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Procedure

TESE — Testicular Sperm Extraction

Testicular sperm extraction (TESE) is a surgical sperm retrieval procedure in which a small incision is made in the testicle and testicular tissue containing seminiferous tubules is removed and examined for viable sperm. Retrieved sperm can be used fresh or cryopreserved for intracytoplasmic sperm injection (ICSI), and TESE may be used for obstructive azoospermia and selected cases of non-obstructive azoospermia, although Micro-TESE is generally preferred when sperm production is severely impaired.

AnaesthesiaLocal + sedation
Operating time30–90 min
Hospital stay0–1 nights
Days in Türkiye3–5 days
Back to work3–7 days
DE
Medically reviewed by Dr. Elif Yılmaz, MD, FECSM
Last reviewed 23 August 2026
✓ Clinician reviewed
TESE — Testicular Sperm Extraction✓ Clinician-reviewed information
Key takeaways
  • TESE retrieves sperm by surgically removing small samples of testicular tissue rather than aspirating tissue through a needle.
  • It can be used when sperm cannot be found in the ejaculate and surgical sperm retrieval is required for ICSI.
  • Sperm retrieval is highly successful in obstructive azoospermia because testicular sperm production is usually preserved.
  • Conventional TESE can also find sperm in some men with non-obstructive azoospermia, but Micro-TESE generally offers a more targeted approach when sperm production is severely impaired.
  • Successful sperm retrieval does not guarantee fertilization, pregnancy or live birth; these depend on both partners and the IVF/ICSI process.

About tese — testicular sperm extraction

TESE stands for Testicular Sperm Extraction.

It is a surgical sperm retrieval procedure that obtains sperm directly from testicular tissue.

Unlike TESA, which uses a needle to aspirate testicular tissue through the skin, TESE involves making a small surgical incision in the scrotum and testicle.

Small samples of seminiferous tubules are removed and immediately examined by an embryology laboratory.

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

Why are sperm retrieved from the testicle?

Sperm are produced inside the seminiferous tubules of the testes.

Some men produce sperm but cannot release them into the semen because their reproductive tract is blocked.

Other men have severely reduced sperm production, with sperm occurring only in limited areas of testicular tissue.

TESE allows the fertility team to search directly within testicular tissue rather than relying on sperm being present in the ejaculate.

How is TESE performed?

The procedure begins with anesthesia and preparation of the scrotal area.

A small incision is made in the scrotal skin and the tissue surrounding the testicle.

The surgeon then creates a small opening in the tunica albuginea, the protective layer surrounding the testis.

A small amount of testicular tissue containing seminiferous tubules is removed.

The sample is immediately transferred to the embryology laboratory, where the tissue is processed and examined for sperm.

If adequate sperm are identified, additional tissue may be collected for cryopreservation when appropriate.

If sperm are not found in the first sample, additional biopsies from other areas may be taken.

The testicular opening and scrotal incision are then closed.

What is conventional TESE?

Conventional TESE refers to testicular sperm extraction performed without microsurgical selection of individual seminiferous tubules.

The surgeon takes one or more testicular biopsies from selected areas.

This differs from Micro-TESE, where the testis is opened more extensively and an operating microscope is used to identify seminiferous tubules that appear more likely to contain sperm.

This distinction is particularly important in non-obstructive azoospermia.

Who usually needs TESE?

TESE may be considered in several situations.

Obstructive azoospermia

In obstructive azoospermia, sperm production is preserved but sperm cannot reach the semen because of a blockage.

Potential causes include:

  • Previous vasectomy

  • Congenital reproductive-tract abnormalities

  • Epididymal obstruction

  • Vas deferens obstruction

  • Previous infection

  • Previous reproductive surgery

Because sperm production is usually preserved, testicular sperm retrieval is highly successful in appropriately diagnosed obstructive azoospermia.

Post-vasectomy infertility

Men who want biological children after vasectomy can consider:

  • Vasectomy reversal

  • Surgical sperm retrieval with IVF/ICSI

TESE is one method of obtaining sperm directly from the testicle when assisted reproduction is chosen.

Failed epididymal sperm retrieval

If PESA or MESA cannot retrieve sufficient epididymal sperm, testicular sperm retrieval may be performed.

Selected non-obstructive azoospermia

Conventional TESE has historically been used for NOA.

However, sperm production in NOA can occur in very small and unpredictable areas.

Multiple conventional biopsies may therefore miss those areas while removing unnecessary testicular tissue.

Micro-TESE was developed partly to address this problem.

TESE vs TESA

Both procedures retrieve sperm from the testicle.

TESA

TESA uses a needle passed through the scrotal skin.

It is:

  • Percutaneous

  • Less invasive

  • Usually faster

  • Particularly useful for obstructive azoospermia

TESE

TESE uses an open surgical approach.

It allows the surgeon to:

  • Directly obtain testicular tissue

  • Retrieve larger tissue samples

  • Take samples from multiple areas when necessary

  • Obtain sperm when needle aspiration has failed

For obstructive azoospermia, both approaches can be highly successful.

TESE vs Micro-TESE

This is the most important distinction for your page.

Conventional TESE

The surgeon takes one or several testicular biopsies without systematically examining individual seminiferous tubules under an operating microscope.

Micro-TESE

The surgeon opens the testicle and uses high-powered optical magnification to identify larger or more opaque seminiferous tubules that may be more likely to contain active sperm production.

Micro-TESE attempts to:

  • Improve sperm detection in focal spermatogenesis

  • Remove less unnecessary testicular tissue

  • Reduce tissue damage

  • Improve retrieval in difficult NOA cases

The EAU considers Micro-TESE the preferred surgical sperm retrieval approach for men with non-obstructive azoospermia.

For Andrology Abroad, TESE and Micro-TESE should therefore remain separate Procedure pages.

How successful is TESE in obstructive azoospermia?

Sperm production is usually intact in obstructive azoospermia.

As a result, sperm retrieval from the testicle is expected to be very high.

Published comparative studies have reported sperm recovery approaching 100% in appropriately selected obstructive azoospermia cases.

The more difficult question is usually not whether sperm exist, but which retrieval technique provides adequate sperm with the least unnecessary intervention.

How successful is conventional TESE in non-obstructive azoospermia?

Results are substantially less predictable.

Published studies report considerable variation depending on:

  • Cause of NOA

  • Testicular histology

  • Patient selection

  • Number of biopsies

  • Previous sperm retrieval

  • Surgical technique

The EAU reports conventional TESE sperm retrieval rates of approximately 50% in single-arm NOA studies, while comparative studies have sometimes reported lower rates.

Therefore, a single universal percentage should not be promised to an individual patient.

Why can multiple biopsies be needed?

Sperm production in NOA may be focal.

One part of the testis can contain no sperm while another small region may still have active spermatogenesis.

Conventional TESE may therefore involve biopsies from multiple areas.

However, taking more tissue increases the potential for:

  • Bleeding

  • Hematoma

  • Fibrosis

  • Loss of testicular tissue

  • Temporary or persistent changes in testosterone production

This is one reason Micro-TESE is often preferred for NOA.

What happens to the testicular tissue in the laboratory?

The embryology laboratory mechanically separates the seminiferous tubules and examines the processed tissue under magnification.

The goal is to identify viable sperm suitable for ICSI.

When sperm are found, they may be:

  • Used fresh

  • Cryopreserved

  • Divided between immediate treatment and storage

Close communication between the surgeon and embryologist during TESE is extremely important.

Why is ICSI used after TESE?

TESE sperm are normally used with intracytoplasmic sperm injection.

During ICSI, an embryologist selects a sperm and injects it directly into an egg.

This bypasses many steps required for natural fertilization.

Conventional IVF or intrauterine insemination generally requires larger numbers of motile sperm and is therefore usually inappropriate for surgically retrieved testicular sperm.

Can TESE sperm be frozen?

Yes.

If sufficient viable sperm are identified, testicular sperm can be cryopreserved.

Freezing sperm can:

  • Reduce the need for another operation

  • Allow future ICSI cycles

  • Separate the timing of male surgery from female egg retrieval

  • Provide backup sperm before an IVF cycle

However, men with very limited focal sperm production may not produce enough sperm for extensive cryopreservation.

Does TESE restore sperm to the semen?

No.

TESE retrieves sperm but does not repair the underlying cause of azoospermia.

Men with reproductive-tract obstruction remain obstructed afterward.

If natural conception is the objective, reconstructive surgery may be considered when appropriate.

TESE or vasectomy reversal?

For post-vasectomy infertility, this is an important decision.

Vasectomy reversal attempts to restore natural sperm passage.

TESE combined with IVF/ICSI bypasses the obstruction.

Factors influencing the decision include:

  • Female partner age

  • Ovarian reserve

  • Time since vasectomy

  • Female fertility factors

  • Desired number of future children

  • Previous fertility history

  • Availability of microsurgical reversal

  • Couple preference

Neither approach should automatically be presented as superior.

Why genetic evaluation matters in azoospermia

Some causes of azoospermia are genetic.

Depending on the clinical presentation, testing may include:

  • Karyotype

  • Y-chromosome microdeletion analysis

  • CFTR testing

Genetic counselling is particularly important because some abnormalities can affect the probability of sperm retrieval or potentially be transmitted to offspring.

Men with complete AZFa or AZFb Y-chromosome microdeletions should not undergo surgical sperm retrieval because sperm retrieval is not expected.

Why medical-tourism coordination matters

TESE should not be treated as an isolated operation.

The procedure needs coordination between:

  • Reproductive urologist or andrologist

  • Embryologist

  • IVF specialist

  • Cryopreservation laboratory

  • Female fertility team

Before travelling, patients should know whether sperm will be retrieved:

  • Before the IVF cycle and frozen

  • On the day of egg retrieval

  • As backup after another retrieval technique

This avoids unnecessary travel and poorly coordinated procedures.

Outcomes
“In obstructive azoospermia, conventional TESE can retrieve sperm in nearly 100% of appropriately selected men because sperm production is usually preserved.”
Source: pubmed.ncbi.nlm.nih.gov

Who it is for

✓ May be suitable if
  • •You have obstructive azoospermia and require sperm retrieval for IVF/ICSI.
  • •You produce sperm but a blockage prevents sperm from reaching the ejaculate.
  • •You have infertility after vasectomy and have chosen sperm retrieval with IVF/ICSI rather than vasectomy reversal.
  • •Epididymal sperm retrieval has failed or is not appropriate.
  • •TESA has failed or is unlikely to provide sufficient testicular tissue.
  • •Your reproductive team needs testicular sperm for ICSI.
  • •You have selected non-obstructive azoospermia where conventional TESE has been considered appropriate after specialist evaluation.
  • •You understand that Micro-TESE may be preferable to conventional TESE in NOA.
  • •You understand that sperm retrieval does not guarantee pregnancy or live birth.
  • •You are medically fit for surgery and the planned anesthesia.
✕ Not suitable if
  • •You have not undergone adequate investigation to determine why sperm are absent from the ejaculate.
  • •You have untreated genital, urinary or systemic infection.
  • •You have an uncontrolled bleeding disorder or anticoagulation that cannot be safely managed.
  • •You are medically unfit for elective surgery or anesthesia.
  • •You have complete AZFa or AZFb Y-chromosome microdeletions, where sperm retrieval is not expected.
  • •You have non-obstructive azoospermia for which Micro-TESE is considered the more appropriate first surgical retrieval approach.
  • •You have potentially reversible hormonal suppression that should be addressed before surgical sperm retrieval.
  • •Your reproductive plan does not include ICSI or another appropriate use for retrieved sperm.
  • •Your primary objective is restoration of natural sperm passage and reconstructive surgery is the more appropriate treatment.
  • •You expect TESE to restore sperm to the ejaculate or guarantee biological fatherhood.

Preparing for surgery

Confirm azoospermia with appropriate semen analyses.
Determine whether azoospermia is obstructive or non-obstructive before choosing a retrieval procedure.
Provide all previous semen-analysis reports.
Complete hormonal testing including FSH, LH and testosterone when indicated.
Provide previous scrotal ultrasound or fertility investigations.
Tell the surgeon about previous vasectomy, vasectomy reversal or reproductive surgery.
Report previous testicular trauma, torsion, infection, chemotherapy or radiation treatment.
Provide records from previous PESA, MESA, TESA, TESE or Micro-TESE attempts.
Complete genetic testing when indicated.
Complete karyotype and Y-chromosome microdeletion testing when recommended for azoospermia.
Complete CFTR-related testing when congenital absence of the vas deferens is suspected.
Arrange genetic counselling when a clinically significant genetic abnormality is identified.
Coordinate surgery with the IVF and embryology laboratory.
Decide whether sperm will be used fresh, frozen or both.
Confirm cryopreservation arrangements before surgery.
Provide a complete medication list.
Inform the medical team about anticoagulant and antiplatelet medication.
Do not stop prescribed blood-thinning medication without medical instructions.
Complete requested blood and urine tests.
Treat active infection before surgery.
Follow fasting instructions when sedation or general anesthesia is planned.
Arrange transportation after anesthesia.
Bring supportive underwear if recommended.
Plan enough time in Turkey for postoperative assessment before flying home.

What recovery looks like

Day 0 — Surgery
A small scrotal and testicular incision is made and one or more samples of seminiferous tissue are removed for immediate examination by the embryology laboratory. If sperm are identified, additional tissue may be collected for cryopreservation when appropriate. The testicular opening and scrotal incision are then closed, and most patients can leave the hospital later the same day after recovering from anesthesia.
Days 1–3 — Early recovery
Testicular soreness, scrotal swelling and bruising are expected during the first several days. Supportive underwear can reduce movement and discomfort, while prescribed pain medication can be used as directed. Gentle walking is encouraged, but patients should avoid running, cycling, heavy lifting and strenuous physical activity.
Days 3–7 — Return to light activity
Pain and swelling should gradually improve during the first week. Many patients can return to desk-based work within several days, although prolonged standing and strenuous activity may remain uncomfortable. The incision should be kept clean according to the surgical team's instructions, and increasing redness, fever, severe pain or rapidly enlarging swelling requires medical assessment.
Week 2 — Progressive recovery
Most uncomplicated patients experience substantial improvement by the second week. Normal daily activity can gradually increase as discomfort resolves, while physically demanding work and intense exercise should resume only when healing is adequate. Patients who underwent multiple or bilateral biopsies may recover more slowly.
Weeks 3–4 — Tissue healing
The external incision is usually well healed, although internal testicular tissue continues to recover. Most patients have returned to normal activities by this stage. Persistent swelling, significant testicular pain or changes in testicular size should be evaluated rather than assumed to be part of routine recovery.
Following months — Fertility and hormonal follow-up
Retrieved sperm may be used immediately or remain cryopreserved for future ICSI cycles. Men who have undergone extensive or repeated testicular procedures, particularly those with pre-existing testicular dysfunction, may require hormonal follow-up because sperm retrieval surgery can temporarily affect testosterone production in susceptible patients.

Risks and complications

Failure to retrieve sperm
TESE cannot guarantee sperm retrieval, particularly in non-obstructive azoospermia.
Testicular pain
Temporary testicular and scrotal discomfort is common after open tissue extraction.
Swelling and bruising
Scrotal swelling and bruising commonly occur during early recovery.
Hematoma
Bleeding within the testicle or scrotum can create a hematoma. Large or expanding hematomas may require additional treatment.
Infection
Scrotal, testicular or wound infection is uncommon but possible.
Testicular fibrosis
Removing testicular tissue can result in localized scar formation. The risk becomes more relevant with multiple conventional biopsies.
Loss of testicular tissue
Conventional TESE removes seminiferous tissue and therefore causes more tissue disruption than simple needle aspiration.
Reduced testosterone
Temporary decreases in testosterone can occur after testicular sperm retrieval, particularly in men with impaired baseline testicular function or after extensive bilateral surgery.
Testicular atrophy
Significant testicular injury or vascular compromise can rarely contribute to loss of testicular volume.
Need for repeat sperm retrieval
Another procedure may be required if insufficient sperm are retrieved, cryopreserved sperm are exhausted or a future ICSI cycle requires additional material.
Anesthesia complications
Local anesthesia, sedation or general anesthesia can produce allergic reactions, cardiovascular or respiratory problems and other uncommon complications.
Fertility treatment failure
Finding sperm does not guarantee fertilization, embryo development, pregnancy or live birth.

Common questions

What is TESE?
TESE stands for Testicular Sperm Extraction. It is a surgical procedure that removes small samples of testicular tissue so the laboratory can search directly for sperm.
Who needs TESE?
TESE may be used for men with azoospermia who require surgically retrieved sperm for IVF/ICSI, particularly men with obstructive azoospermia or selected non-obstructive cases.
Is TESE surgery?
Yes. Conventional TESE involves a small incision in the scrotum and testicle.
What is the difference between TESE and TESA?
TESA uses a needle to aspirate testicular tissue. TESE uses an open surgical incision to remove a tissue sample.
What is the difference between TESE and Micro-TESE?
Conventional TESE removes tissue from selected testicular areas without systematic microscopic selection. Micro-TESE uses an operating microscope to search for seminiferous tubules more likely to contain sperm.
Is TESE or Micro-TESE better for non-obstructive azoospermia?
Micro-TESE is generally preferred for NOA because sperm production may be highly focal and microsurgical exploration can improve the search while limiting unnecessary tissue removal.
Can TESE be used for obstructive azoospermia?
Yes. Sperm retrieval is highly successful because sperm production is usually preserved.
What is the TESE sperm retrieval rate?
In appropriately selected obstructive azoospermia, published studies report retrieval approaching 100%. In non-obstructive azoospermia, outcomes are much more variable.
Can TESE be used after vasectomy?
Yes. Testicular sperm can be retrieved after vasectomy and used with ICSI.
Should I choose TESE or vasectomy reversal?
The decision depends on both partners, including female age, ovarian reserve, time since vasectomy, desired number of children and whether IVF is already required.
What happens if TESE does not find sperm?
Men with NOA may be evaluated for Micro-TESE or salvage Micro-TESE depending on their previous procedure, diagnosis and genetic findings.
Can Micro-TESE find sperm after failed conventional TESE?
Yes, sperm can sometimes be retrieved with salvage Micro-TESE after a failed conventional TESE, although success is not guaranteed.
Does TESE hurt?
The procedure is performed under anesthesia. Testicular soreness and swelling are common during early recovery.
How long does TESE take?
Approximately 30–90 minutes is a practical range for conventional TESE, depending on the number and location of biopsies.
Do I need to stay in hospital?
Most uncomplicated procedures are performed as day surgery, although some patients may remain overnight.
How long should I stay in Turkey?
Approximately 3–5 days is a reasonable planning range for uncomplicated TESE alone.
When can I return to work?
Many patients can return to desk-based work within 3–7 days.
When can I exercise?
Strenuous activity is generally avoided for approximately one to two weeks depending on the extent of surgery and recovery.
When can I have sex?
Sexual activity can usually resume once scrotal pain, swelling and wound discomfort have resolved and the surgeon has confirmed adequate healing.
Can TESE sperm be frozen?
Yes. Viable sperm can be cryopreserved when adequate material is available.
Can frozen TESE sperm be used for ICSI?
Yes. Cryopreserved testicular sperm are routinely used with ICSI.
Is ICSI required after TESE?
In most cases, yes. Surgically retrieved testicular sperm are generally used with ICSI rather than conventional IVF or IUI.
Does TESE cure azoospermia?
No. TESE retrieves sperm for assisted reproduction but does not correct the underlying cause.
Will sperm appear in my semen after TESE?
Not because of the TESE procedure itself. If sperm transport is obstructed, the obstruction remains unless separately reconstructed.
Can TESE affect testosterone?
Temporary testosterone reduction can occur, particularly after extensive tissue removal or in men who already have impaired testicular function.
Can TESE be repeated?
Yes, but repeated testicular surgery increases cumulative tissue exposure. Cryopreservation and selection of the most appropriate retrieval technique can reduce unnecessary repeat procedures.
Can every man with azoospermia undergo TESE?
No. The cause of azoospermia must first be investigated. Some genetic conditions, particularly complete AZFa or AZFb deletions, are associated with essentially no chance of successful surgical sperm retrieval.
Which doctor performs TESE?
TESE should be performed by a reproductive urologist, andrologist or urologist experienced in male infertility and surgical sperm retrieval, with immediate access to an experienced embryology laboratory.

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Sources

  1. The guideline discusses conventional TESE and Micro-TESE, sperm retrieval for obstructive and non-obstructive azoospermia, genetic evaluation and complications of surgical sperm retrieval. https://uroweb.org/guidelines/sexual-and-reproductive-health-2022/chapter/male-infertility
  2. Comparative study reporting 100% sperm recovery with both conventional and microdissection TESE in obstructive azoospermia, while Micro-TESE achieved higher retrieval in non-obstructive azoospermia. https://pubmed.ncbi.nlm.nih.gov/12187223/
  3. Systematic review reporting conventional TESE sperm retrieval rates ranging from approximately 16.7% to 45%, compared with approximately 42.9% to 63% for Micro-TESE across included comparative studies. https://pubmed.ncbi.nlm.nih.gov/24193894/
  4. Systematic review and meta-analysis of 1,890 patients showing higher sperm retrieval with Micro-TESE than conventional TESE and higher retrieval with conventional TESE than TESA in NOA. https://pubmed.ncbi.nlm.nih.gov/26263080/
  5. Large systematic review and meta-analysis of more than 21,000 men evaluating conventional and Micro-TESE sperm retrieval as well as pregnancy and live-birth outcomes following ICSI. https://pubmed.ncbi.nlm.nih.gov/31665451/
  6. Clinical study reporting a conventional TESE sperm retrieval rate of approximately 47.6% in men with NOA. https://pubmed.ncbi.nlm.nih.gov/26872565/
  7. Systematic review and meta-analysis evaluating factors associated with successful salvage Micro-TESE after previous failed conventional TESE or Micro-TESE. https://pubmed.ncbi.nlm.nih.gov/37172416/