Testicular Biopsy TESE micro TESE / PESE Fertulity Fertility Center

What Is Testicular Biopsy?

Testicular biopsy is a specialized medical procedure applied to men with severe fertility issues, such as azoospermia, aiming to retrieve viable sperm directly from the testicle or the epididymis. Techniques such as TESE (Testicular Sperm Extraction), micro-TESE (microdissection testicular biopsy), and PESE (Percutaneous Epididymal Sperm Extraction) offer men who have no sperm in their ejaculate the possibility of fathering a biological child via in vitro fertilization (IVF/ICSI). At Fertulity, we have the experience and expertise to safely apply the most advanced sperm retrieval methods, providing our patients with a personalized approach and the highest possible chances of success.

Testicular biopsy is a diagnostic and simultaneously therapeutic procedure applied in cases of male infertility, when no sperm is detected in the semen analysis (azoospermia). Its goal is the direct retrieval of tissue or sperm from the testicle or the epididymis, to be used in assisted reproduction procedures such as intracytoplasmic sperm injection (ICSI). Depending on the type of azoospermia (obstructive or non-obstructive), the biopsy is performed either through simple sperm aspiration (PESE), surgical tissue retrieval from the testicle (TESE), or using a microscope (micro-TESE), which allows identification of seminiferous tubules with the highest likelihood of sperm production. The choice of technique depends on the patient’s history, diagnostic tests, and the medical team’s expertise. Testicular biopsy is crucial in documenting the potential for biological fatherhood and in determining the appropriate therapeutic approach.

TESE (Testicular Sperm Extraction)

The TESE technique is one of the most widely used methods of testicular biopsy and is mainly applied in men with non-obstructive azoospermia. It involves the surgical extraction of a small tissue sample from the testicle, in search of sperm that may be trapped within the seminiferous tubules. The procedure is performed under local or general anesthesia, is short and painless, and the sperm retrieved can be used immediately for ICSI or cryopreserved for future use. TESE is an ideal option when there are no visible signs of spermatogenesis in the ejaculate, but there is suspicion that small foci of sperm production may exist within the testes.

micro-TESE (Microdissection Testicular Sperm Extraction)

Micro-TESE is the most advanced form of TESE and is mainly recommended for men with severe, non-obstructive azoospermia. It is a microsurgical technique requiring the use of a high-resolution surgical microscope, through which the urologist-andrologist identifies seminiferous tubules with the highest likelihood of sperm production. Microscope usage allows for the minimum possible tissue removal, reducing the risk of testicular injury and significantly increasing success rates. Micro-TESE is considered the most effective choice for men with complete absence of sperm and previous failed attempts with other methods. In Greece, the technique is successfully performed by specialized centers such as Fertulity.

PESE (Percutaneous Epididymal Sperm Extraction)

The PESE technique is used in cases of obstructive azoospermia, where sperm production in the testicles is normal but its passage is blocked due to obstruction of the vas deferens or its absence. PESE is performed using a fine needle inserted percutaneously into the epididymis (the area where sperm is stored prior to ejaculation) to collect fluid containing sperm. It is a quick, minimally invasive procedure that does not require an incision and is often performed without anesthesia or with simple local anesthesia. PESE offers high success rates in cases with an obstructive cause, and the retrieved sperm can be used for ICSI or frozen.

Each of the above techniques is selected based on medical history, test results, and the accurate diagnosis of the type of azoospermia, always aiming for optimal outcomes and patient safety.

Wondering which technique is right for you?

At Fertulity, we offer all modern testicular biopsy methods, tailored to each man’s individual needs.

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When It’s Indicated – Benefits for Azoospermia & Other Conditions

Testicular biopsy is a key therapeutic option in male infertility cases when no sperm is detected in the semen analysis — i.e., in azoospermia. Azoospermia is categorized into two main types: obstructive (normal sperm production but blocked outflow) and non-obstructive (reduced or absent spermatogenesis).

Biopsy is also indicated in:

Men with previous failed IVF attempts due to inability to retrieve sperm

Cases of genetic or hormonal disorders affecting sperm production

Individuals who have undergone chemotherapy or radiation

Men with congenital absence of the vas deferens

Men wishing to collect and freeze sperm prior to hormone therapy or surgeries that may affect fertility

The benefits of the procedure are significant, as it can provide solutions for couples facing male infertility and allow the use of biological sperm for fertilization, avoiding the use of donor sperm.

Explore your options safely

Procedure & What to Expect

The testicular biopsy procedure is generally safe and well-tolerated, especially when performed by a specialized physician in an organized assisted reproduction setting. Depending on the chosen technique (TESE, micro-TESE, or PESE), the details vary, but the basic stages are similar.

Preoperative Preparation

Before the procedure, the patient undergoes blood and hormonal tests, testicular ultrasound, and possibly genetic screening. These tests determine the type of azoospermia and help in choosing the appropriate technique.

Anesthesia

Testicular biopsy can be performed under local anesthesia, sedation, or general anesthesia, depending on the technique and the patient’s needs. Micro-TESE, due to its microsurgical nature, is usually done under general anesthesia to ensure complete stillness and precision.

Surgical Procedure

PESE: Duration 15–30 minutes. No incision required. Performed with a needle in the epididymis.

TESE: Duration approximately 30–45 minutes. Involves a small scrotal incision and tissue removal.

micro-TESE: Duration 1–2 hours. Microsurgical approach using a microscope, maximum precision, minimal trauma.

The retrieved tissue is immediately sent to the lab for sperm identification.

Recovery & Postoperative Care

Recovery is usually quick, with mild discomfort or swelling during the first 1–2 days. Patients are advised to avoid physical activity, sexual intercourse, and prolonged standing for 3–5 days. Antibiotics and painkillers are given preventively. In techniques like micro-TESE, healing is excellent and complications are rare.

The procedure is a major step toward fertility and opens the path for advanced assisted reproduction treatments using biological sperm. At Fertulity, we ensure scientific excellence and compassionate care at every stage.

Frequently Asked Questions About Testicular Biopsy (TESE, micro-TESE, PESE)

Is testicular biopsy painful?

Testicular biopsy is generally painless, as it is performed under local or general anesthesia depending on the technique and the patient’s needs. After the procedure, mild discomfort or swelling may occur, which is managed with simple painkillers and ice packs. Most patients return to daily activities within a few days.

Is there a chance that no sperm will be found?

Yes, there is a possibility that the biopsy may not retrieve sperm, especially in cases of non-obstructive azoospermia with complete absence of spermatogenesis. However, techniques like micro-TESE significantly increase the chances of locating sperm — even in very difficult cases — thanks to microsurgical precision.

Can the sperm retrieved be frozen?

Of course. If viable sperm is found during the biopsy, it can be cryopreserved for future IVF/ICSI attempts. Cryopreservation is an important option for men who wish to preserve their fertility before undergoing chemotherapy or testicular surgery.

What’s the difference between testicular biopsy and a standard semen analysis?

Testicular biopsy is an invasive procedure in which tissue or sperm is collected directly from the testicle or epididymis. In contrast, semen analysis is non-invasive and involves analyzing semen collected naturally. Biopsy is used when no sperm is found in the ejaculate to investigate whether any exists inside the testicles.

Is there a risk to fertility or testicular function after biopsy?

When performed by an experienced team using modern techniques, the risk of long-term testicular damage is extremely low. In micro-TESE, in particular, tissue removal is highly precise, minimizing injury. The patient's overall fertility potential is not negatively affected.

How long before IVF should the biopsy be performed?

The timing of the biopsy depends on the couple’s overall plan. It may be done a few days before ICSI if fresh sperm is required, or earlier with sperm cryopreservation. The doctor will determine the ideal timeframe based on the partner’s condition, IVF protocol, and previous cycle outcomes.

What factors affect the success of testicular biopsy?

Age, hormonal profile, genetic background, and the type of azoospermia are key factors influencing success rates. Use of microsurgical techniques like micro-TESE by experienced urologists significantly improves the chances of retrieving sperm — even in men with very low spermatogenesis.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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Dr. Chrysostomos Papadopoulos - Specialist in Infertility, Endocrinology & Menopause in Athens

Dr. Maria Oikonomou Obstetrician – Gynecologist

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The First Step Starts Now

You don’t need to have all the answers to begin.
All it takes is one first step, and a team that truly listens.

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FertulityThrough the Words of our Parents

100% genuine, public Google reviews.
Because every fertility journey begins with honesty and trust.

      EXCELLENT  
   Based on 12 reviews 
    
 
 
 
   
 
 
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   Μαρια 
 26 days ago
 
 
  The word "thank you" to Dr. Makis Papadopoulos is too small to describe the gratitude we feel for this man. I am pregnant after IVF, having succeeded on the first attempt, and we owe this exclusively to our doctor. First Contact & Communication: From the very first contact, he won us over with his kindness, enthusiasm and willingness to dedicate as much time as we needed. Willing to explain everything in every detail, he solved every question we had in depth — not even a professor to students would analyze them with such patience and contagiousness! Scientific Training: He is an excellent scientist, with deep knowledge of the subject, a perfectionist and focused professional who leaves absolutely nothing to chance. He designed the right treatment for us, solving every problem down to the last detail, making us feel that whatever problem arises, it is certain that it will be solved. HUMANITY & SUPPORT: The most important thing, however, is his humanity. Communication with him was Immediate and he always had as much time as you needed on the phone to solve every question. He showed a deep, real interest, embracing us not just as a doctor, but as if he were our brother. We highly recommend him to every couple starting this journey. He deserves blind trust! We thank you from the bottom of our hearts for the greatest miracle of our lives!

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   Alexandra 
 52 days ago
 
 
  I don't often write reviews, but I feel that Mr. Makis truly deserves it. From the very first moment, he made me feel safe and confident. He listened carefully to what was on my mind, answered every question I had, and explained everything in a simple way, always based on scientific data. Many times, he even sent me relevant scientific studies so that I could better understand why he was suggesting a particular approach. But what stood out to me the most was that he didn't stop at the appointment. He followed up, was genuinely interested in my progress, and was available when I needed him. This is something you rarely encounter. Fortunately, he returned to Greece. He is one of the few doctors who, beyond their knowledge, remain above all human beings. He makes you feel like he sees you as a person and not as just another incident.

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   Matina 
 69 days ago
 
 
  A big thank you to Dr. Makis Papadopoulos who supported us from day one, who checked every little detail, who explained to us every move-step, every test, every medication for the reason we were doing it and what we would achieve. With incredible experience, knowledge, a lot of patience (because we had two other failed attempts with another doctor) and trust, within 8 months he adapted the protocols for our case and we achieved the positive result and we hold in our arms a priceless diamond. Above all, a rare person, calm and always available to listen to our concerns and reassure us. I highly recommend him!

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   Eva 
 93 days ago
 
 
  Thanks to Dr Makis Papadopoulos, I am now holding my two beautiful babies in my arms! He is a true expert. Professional with a human centric approach, friendly and empathetic, always available to answer our (many many) questions. I trust Dr Makis blindly and, honestly, I cannot recommend him enough!
  
 
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   Ivy 
 100 days ago
 
 
  My experience with Dr. Makis took me from a clinical stagnation to an incredible breakthrough, highly recommend Dr. Makis! Navigating the exhausting world of IVF, you know how devastating it is to watch your protocol dosages go up while your results go down. After three intense, high-dosage cycles with a previous clinic, I was left feeling incredibly discouraged. Despite escalating medications and growth hormones, my blastocyst yield was dwindling, culminating in a heartbreaking round with zero blastocysts. I knew I needed a doctor who didn't just follow a standard script, but who truly understood the nuances of egg quality and customized protocols. That is when I found Dr. Makis. Dr. Makis completely revolutionized my treatment plan. Instead of just pushing maximum dosages, he took a highly strategic, tailored approach. The result? Quality over pure protocol size. While my previous doctors kept increasing the medication dosages (which yielded fewer or zero blastocysts), Dr. Makis completely changed the strategy. He lowered the heavy stimulation, introduced smart egg-quality support (like melatonin), changed the protocol style entirely, and achieved a 700% increase in blastocysts compared to my best previous rounds. Beyond the incredible results, Dr. Makis brings a level of expertise, precision, and reassuring care that is rare to find. He looks at you as an individual, not a statistic, and knows exactly how to pivot when traditional routes fail. If you are looking for a specialist who can turn a difficult prognosis into an overwhelming success, look no further than Dr. Makis. I am incredibly grateful for his care.
  
 
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   Olga 
 111 days ago
 
 
  Dr. Makis Papadopoulos was excellent, professional, and very reassuring throughout the entire process. Thanks to his expertise and guidance, we were able to identify the issue early and take the appropriate steps from the beginning. He took the time to explain everything clearly, answered all our questions with patience, and made us feel comfortable and confident throughout our journey. We truly appreciated his caring approach, professionalism, and dedication. Highly recommended!
  
 
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   Euaggelia 
 122 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist and above all a rare person! He is an approachable and smiling doctor, with excellent medical knowledge, who from the first moment I met him made me feel comfortable and trust him completely, answering every question I had with patience and documenting every answer with scientific studies and articles! The most important thing, however, is that Dr. Makis Papadopoulos is always there on the other end of the line to listen to you and reassure you without a trace of haste, a doctor who truly cares and makes you feel like he is your own person! Makis, thank you very much for everything!!! I am very lucky to have met you!

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   Anastasia 
 129 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist with a human-centered interest. Our collaboration was excellent from the very beginning and he made me feel confident and secure by explaining every step of the process in great detail. I highly recommend him!

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   Fay 
 131 days ago
 
 
  Dr Makis Papadopoulos is very professional, caring and attentive. Very thorough in explaining the whole process throughout every step. Thank you! Highly recommended!!
  
 
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   Christina 
 134 days ago
 
 
  I would like to share my experience with Dr. Makis Papadopoulos, an outstanding gynecologist and scientist. We first connected in the summer of 2024, while he was based in Germany, through a mutual acquaintance, following a particularly challenging period for us. Prior to meeting him, we had gone through repeated unsuccessful attempts of stimulation and fertilization with other gynecologists. Unfortunately, those approaches relied largely on standardized protocols, without sufficient personalization to address the specific needs of my case. From the very beginning, Dr. Makis stood out for his human-centered approach and his willingness to dedicate time to truly understand our situation in depth. With strong, up-to-date scientific knowledge, he approaches every case holistically, focusing on individualized treatment and adapting protocols to the patient's unique needs. Throughout our collaboration, which now spans approximately two years (with a few breaks on our side), he has consistently been available, supportive, and clear in his guidance. He inspired confidence and helped us stay positive even during difficult phases of the journey. Beyond his scientific expertise, what truly sets him apart is his genuine care for the person behind each case: his empathy, honesty, and continuous effort to achieve the best possible outcome. My husband and I are deeply grateful for his support and guidance, and we now feel ready and optimistic to move forward to the next final stage. We highly recommend him to anyone seeking a gynecologist with true expertise, professionalism, and compassion. I would like to share my experience with Dr. Makis Papadopoulos, an excellent gynecologist and scientist. We met in the summer of 2024, when he was in Germany, through a mutual acquaintance, after a particularly demanding period for us. Before meeting him, we had gone through repeated failed attempts at stimulation and fertilization with other gynecologists. Unfortunately, the approaches that had been followed were mainly based on standardized protocols, without the necessary individualization to the specifics of my case. From the beginning, Dr. Makis stood out for his human approach and his willingness to spend time to understand our case in depth. With modern knowledge and scientific training, he approaches each issue multidimensionally, emphasizing the individualization of treatment and adapting the protocols to the real needs of the patient. During our collaboration, which now spans about two years (with short breaks on our part), he was always available, supportive and clear in his guidance. He inspired confidence in us and helped us remain optimistic even in difficult phases. In addition to his scientific competence, what sets him apart is his genuine interest in the person behind each case: his empathy, his honesty and his constant effort to achieve the best possible outcome. My husband and I thank him warmly for his support and guidance and we now feel ready and optimistic to move on to the next final stage. We highly recommend him to anyone looking for a gynecologist with real knowledge, professionalism and humanity.

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   Faidra 
 135 days ago
 
 
  Dr. Makis Papadopoulos is an excellent gynecologist and above all an excellent person! I truly thank him for his support and care during the egg freezing process. Although my case was particularly demanding, he stood by me with patience, knowledge, great experience and real interest. Our communication was direct and human, while his availability at the many appointments made me feel safe at every step. The protocols were designed specifically for me, aiming for the best possible result, while also taking into account the cost of the medications. I recommend him with all my heart to every woman who wants to trust someone for something so important and sensitive for her.

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   Iliana 
 137 days ago
 
 
  I highly recommend Dr. Makis, he is an incredible specialist. My journey was far from easy, encountering several challenges that  made the process feel overwhelming at times. What sets him apart is his willingness to go beyond standard procedures. He developed a specialized, custom protocol, tailored to my situation, which ultimately made all the difference. Beyond his technical expertise, his calm and clear communication kept me grounded throughout the process. I am so grateful for his persistence and high level of care!

Why choose FertUlity?

Because every fertility journey deserves the right support. At FertUlity, we provide science-based fertility care with a human approach. We support every path, from fertility assessment and preservation to modern assisted reproduction.

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