Testicular Biopsy TESE micro TESE / PESE Fertulity Fertility Center

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.

What Is Testicular Biopsy?

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. Maria Oikonomou Obstetrician – Gynecologist

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

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