It takes about 60-70 days for a sperm to mature. Sperm are produced in the testicle, stored and matured in the epididymis, transported to the ejaculatory ducts and after mixing with fluid from the seminal vesicles and the prostate, they are finally ejaculated. When this doesn’t occur naturally, PESA or TESA may be indicated to extract sperms directly from the testis. It takes about 60-70 days for a sperm to mature. Sperm are produced in the testicle, stored and matured in the epididymis, transported to the ejaculatory ducts and after mixing with fluid from the seminal vesicles and the prostate, they are finally ejaculated. When this doesn’t occur naturally, PESA or TESA may be indicated. Percutaneous Epidydimal Sperm Aspiration (PESA) or Testicular Sperm Aspiration (TESA) are simplified minimally invasive in-office procedures that allow the physician to recover sperm cells for fertilization in patients with azoospermia (lack of sperm). Prior to the development of in office sperm aspiration, men suffering from azoospermia had to undergo surgery to collect sperm from the epididymis or testis. The operation required hospitalization, and costs were high. PESA and TESA are rapid and performed as an outpatient procedure, virtually painless, conducted under mild sedation, with immediate recovery. The cost in our facility is approximately 10% of the cost of surgery, including the sperm processing and cryopreservation. It must be noted that for some patients a single procedure may produce enough sperm for several ICSI attempts. PESA and TESA are simpler and less expensive procedures than the older micro surgical approach. They are performed in the convenient environment of our office setting and takes between 20-40 minutes. Local anesthesia is infiltrated into the spermatic canal and around the scrotum. Once the analgesic has produced its effects, a PESA requires a needle to be introduced into the epidydimal area of a testicle and gentle aspiration is applied. The aspirate is observed under the microscope to determine if motile sperm cells are present. In some instances there is no need to aspirate the other side. In TESA, the needle is introduced into the testicle itself. The sperm may be frozen for future ICSI cycles or used fresh. Our protocol for PESA and TESA includes a diagnostic sperm aspiration that is done prior to starting ovarian stimulation to ensure sperm will be available. The sperm obtained from this procedure are frozen to be used as the primary source for fertilization. Sometimes, however, frozen-thawed sperm do not survive well and a second procedure may be done on the day of egg retrieval. But this need arise very rarely.