Surgical Sperm Retrieval (TESE & Micro-TESE)
Surgical sperm retrieval collects sperm directly from the testicles or the epididymis when a man has very few or no sperm in his semen. Techniques range from a fine-needle aspiration to microsurgical extraction (micro-TESE). The retrieved sperm is used with IVF and ICSI, giving many men with male-factor infertility the chance to father a biological child.
Medically reviewed by the Florence Healthcare medical team · Last reviewed June 2026
Overview
When there is no sperm in the ejaculate (a condition called azoospermia), sperm can often still be found within the testicles or the tubes that store them. The right approach depends on the cause. Where there is a blockage (obstructive azoospermia), simpler needle techniques such as testicular or epididymal aspiration (TESA/PESA) are often enough. Where the testicles produce very little sperm (non-obstructive azoospermia), microsurgical extraction — micro-TESE — uses an operating microscope to find the tiny areas that are producing sperm.
The retrieved sperm is prepared by the embryology laboratory and used to fertilize eggs through ICSI, either straight away in time with the partner's egg collection or after freezing for a later IVF cycle. Care is coordinated between andrology, urology and the IVF team, and an assessment beforehand — including semen tests, hormone levels and sometimes genetic tests — helps plan the best technique.
For international patients, a coordinator arranges the evaluation and a transparent, itemized cost estimate before travel, and our specialists can review your reports remotely. The procedure can be timed with the IVF cycle or scheduled with sperm freezing so treatment fits around your visit.
Who is a candidate?
- Men with no sperm in the ejaculate (azoospermia) on repeated semen tests
- Men with a blockage preventing sperm from reaching the semen (including after vasectomy)
- Men whose testicles produce very little sperm (non-obstructive azoospermia)
- Couples proceeding with IVF and ICSI who need surgically retrieved sperm
- Men in whom ejaculation or sperm delivery is not possible for medical reasons
What happens
- 1
Assessment
Semen tests, hormone blood tests and sometimes genetic tests help find the cause of the low or absent sperm and decide which retrieval technique is most likely to succeed.
- 2
Sperm retrieval
Under local anesthesia with sedation, or general anesthesia for micro-TESE, sperm is collected using a needle (TESA/PESA) or through a small microsurgical exploration of the testicle (TESE/micro-TESE).
- 3
Laboratory and ICSI
The embryology team searches the sample for healthy sperm, which is used to fertilize eggs by ICSI — either fresh, timed with the partner's egg collection, or frozen for a later cycle.
- 4
Recovery
You rest for a few days, with some bruising or discomfort that settles over about a week. Your team explains the results and the next steps in the IVF cycle.
Benefits
- Can retrieve sperm for men who have none in the ejaculate, enabling biological fatherhood
- Micro-TESE improves the chance of finding sperm when production is very low
- Retrieved sperm can be used fresh or frozen to fit the IVF timetable
- A day-case procedure, with recovery usually within about a week
- Planned together by andrology, urology and the IVF laboratory
Risks & considerations
- Sperm is not always found, particularly in non-obstructive azoospermia
- Temporary pain, swelling or bruising of the scrotum after the procedure
- Uncommon risks include bleeding (a hematoma) or infection
- Repeated or extensive extraction can, rarely, affect testosterone levels over time
- Success ultimately depends on both retrieving sperm and the IVF/ICSI outcome
Conditions this treats
Where it is performed
This procedure is delivered by our Infertility & IVF Center.
Learn more before you decide
Provider-reviewed guides on the related conditions, symptoms and tests in our Health Library.
Surgical Sperm Retrieval (TESE & Micro-TESE) — frequently asked questions
TESA and PESA use a fine needle to draw sperm from the testicle or epididymis, and are often used when there is a blockage. TESE takes a small piece of testicular tissue. Micro-TESE uses an operating microscope to find and collect sperm from the areas most likely to contain it, and is used when sperm production is very low.
Often, yes. Many men with no sperm in the ejaculate still have small amounts within the testicles that can be retrieved surgically, especially with micro-TESE. Success depends on the underlying cause, which the assessment helps predict, though sperm cannot always be found.
It is done under local anesthesia with sedation, or general anesthesia for micro-TESE, so you are comfortable during it. Afterwards, some pain, swelling or bruising of the scrotum is normal and usually settles within about a week with simple measures.
Yes. Retrieval can be timed with your partner's egg collection so fresh sperm is used for ICSI, or the sperm can be frozen for a later cycle. Your coordinator arranges the timing so it fits around your travel.
Surgical sperm retrieval is a day-case procedure, so no overnight stay is usually needed. We provide a transparent, itemized estimate after reviewing your case and do not quote fixed prices online because each plan — often combined with IVF and ICSI — is individual.
Related treatments
Considering surgical sperm retrieval (tese & micro-tese)?
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