Objective: Describe percutaneous epididymal sperm aspiration (PESA), its use in a major fertility center in patients with obstructive and nonobstructive anejaculation/ azoospermia (NOA), and its application in a man with SCI.

Methods: We reviewed the literature for PESA and describe this relatively new technique for retrieving sperm for in vitro fertilization (IVF). We reviewed the experience of a major fertility center over the past 4 years for all men with NOA using PESA and describe a man with SCI and NOA who underwent PESA.

Results: PESA was first described in 1994 and has many advantages over other methods for sperm retrieval. No reports were found describing PESA in SCI men. At the fertility center, all 303 men with NOA who had PESA had sperm suitable for use in IVF. There were no complications and repeated procedures were performed without difficulty when pregnancy was not achieved. Pregnancy rates were comparable to other methods of obtaining sperm. A 30-year-old man with C-5 tetraplegia ASIA A underwent recent PESA with retrieval of good quality sperm. IVF is pending.

Conclusions: PESA is a practical, safe, repeatable technique with a high success rate for sperm retrieval in men with NOA . We describe using PESA in a man with SCI and believe it represents a reasonable option for many other SCI men who typically have nonobstructive anejaculation.