PESA, MESA, TESA, and TESE are all methods of extracting sperm from a male with infertility. PESA involves surgery using a needle and a syringe to extract sperm from the epididymis. MESA is an open-surgery method that uses a microscope to extract sperm from the epididymis. TESA involves the process of opening of the scrotum to extract a large volume of testicular tissues. TESE is performed when the other procedures don’t work.