Surgical sperm retrieval (TESA / TESE / PESA)
A minor surgical procedure to collect sperm directly from the testicle or the tube beside it (epididymis) when there is little or no sperm in the semen.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It collects sperm directly from the testicle or epididymis when there is little or no sperm in the semen.
- It is a minor operation involving a needle or a small scrotal cut, done under local or general anaesthetic, usually as a day case.
- Finding sperm is not guaranteed, especially in non-obstructive azoospermia where the testicles make very little; success is higher when the problem is a simple blockage.
- Any sperm found is used with IVF and ICSI, not for natural conception, and is usually frozen for later treatment.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can find usable sperm even when there is none in the semen, allowing you to have a genetically related child through IVF/ICSI.
When sperm can be obtained more simply, for example by treating a reversible cause or with a normal ejaculated sample.
Rest with supportive underwear and use simple pain relief. Some scrotal aching, bruising and swelling is normal. Avoid getting any wound wet until advised.
Clear wound and pain advice, supportive underwear, and a named contact for problems.
Rest with supportive underwear and use simple pain relief. Some scrotal aching, bruising and swelling is normal...
Discomfort and bruising start to settle. Many people return to desk work within a few days, sooner after needle...
Avoid heavy lifting, strenuous exercise, cycling and sex until your team says it is safe, to let the area heal.
You usually learn on the day whether sperm was found; if frozen, it is stored for future IVF/ICSI. The team will...
What is surgical sperm retrieval?
Surgical sperm retrieval is a minor operation to collect sperm directly from the testicle, or from the epididymis (the coiled tube next to the testicle that stores sperm). It is used when there is no sperm, or almost no sperm, in the semen, a condition called azoospermia.
There are two broad situations. In obstructive azoospermia, sperm are being made normally but cannot get out because of a blockage, a previous vasectomy, or a missing vas deferens; here, simpler needle methods often work well. In non-obstructive azoospermia, the testicles make very little or no sperm; here, more thorough surgery (TESE or micro-TESE) is needed, and sperm is found less often.
The sperm collected is not used for natural conception. It is used in the laboratory with IVF and ICSI, where a single sperm is injected into an egg. Any usable sperm is normally frozen straight away for future treatment.
It is a real surgical procedure that involves a needle or a small cut into the scrotum, so it has the risks of minor surgery. It also cannot guarantee that sperm will be found, especially when the testicles are making very little.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Needle methods vs surgical extraction
| PESA / TESA (needle) | TESE / micro-TESE (incision) | |
|---|---|---|
| How sperm is taken | Fine needle | Small cut, tissue removed |
| Usual anaesthetic | Local | Often general |
| Best for | Blockages (obstructive) | Low sperm production (non-obstructive) |
| Chance of finding sperm | Often high with a blockage | Lower; micro-TESE may improve it |
Your urologist or fertility specialist will recommend a method based on whether the cause is a blockage or low sperm production, and on previous tests. Needle methods are less invasive; micro-TESE is more thorough when production is the problem.
Preparing for your surgery
- See a urologist or fertility specialist, who will examine you and review hormone tests and previous semen analyses to plan the right method.
- Be screened for HIV and hepatitis B and C before any sperm can be frozen and stored.
- Discuss whether the procedure will be combined with your partner's egg collection (fresh) or done earlier so sperm can be frozen.
- Tell the team about all medicines and supplements, especially blood thinners, which may need managing.
- Arrange a day off and someone to drive you home, particularly if you are having a general anaesthetic.
- Bring or buy supportive underwear, which helps comfort and healing afterwards.
- Complete the HFEA consent forms for storing and using your sperm, including what happens to it in different circumstances.
What happens
On the day, the type of anaesthetic depends on the method. Needle methods (PESA and TESA) are usually done under local anaesthetic, where the area is numbed and you stay awake. TESE and micro-TESE are often done under general anaesthetic, so you are asleep.
For needle methods, a fine needle is passed through the scrotal skin into the epididymis (PESA) or the testicle (TESA) to draw out fluid or a small amount of tissue. For TESE and micro-TESE, a small cut is made in the scrotum and testicle, and tiny pieces of tissue are removed; in micro-TESE an operating microscope is used to find the areas most likely to contain sperm.
The samples are passed to an embryologist, who examines them under the microscope, often while you are still in the clinic, to see whether sperm is present. Any usable sperm is normally frozen straight away. The cut, if there is one, is closed with dissolvable stitches. Most people go home the same day with supportive underwear and pain relief.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When sperm can be obtained more simply, for example by treating a reversible cause or with a normal ejaculated sample.
- When there is an untreated infection or skin problem of the scrotum until it is managed.
- When blood-thinning medicines or a bleeding tendency cannot be safely managed around surgery.
- When IVF/ICSI is not planned or possible, since the sperm is only used in the laboratory.
Delay surgery if…
- There is an active scrotal or urinary infection.
- HIV or hepatitis screening is not yet complete, as it is required before storage.
- Blood thinners or other medicines need adjusting before surgery.
- Hormone tests or other investigations that would change the plan are missing.
- You have not completed the HFEA consent forms for storage and use of the sperm.
Alternatives to discuss
- Treating a reversible cause, such as reversing a blockage, where possible.
- Using a fresh ejaculated sample if any sperm can be produced naturally.
- Hormone treatment in selected cases of low sperm production, on specialist advice.
- Using donor sperm if no usable sperm can be retrieved.
- Deciding, with counselling, not to pursue treatment.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can find usable sperm even when there is none in the semen, allowing you to have a genetically related child through IVF/ICSI.
- Offers a route to fatherhood after vasectomy, with a blockage, or with a missing vas deferens.
- Lets sperm be frozen for one or more future treatment cycles from a single procedure.
- Needle methods are quick, done under local anaesthetic, and have a fast recovery.
- Micro-TESE can find sperm in some men whose testicles make very little, when simpler methods fail.
Risks & complications
- Pain, aching or tenderness in the scrotum for a few days
- Bruising and swelling of the scrotum
- A small wound or puncture site that needs keeping clean and dry
- Not finding usable sperm, especially in non-obstructive azoospermia
- A collection of blood in the scrotum (haematoma)
- Infection of the wound or testicle, needing antibiotics
- Longer-lasting discomfort or a tender lump as healing settles
- Needing a further or more extensive procedure if no sperm is found
- Damage to the testicle or its blood supply, which can affect testicle size or function
- A drop in testosterone over time, particularly after more extensive testicular surgery such as micro-TESE
- Persistent or chronic scrotal pain
The two things to weigh up are the small-surgery risks (pain, bruising, haematoma, infection) and the chance that no sperm is found, which depends heavily on whether the cause is a blockage or low sperm production. More extensive testicular surgery, such as micro-TESE, carries a small risk of affecting testosterone over time. Ask your specialist about your likely chance of finding sperm, and what the plan is if none is found.
Published figures to discuss
The chance of finding sperm varies a great deal and is driven mainly by the cause. With obstructive azoospermia (a blockage), sperm is found in most men. With non-obstructive azoospermia (low production), sperm is found in a smaller proportion, and micro-TESE may improve the odds. Surgical complications are uncommon. The figures below are cautious and indicative; ask your specialist for your own likely chance.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Sperm found with a blockage (obstructive azoospermia) | High, commonly described as around 90% or more with needle or surgical methods | When sperm are made normally but blocked, retrieval usually succeeds. | NHS (Manchester) — Surgical sperm retrieval patient leafletmft.nhs.ukPublished figure |
| Sperm found with low production (non-obstructive azoospermia) | Lower and variable, often reported around half of men, higher in some micro-TESE series | Depends on the cause and the method; micro-TESE may find sperm when other methods cannot. | Guide sourcesClinical context |
| Surgical complications (haematoma, infection) | Uncommon; low single digits in most reports, higher after more extensive surgery | Most settle with simple care or antibiotics; report a growing, painful swelling promptly. | NHS (Manchester) — Surgical sperm retrieval patient leafletmft.nhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is usually quick, especially after needle methods. Expect a sore, bruised and swollen scrotum for a few days, eased by supportive underwear, rest and simple pain relief. Recovery after TESE or micro-TESE can take a little longer because a cut is involved.
- A sore, tender or aching scrotum for several days
- Bruising and swelling of the scrotum that fades over a week or two
- A small puncture mark or a short scar that heals over the following weeks
- Feeling tired for a day after a general anaesthetic
- A mix of relief and anxiety while waiting to hear whether sperm was found and frozen
Aftercare
- Wear supportive underwear day and night for the first few days to ease swelling and discomfort.
- Use simple pain relief such as paracetamol as advised, and apply cold packs over clothing if recommended.
- Keep any wound clean and dry, and follow advice on when you can shower or bathe.
- Rest for the first day or two and avoid heavy lifting, exercise, cycling and sex for up to about 2 weeks.
- Watch for signs of infection or a growing, painful swelling and contact the clinic if they occur.
- Make sure your HFEA consent and contact details are up to date so stored sperm is not lost.
- Keep the clinic's contact number to hand for questions about healing or your results.
- Supportive underwear ready
- Simple pain relief at home
- Someone to drive you home (especially after a general anaesthetic)
- HIV and hepatitis screening completed
- HFEA consent and storage forms signed
- A day or two off work arranged
- Clinic contact number saved and result appointment noted
Scars and how they heal
What is left behind depends on the method. PESA and TESA use a fine needle, so they usually leave only a tiny puncture mark that heals quickly, often with little or no visible scar. TESE and micro-TESE involve a small cut in the scrotal skin, closed with dissolvable stitches; this leaves a short scar that is normally well hidden in the scrotal skin and fades over the following weeks and months. Bruising and swelling are common at first whichever method is used.
⚠ Get urgent help if…
- A rapidly growing, very painful or hard swelling of the scrotum (possible bleeding/haematoma)
- Increasing redness, heat, swelling or discharge from the wound (signs of infection)
- A high temperature or feeling generally unwell
- Severe or worsening pain not controlled by simple pain relief
- Bleeding from the wound that will not stop
- Difficulty passing urine
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A 'good' result is finding enough healthy sperm to freeze for IVF and ICSI. Whether this happens depends a lot on the cause: when the problem is a simple blockage, sperm is found in most men, but when the testicles are making very little sperm (non-obstructive azoospermia), sperm is found less often, even with micro-TESE.
Finding sperm is only the first step. A baby still depends on the IVF/ICSI cycle, your partner's eggs, and many other factors, so this procedure cannot promise a pregnancy or a child. Your team should be honest about your likely chance of finding sperm and what it means for treatment.
Frozen sperm from the procedure can be stored and used for future IVF/ICSI cycles, within the HFEA storage rules (up to 55 years, with consent renewed every 10 years). One successful retrieval may provide enough sperm for more than one treatment cycle. The procedure does not change the underlying reason for the low or absent sperm, and repeat retrieval is sometimes needed.
Combining with other procedures
Surgical sperm retrieval is closely linked to IVF and ICSI: the sperm collected is injected into eggs in the laboratory. It can be timed to your partner's egg collection (a 'fresh' cycle) or done earlier so sperm can be frozen and used later. It is also linked to sperm freezing and storage, and to investigation of the cause of azoospermia.
Follow-up & long-term care
You usually learn on the day whether sperm was found and frozen. A follow-up appointment reviews healing, the laboratory result, and the plan for IVF/ICSI, including what to do if no usable sperm was found, such as considering a different method, repeat surgery, or donor sperm. Report any wound or pain concerns promptly.
- Frozen sperm needs ongoing storage, with consent renewed within HFEA time limits.
- Keep your contact and consent details up to date with the clinic so stored sperm is not lost.
- After more extensive testicular surgery, your team may check testosterone levels over time.
- Discuss whether one retrieval has provided enough sperm for future cycles or whether more may be needed.
Revision and secondary surgery reality
- If no sperm is found, a more extensive procedure such as micro-TESE may be considered, or donor sperm discussed.
- Repeat retrieval is sometimes needed for a later cycle if not enough sperm was frozen.
- More extensive testicular surgery can occasionally affect testosterone, sometimes needing monitoring.
- Finding sperm does not guarantee a successful IVF/ICSI cycle or a pregnancy.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear wound and pain advice, supportive underwear, and a named contact for problems.
- Same-day or prompt information on whether sperm was found and frozen.
- A follow-up appointment to review healing, the result and the IVF/ICSI plan.
- Monitoring of testosterone after more extensive surgery where appropriate.
- Proper storage, consent and record-keeping for any frozen sperm.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The method used (needle methods such as PESA/TESA, or surgical extraction such as TESE/micro-TESE).
- The type of anaesthetic, as a general anaesthetic and theatre time add cost.
- The surgeon or operator's fee and the facility or theatre fee.
- Laboratory work to search for and prepare the sperm.
- Freezing and ongoing storage of any sperm found.
- Screening tests and consultations before the procedure.
- Whether it is timed with IVF/ICSI or done as a separate, earlier step.
- Exactly which method and anaesthetic the quote covers.
- The surgeon or operator's fee and the theatre or facility fee.
- The laboratory fee for searching for and preparing sperm.
- Freezing and yearly storage fees for any sperm found.
- Screening test costs and any pre-procedure consultations.
- What happens to the cost if no sperm is found or a repeat procedure is needed.
- Whether the cost of the linked IVF/ICSI cycle is separate.
On the NHS? Surgical sperm retrieval is funded on the NHS for some men who meet local criteria, often alongside IVF/ICSI. Who qualifies is decided by NHS or HSC commissioners, not by national clinical guidance alone: NICE guidance (NG257) sets out the clinical recommendations for England, but each part of the UK — England, Scotland, Wales and Northern Ireland — has its own funding rules, and these can differ from one area to another and change over time. Access and waiting times vary, and many people pay privately for speed or choice. Ask the relevant NHS or HSC fertility service, or your clinic, to confirm the current eligibility rules where you live.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told how the chance of finding sperm depends on the cause (blockage versus low production).
- Not having a clear plan for what happens if no sperm is found on the day.
- Not understanding the small risk to testosterone from more extensive testicular surgery.
- Not completing the HFEA consent and storage forms for the sperm.
- Assuming the sperm can be used naturally rather than only with IVF/ICSI.
Marketing red flags
- Describing the procedure as 'guaranteed' to find sperm.
- Calling it 'quick and without risks' without mentioning bruising, haematoma, infection or the testosterone risk.
- Not distinguishing obstructive from non-obstructive azoospermia when quoting success.
- Pressure to book surgery before proper investigation of the cause.
- No clear plan or honest discussion of what happens if no sperm is found.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Is my problem likely a blockage or low sperm production, and which method do you recommend for me?
- What is my realistic chance of finding usable sperm with this method?
- Will the procedure be timed with my partner's egg collection, or will sperm be frozen first?
- What is the plan if no sperm is found on the day?
- What are my specific risks, including any effect on testosterone, given my situation?
- How will my sperm be stored, and what consent and storage rules apply?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will it hurt?
Will sperm definitely be found?
Is there a scar?
Can the sperm be used to conceive naturally?
Can I get it on the NHS?
Could it affect my hormones or future fertility?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS (Manchester) — Surgical sperm retrieval patient leaflet NHS England — Clinical commissioning policy: surgical sperm retrieval NHS — Infertility treatment HFEA — Fertility preservation HFEA — Consent to treatment and storage NICE — Fertility problems: assessment and treatment (NG257) NHS inform (Scotland) — Infertility and access to treatment NHS Wales — Specialist fertility services commissioning policy (CP38) Northern Ireland — Regional Fertility Centre (Belfast HSC Trust)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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