TESE procedure

Quick takeaways

• TESE means testicular sperm extraction, a procedure used to retrieve sperm directly from the testicle.
• It is commonly used in men with azoospermia, severe sperm transport problems, or inability to ejaculate sperm normally.
• Retrieved sperm are often used for IVF with ICSI, since the sperm count from TESE may be low.
• TESE is not the same as micro-TESE; micro-TESE uses an operating microscope and is often preferred in certain cases of non-obstructive azoospermia.
• Success depends on the underlying cause of infertility, hormone profile, testicular function, genetics, and surgical technique.
• Most men have a relatively short recovery, but bruising, swelling, pain, bleeding, and infection can occur.
• Before TESE, men often need a full fertility workup, including semen analysis, hormones, exam, and sometimes genetic testing.
• The procedure should usually be planned with a male fertility specialist or reproductive urologist.

What is the TESE procedure?

The TESE procedure is a surgical sperm retrieval technique in which a doctor removes a small piece of testicular tissue and examines it for sperm. If sperm are found, they may be used immediately during fertility treatment or frozen for future use.

Sperm are made in the seminiferous tubules inside the testicles. In some men, sperm production is present but sperm do not make it into the semen because of a blockage, prior vasectomy, absent vas deferens, or another transport issue. In other men, sperm production is reduced or patchy, so sperm may be absent from the ejaculate even though a small number are still present inside the testes. TESE is designed to find and recover those sperm.

Because retrieved sperm are often limited in number and may not move as well as ejaculated sperm, they are usually used with ICSI, where a single sperm is injected directly into an egg.

Why TESE is done

Doctors use TESE when a semen sample does not provide usable sperm, but there is still a reasonable chance that sperm may be present in the testicular tissue.

Common reasons TESE may be recommended

• Azoospermia, especially when the cause is unclear or known
• Obstructive azoospermia, where sperm production is intact but blocked from entering semen
• Non-obstructive azoospermia, where sperm production is severely reduced but not always completely absent
• Previous vasectomy, especially if sperm retrieval is being used instead of or after reversal
• Congenital absence of the vas deferens, which can occur in men with CFTR gene variants
• Spinal cord injury or neurological conditions that impair ejaculation
• Failure of less invasive sperm retrieval methods
• Need for sperm retrieval on the same day as egg retrieval during IVF

TESE is one of several sperm retrieval options. The best approach depends on whether the problem is a blockage, a sperm production issue, or both.

Who may need testicular sperm extraction?

TESE is usually considered for men who have no sperm in the ejaculate or who have a condition that makes semen collection unlikely to yield sperm. It is not typically a first-line step for every fertility issue. In many cases, the decision comes after a detailed infertility evaluation.

Men who may be candidates include those with:

• Repeated semen analyses showing azoospermia
• A prior vasectomy with plans for assisted reproduction
• Suspected duct blockage, including epididymal or ejaculatory duct obstruction
• Very low-volume semen with absent sperm
• Retrograde ejaculation or severe ejaculation dysfunction when other methods fail
• History of testicular injury, surgery, or infection affecting sperm delivery
• Genetic causes of azoospermia
• Prior chemotherapy or radiation, depending on residual testicular function

A man may not be an ideal candidate if there is strong evidence that no sperm production remains at all, though even in severe cases a specialist may discuss the possibility of microdissection-based retrieval.

TESE vs micro-TESE and other sperm retrieval methods

People often use “TESE” as a general term for surgical sperm retrieval, but several different techniques exist. They are not interchangeable in every case.

TESE vs micro-TESE

The difference matters most in men with non-obstructive azoospermia. In that setting, sperm production may be sparse and unevenly distributed. Micro-TESE uses an operating microscope to identify larger or more promising tubules, which may improve retrieval in some men while helping avoid unnecessary tissue removal. Standard TESE may still be appropriate in many obstructive cases or in selected clinical situations.

The best technique is highly individualized and should be chosen by a reproductive urologist based on the diagnosis.

How the TESE procedure works step by step

Exact technique varies by surgeon and clinic, but the process usually follows a fairly standard path.

1. Pre-procedure evaluation

Before TESE, your doctor will usually review your reproductive history, prior semen analyses, medical conditions, medications, hormone levels, and any imaging or genetic test results. This helps determine whether TESE, micro-TESE, or another method gives the best chance of success.

2. Anesthesia

TESE may be done under local anesthesia with sedation or under general anesthesia, depending on the setting, the technique used, and patient preference.

3. Small incision or tissue access

The surgeon makes a small opening in the scrotal skin and testicular covering, or in some cases uses a needle-based technique if aspiration is planned instead of open extraction.

4. Tissue removal

A small sample of testicular tissue is removed. In micro-TESE, the surgeon uses a microscope to look for tubules more likely to contain sperm.

5. Sperm search in the lab

The tissue is processed by an embryology or andrology laboratory to look for sperm. If sperm are found, they may be used fresh the same day or cryopreserved for future IVF-ICSI cycles.

6. Closure and recovery

The incision is closed if needed, and the patient is sent home with instructions on pain control, activity restrictions, and signs of complications to watch for.

How long does TESE take?

The procedure itself is usually relatively short, but the total time at the clinic or surgical center can be longer because of preparation, anesthesia, and lab processing. Whether sperm are found may be known the same day or after more detailed lab review, depending on the clinic.

How to prepare for TESE

Preparation is not just about the day of surgery. It usually starts with understanding why sperm are absent from semen in the first place.

Typical pre-TESE workup

• At least two semen analyses to confirm azoospermia or severe abnormality
• Physical exam by a urologist or reproductive specialist
• Hormone testing, often including FSH, LH, testosterone, and sometimes prolactin and estradiol
• Genetic testing when appropriate, such as karyotype, Y chromosome microdeletion testing, or CFTR testing
• Scrotal ultrasound in selected cases
• Review of prior surgeries, vasectomy, infections, medications, and cancer treatments

How to prepare in the days before the procedure

1. Follow fasting instructions if your surgeon or anesthesia team gives them.
2. Ask which medications should be stopped, especially blood thinners, aspirin, NSAIDs, testosterone, anabolic steroids, and supplements that may increase bleeding risk.
3. Arrange a ride home if sedation or general anesthesia will be used.
4. Wear supportive underwear or bring an athletic supporter for after the procedure.
5. Clarify whether the goal is same-day IVF use or sperm freezing for later treatment.

If the female partner is undergoing IVF at the same time, timing can be especially important. Coordination between the reproductive urologist, fertility clinic, and embryology lab matters.

Recovery, pain, and side effects after TESE

Most men recover fairly quickly from TESE, but some soreness is expected. Recovery tends to depend on how much tissue was removed, whether the procedure was open or microsurgical, and whether one or both testicles were involved.

Common short-term symptoms

• Mild to moderate scrotal pain or aching
• Swelling
• Bruising
• Tenderness at the incision site
• Temporary activity limitation

Typical recovery advice

• Rest for the first day or two
• Use scrotal support
• Apply ice packs if your clinician recommends them
• Avoid sex, heavy lifting, vigorous exercise, and straining for the period advised by your surgeon
• Take pain medicines exactly as directed
• Keep the area clean and follow wound care instructions

Some men are back to desk work quickly, while others need a bit longer. Your surgeon’s instructions should guide your return to normal activities.

TESE success rates and what affects them

When people ask about TESE success rates, they may mean different things:

• Sperm retrieval success: whether sperm are found
• Fertilization success: whether ICSI works with those sperm
• Pregnancy or live birth success: whether treatment leads to a baby

These are not the same outcome. A man may have successful sperm retrieval but still face limits related to egg quality, embryo development, maternal age, or underlying genetic factors.

What most strongly affects sperm retrieval success?

• Obstructive vs non-obstructive azoospermia
• Amount of sperm production still occurring in the testicle
• FSH level and overall hormone pattern
• Testicular size, though this is only part of the picture
• History of cryptorchidism, mumps orchitis, chemotherapy, or testicular injury
• Genetic findings, including certain Y chromosome microdeletions
• Choice of retrieval technique, such as TESE vs micro-TESE
• Experience of the surgeon and lab team

If your doctor discusses “success rate,” make sure you ask which type of success they mean.

Risks and complications of the TESE procedure

TESE is generally considered a low-risk procedure when done by experienced clinicians, but it is still surgery.

Possible risks include:

• Pain that lasts longer than expected
• Bleeding or hematoma
• Infection
• Swelling or delayed healing
• Scarring within the testicle
• Temporary or, less commonly, more lasting changes in testicular function
• Rarely, a drop in testosterone in some men after more extensive tissue removal
• Anesthesia-related risks

Risk may be higher when larger amounts of tissue are removed or when repeat procedures are needed. For this reason, men with non-obstructive azoospermia are often referred to specialists experienced in micro-TESE when appropriate.

What TESE means for fertility treatment

TESE is usually not a stand-alone fertility treatment. It is a sperm retrieval method that fits into a larger reproductive plan.

How TESE fits into IVF and ICSI

In many cases, sperm retrieved through TESE are used in IVF with ICSI. During ICSI, an embryologist injects one sperm directly into one mature egg. This approach is used because surgically retrieved sperm may be limited in number and may not function well for conventional insemination.

Fresh vs frozen TESE sperm

Clinics may use sperm:

• Fresh, on the same day as egg retrieval
• Frozen after cryopreservation for later IVF use

There are pros and cons to each approach. Fresh use can avoid a separate storage step, but if no sperm are found on egg retrieval day, the cycle becomes more complicated. Freezing sperm ahead of time can reduce that uncertainty in some situations.

Will TESE improve natural fertility?

No. TESE itself does not restore sperm to the semen or improve natural conception chances. It is a retrieval procedure, not a cure for the underlying cause of azoospermia. If the problem is surgically correctable, such as some obstructive causes, your doctor may discuss reconstruction or other alternatives.

What’s normal after TESE vs what’s not?

After TESE, some discomfort and swelling are expected. The key is knowing what falls within the normal recovery range and what needs medical attention.

If anything feels significantly worse instead of gradually better, it is worth contacting your surgical team.

Can TESE affect testosterone?

It can, but not always. Because TESE involves removing testicular tissue, there is some potential for a temporary drop in testosterone, especially when more extensive tissue sampling is required. This concern is more relevant in men who already have borderline testicular function or who undergo larger or repeated procedures.

Most men do not develop major hormone problems from a carefully performed single procedure, but testosterone follow-up may be considered in selected patients, especially if they develop symptoms such as fatigue, reduced libido, erectile changes, or mood shifts afterward.

Men trying to preserve fertility should also be careful with outside testosterone use. Testosterone replacement therapy can suppress sperm production and should never be started without discussing fertility goals first.

Underlying causes that may lead to TESE

TESE is a procedure, not a diagnosis. The reason someone needs TESE often points to a deeper male reproductive issue.

Common underlying causes include:

• Obstructive azoospermia: a blockage prevents sperm from entering the ejaculate
• Non-obstructive azoospermia: impaired sperm production inside the testes
• Vasectomy or failed vasectomy reversal
• Congenital bilateral absence of the vas deferens
• Genetic conditions, including Klinefelter syndrome or Y chromosome microdeletions
• History of undescended testicles
• Testicular failure from infection, trauma, torsion, or toxins
• Cancer treatment, including chemotherapy and radiation
• Hormonal disorders, though some may be medically treatable before surgery is considered

Understanding the cause matters because it affects treatment choices, sperm retrieval odds, genetic counseling, and whether alternative options should be discussed.

Alternatives to the TESE procedure

Depending on the diagnosis, TESE may not be the only option.

Possible alternatives or related approaches

• Medical treatment for certain hormonal causes of azoospermia
• Repeat semen testing, including centrifuged pellet analysis, when rare sperm may have been missed
• PESA, MESA, or TESA in selected obstructive cases
• Microsurgical reconstruction for a correctable blockage
• Vasectomy reversal if prior vasectomy is the issue and natural conception is the goal
• Donor sperm if no sperm can be retrieved or if this aligns better with family-building goals

A reproductive urologist can help determine whether TESE is the right first move or whether another strategy makes more sense.

Questions to ask your doctor before TESE

If you are considering the TESE procedure, these questions can help you make a better-informed decision:

• Do I likely have obstructive or non-obstructive azoospermia?
• Is standard TESE the best option for me, or would micro-TESE be better?
• What are my realistic chances of sperm retrieval?
• Do I need genetic testing before the procedure?
• Should sperm be frozen ahead of IVF, or used fresh on egg retrieval day?
• What are the risks to testicular function and testosterone in my specific case?
• How many TESE or micro-TESE procedures do you perform?
• What should I expect for pain, recovery, and time off work?
• What happens if no sperm are found?
• If sperm are found, what are the next steps with IVF or ICSI?

Related tests and terms

If you are researching TESE, you will likely come across these related men’s fertility terms:

• Azoospermia: no sperm seen in semen
• Obstructive azoospermia: sperm are made but blocked from the ejaculate
• Non-obstructive azoospermia: severely impaired sperm production
• ICSI: intracytoplasmic sperm injection
• IVF: in vitro fertilization
• Semen analysis: lab test measuring sperm count, motility, volume, and more
• FSH: follicle-stimulating hormone, often used in male infertility workups
• Y chromosome microdeletion testing: genetic test relevant in some men with severe infertility
• CFTR testing: genetic testing often considered when the vas deferens are absent
• Varicocele: enlarged scrotal veins that may affect sperm production in some men

Common misconceptions about TESE

“If I need TESE, I definitely have no sperm at all.”

Not necessarily. Some men have no sperm in semen but still produce sperm inside the testes.

“TESE and micro-TESE are the same thing.”

No. Micro-TESE is a more specialized microsurgical approach and is especially important in some men with non-obstructive azoospermia.

“If sperm are found, pregnancy is guaranteed.”

No fertility treatment can guarantee pregnancy. Sperm retrieval is only one part of the process.

“TESE fixes the infertility problem permanently.”

TESE retrieves sperm; it does not usually correct the underlying cause of infertility.

“A normal testosterone level means TESE will work.”

Normal testosterone does not guarantee sperm retrieval. Hormones help with the overall picture but do not predict everything.

When to see a doctor

You should consider seeing a reproductive urologist or fertility specialist if:

• Your semen analysis shows azoospermia or extremely low sperm count
• You have a history of vasectomy and want biological children
• You have known testicular disease, undescended testicles, or prior cancer treatment
• You and your partner have been trying to conceive without success and there is concern about male factor infertility
• You have symptoms of low testosterone or testicular dysfunction along with fertility concerns

If you have recently had TESE, contact your surgeon urgently for fever, severe pain, heavy bleeding, rapidly increasing swelling, or signs of infection.

FAQs about the TESE procedure

Is the TESE procedure painful?

During the procedure, anesthesia is used to control pain. Afterward, mild to moderate soreness, bruising, and swelling are common for a short period.

What does TESE stand for?

TESE stands for testicular sperm extraction.

What is the difference between TESE and micro-TESE?

Standard TESE removes testicular tissue without microscope-guided dissection. Micro-TESE uses an operating microscope to look for tubules more likely to contain sperm and is often preferred in certain cases of non-obstructive azoospermia.

Can sperm retrieved by TESE be frozen?

Yes. If sperm are found, they can often be cryopreserved for future IVF-ICSI treatment, depending on sperm quantity and quality.

Can TESE be done after a vasectomy?

Yes. TESE is one option for sperm retrieval after vasectomy, especially if IVF-ICSI is planned or vasectomy reversal is not desired or not suitable.

How successful is the TESE procedure?

Success depends heavily on the cause of infertility. Retrieval tends to be more predictable in obstructive azoospermia than in non-obstructive azoospermia. Ask your specialist for success estimates based on your diagnosis.

Will I still produce testosterone after TESE?

Most men continue to produce testosterone, but some may have a temporary or occasionally more meaningful decline, especially after more extensive tissue removal. This should be discussed before surgery.

Can TESE help me conceive naturally?

Usually no. TESE is primarily a sperm retrieval technique for assisted reproduction, most commonly IVF with ICSI.

How long is recovery after TESE?

Many men recover over several days to a couple of weeks, depending on the extent of the procedure and their activity level. Your surgeon will give specific guidance.

What happens if no sperm are found during TESE?

Your doctor may review whether repeat retrieval, micro-TESE, additional evaluation, or other family-building options make sense. The next step depends on the original diagnosis and prior testing.

References

• American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM). Diagnosis and Treatment of Infertility in Men.
• American Society for Reproductive Medicine (ASRM). Patient and clinical resources on male infertility, azoospermia, and surgical sperm retrieval.
• European Association of Urology (EAU). EAU Guidelines on Sexual and Reproductive Health.
• National Institute of Child Health and Human Development (NICHD). Male infertility overview and related educational resources.
• Merck Manual Professional Edition. Clinical overviews of male infertility and azoospermia.
• Peer-reviewed literature on testicular sperm extraction, microdissection TESE, and outcomes in obstructive and non-obstructive azoospermia.