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Procedure

TESA — Testicular Sperm Aspiration

Testicular sperm aspiration (TESA) is a minimally invasive sperm retrieval procedure in which a needle is inserted through the scrotal skin directly into the testicle to aspirate seminiferous tissue and sperm for use with intracytoplasmic sperm injection (ICSI). It is most commonly used in men with obstructive azoospermia when sperm production is preserved but sperm cannot reach the ejaculate, and it may also be used as a backup when epididymal sperm retrieval is unsuccessful.

AnaesthesiaLocal + sedation
Operating time15–45 min
Hospital stay0 nights
Days in Türkiye2–4 days
Back to work1–3 days
DE
Medically reviewed by Dr. Elif Yılmaz, MD, FECSM
✓ Clinician reviewed
TESA — Testicular Sperm Aspiration✓ Clinician-reviewed information
Key takeaways
  • TESA retrieves sperm directly from the testicle through a needle inserted through the scrotal skin.
  • It is primarily used for obstructive azoospermia when sperm production is preserved but sperm cannot reach the ejaculate.
  • In appropriately selected obstructive azoospermia, published series report sperm retrieval rates close to 99%.
  • TESA is less invasive than open testicular sperm extraction because it generally does not require a surgical testicular incision.
  • Retrieved sperm are typically used with ICSI, and successful sperm retrieval does not guarantee fertilization, pregnancy or live birth.

About tesa — testicular sperm aspiration

TESA stands for Testicular Sperm Aspiration.

It is a percutaneous sperm retrieval procedure in which sperm are obtained directly from the testicle.

A fine needle is inserted through the scrotal skin into the testicular tissue, and gentle suction is used to aspirate small amounts of seminiferous tissue.

The laboratory then examines this tissue for viable sperm.

When sperm are identified, they can be used fresh for ICSI or cryopreserved for future fertility treatment.

Why retrieve sperm directly from the testicle?

Sperm are produced inside microscopic structures called seminiferous tubules within the testes.

In obstructive azoospermia, sperm production may remain normal, but sperm cannot travel through the epididymis, vas deferens or ejaculatory pathway into the semen.

TESA bypasses the obstruction completely by obtaining sperm directly from the source.

This makes it useful in men whose testes produce sperm normally but whose reproductive tract is blocked.

How is TESA performed?

The scrotal skin is cleaned and anesthetized.

The surgeon stabilizes the testicle and inserts a fine aspiration needle through the skin into the testicular tissue.

Gentle negative pressure is applied while the needle is moved through a small area of the testis.

Small fragments of seminiferous tissue are aspirated into the syringe.

These samples are immediately passed to the embryology laboratory.

The embryologist examines the tissue to determine whether viable sperm are present and whether enough sperm have been obtained for ICSI.

Several needle passes may be performed if necessary.

When sufficient sperm are retrieved, the procedure is completed.

Who usually needs TESA?

TESA is mainly used in men with obstructive azoospermia.

Common situations include:

After vasectomy

A vasectomy blocks the vas deferens and prevents sperm from reaching the ejaculate.

If a man later wants biological children, sperm can sometimes be retrieved directly from the testicle and used with ICSI.

Congenital absence of the vas deferens

Men with congenital bilateral absence of the vas deferens may have normal testicular sperm production but no pathway for sperm to reach the semen.

TESA can provide sperm for assisted reproduction.

Epididymal or vasal obstruction

Previous infection, surgery, injury or congenital abnormalities can block sperm transport.

TESA bypasses these structures.

Failed epididymal retrieval

TESA is commonly used as a backup when PESA does not retrieve enough usable sperm.

This is sometimes called rescue TESA.

TESA vs PESA

These procedures differ primarily in where sperm are obtained.

PESA retrieves sperm from the epididymis.

TESA retrieves sperm directly from the testicle.

In men with obstructive azoospermia, PESA may be attempted first because mature sperm are often readily available in the epididymis.

If PESA fails or provides inadequate sperm, TESA can be performed during the same treatment session.

TESA vs MESA

MESA retrieves sperm microsurgically from the epididymis through a small incision and operating microscope.

TESA is less invasive and does not require microsurgical exposure of the epididymis.

MESA may produce larger quantities of sperm for extensive cryopreservation, while TESA offers a simpler percutaneous testicular approach.

Neither method is universally superior.

The best procedure depends on:

  • Location of obstruction

  • Previous surgery

  • Need for sperm cryopreservation

  • Availability of microsurgical expertise

  • Couple's IVF plan

TESA vs TESE

Both procedures retrieve sperm directly from the testicle.

TESA

Uses a needle aspiration technique.

Advantages include:

  • No open testicular incision in most cases

  • Shorter procedure

  • Faster recovery

  • Less invasive approach

TESE

Uses a small surgical incision to obtain testicular tissue.

TESE allows direct removal of larger pieces of tissue and may be useful when aspiration does not retrieve adequate sperm.

In obstructive azoospermia, TESA often provides sufficient sperm without requiring open extraction.

TESA vs Micro-TESE

These procedures should remain clearly separated on your platform.

TESA is particularly useful when sperm production is expected to be normal, especially in obstructive azoospermia.

Micro-TESE is a microsurgical procedure designed primarily for non-obstructive azoospermia, where sperm production is severely impaired and may exist only in small focal areas of the testis.

The surgeon uses an operating microscope during Micro-TESE to search for enlarged seminiferous tubules that may contain sperm.

For a patient with classic NOA, Micro-TESE is generally a more important specialist procedure than blind aspiration.

How successful is TESA?

Success depends strongly on why the patient is azoospermic.

In obstructive azoospermia, where sperm production is preserved, retrieval rates are extremely high.

A large study of 327 TESA/ICSI cycles reported sperm retrieval in approximately 99.4% of men with obstructive azoospermia.

This should not be generalized to non-obstructive azoospermia.

When sperm production is severely impaired, aspiration can fail even if isolated areas of spermatogenesis remain elsewhere in the testis.

Why is ICSI used after TESA?

Testicular sperm are generally used with intracytoplasmic sperm injection (ICSI).

During ICSI, an embryologist injects a single sperm directly into an egg.

This is important because testicular sperm have not completed the same maturation pathway as ejaculated sperm and may have limited natural motility.

ICSI bypasses the need for sperm to travel through the female reproductive tract and independently penetrate the egg.

Can TESA sperm be frozen?

Yes.

When adequate viable sperm are retrieved, the laboratory may cryopreserve them for later ICSI treatment.

Cryopreservation can reduce the need for another surgical sperm retrieval procedure.

However, the amount of sperm obtained through TESA varies.

Some patients produce enough sperm for several cycles, while others may have only enough material for a single treatment.

Fresh or frozen TESA sperm?

Both fresh and cryopreserved testicular sperm can be used successfully with ICSI.

The choice depends on:

  • Quantity retrieved

  • Laboratory quality

  • Timing of the partner's egg retrieval

  • Previous treatment

  • Whether backup sperm storage is desired

For international patients, retrieving and successfully freezing sperm before the female partner's IVF cycle can sometimes simplify travel logistics.

Does TESA restore natural fertility?

No.

TESA retrieves sperm for assisted reproduction but does not remove the underlying blockage.

A patient with obstructive azoospermia generally remains azoospermic after TESA.

Men who want sperm to return naturally to the ejaculate may instead be candidates for reconstructive procedures such as:

  • Vasovasostomy

  • Vasoepididymostomy

depending on the location and cause of obstruction.

Why accurate diagnosis matters before TESA

Before choosing TESA, the medical team should determine whether azoospermia is likely to be:

  • Obstructive

  • Non-obstructive

This distinction changes the expected sperm retrieval rate dramatically.

Evaluation may include:

  • Repeat semen analysis

  • Medical history

  • Physical examination

  • Testicular volume

  • FSH

  • LH

  • Testosterone

  • Genetic testing when indicated

  • Ultrasound in selected patients

A man should not be sent for routine TESA simply because his semen analysis shows no sperm.

Outcomes
A study of 327 TESA/ICSI cycles reported sperm retrieval in approximately 99.4% of men with obstructive azoospermia.
Source: pubmed.ncbi.nlm.nih.gov

Who it is for

✓ May be suitable if
  • •You have confirmed obstructive azoospermia with preserved sperm production.
  • •You have infertility after vasectomy and have chosen sperm retrieval with IVF/ICSI.
  • •You have congenital absence of the vas deferens and require sperm retrieval for assisted reproduction.
  • •You have vasal or epididymal obstruction that prevents sperm from reaching the ejaculate.
  • •PESA has failed or has not produced sufficient sperm for ICSI.
  • •Your fertility team expects viable sperm to be readily present in the testicular tissue.
  • •You prefer a minimally invasive testicular retrieval procedure when clinically appropriate.
  • •Your partner is undergoing IVF/ICSI and testicular sperm retrieval is part of the reproductive plan.
  • •You understand that TESA retrieves sperm but does not repair the obstruction.
  • •You understand that ICSI is generally required to use testicular sperm.
✕ Not suitable if
  • •You have confirmed severe non-obstructive azoospermia for which Micro-TESE is considered the more appropriate retrieval strategy.
  • •Your azoospermia has not yet been evaluated to determine whether it is obstructive or non-obstructive.
  • •You have an untreated scrotal infection.
  • •You have an untreated urinary or systemic infection.
  • •You have an uncontrolled bleeding disorder or anticoagulation that cannot be safely managed.
  • •You are medically unsuitable for the planned anesthesia or procedure.
  • •You are primarily seeking restoration of natural sperm passage and reconstructive surgery is more appropriate.
  • •Your reproductive treatment plan does not include ICSI or another appropriate use for retrieved sperm.
  • •You expect the procedure to restore sperm to the semen.
  • •You expect sperm retrieval to guarantee fertilization, pregnancy or live birth.

Preparing for surgery

Confirm azoospermia with appropriate semen analysis before surgical sperm retrieval.
Complete assessment to distinguish obstructive from non-obstructive azoospermia.
Provide all previous semen-analysis reports.
Complete hormone tests such as FSH, LH and total testosterone when requested.
Provide results of previous fertility evaluations.
Tell the surgeon about previous vasectomy, vasectomy reversal, infection, scrotal surgery or genital trauma.
Provide reports from previous PESA, MESA, TESA, TESE or Micro-TESE procedures.
Complete genetic testing when clinically indicated.
Men with congenital absence of the vas deferens should undergo appropriate CFTR-related genetic evaluation and reproductive counselling.
Coordinate TESA with the IVF/ICSI laboratory before the procedure.
Decide whether retrieved sperm will be used fresh, cryopreserved or both.
Confirm availability of sperm freezing before surgery when cryopreservation is planned.
Provide a complete medication list.
Inform the team about anticoagulant and antiplatelet medication.
Do not independently stop prescribed blood thinners; follow medical instructions.
Complete requested blood and urine tests.
Treat active urinary, genital or systemic infection before the procedure.
Follow fasting instructions when sedation is planned.
Arrange transportation after sedation because you should not drive yourself.
Wear supportive underwear after the procedure if advised by the surgical team.

What recovery looks like

Day 0 — Procedure
TESA is performed by passing a fine needle through the scrotal skin into the testicular tissue and aspirating small amounts of seminiferous tissue. The samples are immediately examined by the embryology laboratory, and additional needle passes may be performed until sufficient sperm are identified or the surgeon determines that another retrieval method is necessary. Most patients leave the clinic or hospital the same day after recovering from sedation.
Days 1–2 — Early recovery
Mild testicular aching, tenderness, bruising or localized swelling is common during the first one or two days. Supportive underwear and simple prescribed pain relief can improve comfort. Walking and light activity are usually possible, but heavy lifting, running, cycling and strenuous exercise should be avoided.
Days 3–5 — Return to routine activity
Most patients experience substantial improvement within several days and can return to desk-based work and ordinary daily activity. Small areas of bruising or sensitivity can remain temporarily. Increasing pain, rapidly enlarging swelling, fever, significant redness or severe bruising should prompt medical review.
Week 1 — Near-complete physical recovery
By approximately one week, most men undergoing uncomplicated TESA have little residual discomfort and can gradually return to normal physical activity according to the surgeon's instructions. Patients who required multiple aspirations or an additional TESE procedure may need a longer recovery.
Following weeks — Fertility treatment
Physical recovery from TESA is usually complete well before the fertility-treatment process ends. Retrieved sperm may be used immediately with ICSI or remain frozen for a later cycle. The reproductive team continues follow-up based on embryo development, transfer planning and the couple's overall fertility strategy.

Risks and complications

Failure to retrieve sperm
TESA has a very high retrieval rate in obstructive azoospermia but cannot guarantee sperm retrieval in every patient. If TESA fails, TESE or another retrieval method may be necessary.
Testicular pain
Temporary aching or tenderness can occur after aspiration.
Scrotal bruising
Minor bruising around the needle-entry site is relatively common and usually resolves without treatment.
Hematoma
Bleeding within or around the testicle can create a hematoma. Most are small, but a large or expanding hematoma requires evaluation.
Infection
Testicular, scrotal or wound infection is uncommon but possible.
Testicular swelling
Localized swelling may occur during early recovery.
Testicular tissue injury
TESA removes or disrupts a small amount of testicular tissue. Clinically significant testicular injury is uncommon when the procedure is correctly performed.
Reduced testosterone
A single uncomplicated TESA is unlikely to cause clinically meaningful long-term testosterone deficiency in most men, but repeated or extensive testicular procedures may carry greater tissue impact.
Need for additional sperm retrieval
If inadequate sperm are retrieved or cryopreserved sperm are exhausted, another TESA or different retrieval procedure may be necessary.
Sedation or anesthesia complications
Sedation may cause nausea, dizziness, allergic reaction, breathing problems or other uncommon complications.
Fertility treatment failure
Successful sperm retrieval does not guarantee successful fertilization, embryo development, pregnancy or live birth.

Common questions

What is TESA?
TESA stands for Testicular Sperm Aspiration. It retrieves sperm directly from testicular tissue through a needle passed through the scrotal skin.
Who needs TESA?
TESA is mainly used in men with obstructive azoospermia who continue to produce sperm but cannot release sperm into the ejaculate because of a blockage.
Can TESA be used after vasectomy?
Yes. TESA can retrieve sperm for IVF/ICSI after vasectomy when the couple chooses assisted reproduction rather than vasectomy reversal.
Can TESA be used for CBAVD?
Yes. Men with congenital bilateral absence of the vas deferens often have preserved testicular sperm production and can be candidates for testicular sperm retrieval.
How successful is TESA?
A large clinical series reported sperm retrieval in approximately 99.4% of men with obstructive azoospermia.
Is the success rate the same for non-obstructive azoospermia?
No. Sperm retrieval is much less predictable when sperm production itself is impaired.
Can TESA be used for non-obstructive azoospermia?
It can retrieve sperm in some selected NOA cases, but Micro-TESE is generally the more important specialist surgical approach when sperm production is severely impaired.
What is the difference between TESA and PESA?
PESA retrieves sperm from the epididymis. TESA retrieves sperm directly from the testicle.
What happens if PESA fails?
TESA can often be performed immediately as a rescue procedure.
What is the difference between TESA and TESE?
TESA uses needle aspiration. TESE uses a small surgical incision to remove testicular tissue.
Is TESA less invasive than TESE?
Yes. TESA generally avoids an open testicular incision and usually has a shorter recovery.
What is the difference between TESA and Micro-TESE?
TESA aspirates testicular tissue without microscopic selection. Micro-TESE uses an operating microscope to identify areas of potentially active sperm production and is mainly used for non-obstructive azoospermia.
Does TESA hurt?
Local anesthesia and sedation are commonly used. Mild testicular soreness can occur afterward.
Does TESA require an incision?
Usually no surgical incision is required beyond the needle puncture through the scrotal skin.
How long does TESA take?
Approximately 15–45 minutes is a practical range for uncomplicated aspiration.
Do I need to stay in hospital?
Usually not. TESA is commonly performed as a day procedure.
Can TESA sperm be frozen?
Yes. Viable retrieved sperm can be cryopreserved when sufficient material is available.
Can frozen TESA sperm be used for ICSI?
Yes. Cryopreserved testicular sperm can be used successfully for ICSI.
Is ICSI required after TESA?
TESA sperm are generally used with ICSI because the embryologist can directly inject a selected testicular sperm into an egg.
Can TESA sperm be used for IUI?
Generally no. Surgically retrieved testicular sperm are typically used with IVF/ICSI rather than intrauterine insemination.
Does TESA cure azoospermia?
No. It retrieves sperm but does not repair the obstruction.
Will sperm return to my semen after TESA?
No. The underlying blockage remains unless reconstructive surgery is performed.
Can TESA be repeated?
Yes, although cryopreservation of adequate sperm during the initial procedure may reduce the need for repeat aspiration.
Does TESA affect testosterone?
A limited aspiration procedure usually has little effect on overall testicular testosterone production, but repeated or extensive testicular procedures should always be considered carefully.
Can TESA damage the testicle?
Serious testicular damage is uncommon, but bleeding, hematoma, inflammation and tissue injury are recognized risks.
TESA or vasectomy reversal — which is better?
Neither is universally better. The decision depends on female partner age, ovarian reserve, time since vasectomy, desired number of children, IVF requirements and couple preference.
How long should I stay in Turkey?
Approximately 2–4 days is often sufficient for uncomplicated TESA alone.
When can I return to work?
Many patients can return to desk-based work within 1–3 days.
When can I exercise?
Strenuous activity is usually avoided for several days to approximately one week depending on discomfort and the surgeon's instructions.
When can I have sex?
Sexual activity can usually resume once testicular discomfort and swelling have settled and the surgeon considers it safe, often within several days to approximately one week.
Which doctor performs TESA?
TESA is generally performed by an andrologist, reproductive urologist or urologist experienced in male infertility and surgical sperm retrieval, working in coordination with an IVF laboratory.

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Sources

  1. Large clinical series reporting approximately 99.4% sperm retrieval efficiency in men with obstructive azoospermia undergoing TESA. https://pubmed.ncbi.nlm.nih.gov/17184103/
  2. Study reporting sperm recovery with PESA or TESA in all men with obstructive azoospermia and examining testicular retrieval in non-obstructive cases. https://pubmed.ncbi.nlm.nih.gov/10374107/
  3. Recent series evaluating PESA with rescue TESA, reporting successful retrieval in all 157 retrieval attempts in the study cohort. https://pubmed.ncbi.nlm.nih.gov/39723884/
  4. Study using PESA as the first retrieval method and TESA or TESE as rescue procedures when epididymal sperm were insufficient. https://pubmed.ncbi.nlm.nih.gov/11853299/
  5. Study comparing reproductive outcomes with TESA sperm from obstructive azoospermia, Micro-TESE sperm from non-obstructive azoospermia and ejaculated sperm. https://pubmed.ncbi.nlm.nih.gov/38000348/
  6. Study demonstrating that TESA has substantially lower and less predictable retrieval success in non-obstructive azoospermia and that subsequent TESE can identify additional sperm. https://pubmed.ncbi.nlm.nih.gov/18850334/
  7. EAU Guidelines on Sexual and Reproductive Health — Male Infertility https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility