Infertility in Men

Causes & Procedures

Statistics show that up to 50% of infertility problems among couples can be traced to male medical conditions. Difficulties range from issues with sperm production to obstruction of sperm delivery. Reproductive Partners Fertility Center – San Diego (RPSD) was the first In Vitro Fertilization (IVF) center in the region to directly address and treat male infertility on site. Our patients have found this to be a great convenience as they undergo fertility treatment.

Highly Individualized Treatment

Recognizing that each patient’s medical challenge is unique, our urologist and male infertility specialist, Dr. T. Mike Hsieh will identify the cause of infertility and provide a personalized treatment plan that works best for the couple. In the case of obstruction in sperm delivery, Dr. Hsieh will select from among several sperm retrieval procedures to find the appropriate technique for you.


The following procedures are performed either in our facility or in an operating room at the UC San Diego Health System:

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a non-invasive technique used to retrieve sperm in the event of a blockage. It is a quick, in-office procedure performed under local anesthesia. Tiny needles are used to collect fluid from the epididymis, where sperm is stored after production in the testes.

Testicular Sperm Aspiration (TESA)

TESA is another in-office procedure focused on sperm retrieval–this time directly from the testes. It is done under local anesthesia with a small needle that extracts sperm from the testicle.

Trans-rectal Ultrasound of the Prostate with Seminal Vesicle Aspiration

This is the most widely used technique for diagnosing an obstruction within the male reproductive system. In this diagnostic test, your physician uses ultrasound to determine if there is a sperm blockage and to pinpoint the location. This very specific and simple ultrasound requires no sedation.

Microscopic Testicular Dissection

Patients who have problems with sperm production may undergo this technique. It is performed under general anesthesia in an operating room setting. Under a high-powered microscope, testis tissue is examined for sperm retrieval. The procedure can take up to three or four hours, but the patient goes home the same day.

Microscopic Epididymal Sperm Aspiration

A slightly more invasive technique than PESA, this procedure uses microsurgical techniques to collect sperm from the epididymis. It is done in an operating room under general anesthesia. Your physician retrieves a large quantity of sperm, some of which can be frozen, in order to avoid the necessity of additional procedures. Patients go home the same day.

Microscopic Vasectomy Reversal/Vasal Reconstruction

This allows men who have undergone a vasectomy to become fathers again. An intricate, microscopic reconstruction is performed in an operating room under general anesthesia to reverse the previous vasectomy. Patients return home the same day.

Microscopic Varicocel Repair

This is the most common surgical procedure used to treat male infertility. Varicoceles are varicose testicular veins in the scrotum that can affect fertility. During a one-hour operation under general anesthesia—and with the help of an operative microscope—veins are ligated to decrease venous blood flow in the reproductive tract and improve testicular function by reducing scrotal temperature.

Let’s Take the Next Step Together

Our skilled fertility specialists are here to help. Contact us today and let’s discuss the next phase of your fertility journey.