. In non-obstructive azoospermia, production is patchy, so a needle may miss the active areas and micro-TESE is generally the better-evidenced operation. A retrieval booked before this is known is planned backwards.

We do not publish a TESA success rate, because a single number tells you little about your own chance. What decides it is your diagnosis, and then her age and eggs.

First, whether sperm is found: where a blockage is the cause and production is normal, sperm can usually be collected; where production is the problem, some men have sperm and some do not, and no test predicts it reliably. Second, whether sperm leads to a pregnancy: that depends on the IVF cycle with ICSI, mainly her age and egg reserve. Dr Vani goes through your hormone results, examination and genetic tests and tells you what they suggest.

It is used with ICSI, and anything left over is frozen.

Retrieved sperm usually cannot swim well or is too few, so one sperm is injected into each egg. Freezing spare sperm can spare him a second procedure if another IVF cycle is needed. Retrieval can be done on the day of her egg collection, or before her cycle with the sperm frozen; which suits you is decided with you before either of you starts medication.

Then you will know, and you will have talked through the options before the day, not while recovering.

It is not a failure of effort. It reflects what was in the tissue. Some men go on to micro-TESE if a needle method found nothing. Others consider donor sperm, adoption, or decide they have gone far enough. All are legitimate, and none has to be chosen in the same conversation.