TESA (Testicular Sperm Aspiration) in Turkey: what it is and how it works
TESA (testicular sperm aspiration) is a short procedure in which a fine needle is passed through the scrotal skin into the testis to draw out sperm-containing fluid and tissue. The sample goes straight to the embryology laboratory, where sperm are identified under a microscope and used fresh or frozen for ICSI, in which a single sperm is injected into each egg. TESA is offered to men who have no sperm in their ejaculate (azoospermia) because of a blockage or after a vasectomy, and sometimes to men whose ejaculated sperm cannot be used.
This guide explains how TESA works, when it is the right choice, how it compares with TESE and PESA, what affects success, the approximate cost in Turkey against the UK, US and Germany, and what recovery involves. For the full range of care see our guide to IVF and fertility treatments in Turkey.
Who is TESA suitable for?
TESA works best when sperm production is normal and something is stopping sperm reaching the semen. This is called obstructive azoospermia. Common causes are a previous vasectomy that cannot be reversed, congenital absence of the vas deferens (often linked to cystic fibrosis gene changes), scarring after infection or hernia surgery, and failed vasectomy reversal. It is also used when ejaculation is impossible or retrograde, for example after spinal injury, or when sperm in the ejaculate are of very poor quality because of DNA damage, a situation in which testicular sperm are sometimes chosen.
TESA is less reliable in non-obstructive azoospermia, where the testis itself produces very few sperm. In that case, a more extensive operation such as TESE or micro-TESE is usually needed, and a testicular biopsy may help to explain the cause.
How is TESA performed, step by step?
The procedure is normally done under local anaesthesia with or without light sedation; some centres use short general anaesthesia. The doctor cleans the scrotum, injects anaesthetic around the spermatic cord, then inserts a fine needle (often 21 to 23 gauge) attached to a syringe into the testis and applies gentle suction while moving the needle in several directions. A few samples may be taken from each side if needed. No cut is made and no stitches are needed. The whole procedure takes about 10 to 30 minutes.
The embryologist examines the sample immediately. If sperm are found, they are either injected into eggs the same day or frozen in small straws for later use. If none is seen, the team may repeat the aspiration, take more samples or advise a different method.
TESA, PESA or TESE: which method suits which man?
The names describe where the sperm come from and how. PESA collects them from the epididymis, the coiled tube behind the testis, with a needle. TESA collects them from the testis with a needle. TESE removes tiny pieces of testicular tissue through a small cut, and micro-TESE does the same with an operating microscope to select the best tubules.
| Method | Best suited to | Typical limits |
|---|---|---|
| PESA (epididymis, needle) | Obstructive azoospermia with healthy epididymal sperm | May yield few sperm; not helpful in non-obstructive cases |
| TESA (testis, needle) | Obstructive azoospermia; second choice after failed PESA | Small sample; lower yield when production is patchy |
| TESE or micro-TESE | Non-obstructive azoospermia | More tissue removed; needs a surgeon and laboratory with experience |
The right choice depends on the cause, hormone and genetic tests, and the laboratory's experience. Ask your doctor why TESA has been recommended and what the fallback is if no sperm are found.
Does TESA work? What does success depend on?
In obstructive azoospermia, sperm are found in the large majority of men by needle retrieval, and ICSI with retrieved sperm gives fertilisation and pregnancy rates close to those with ejaculated sperm in the same age group. In non-obstructive azoospermia the chance of finding sperm by needle is much lower, and professional guidelines from the European Association of Urology and the European Society of Human Reproduction and Embryology recommend TESE or micro-TESE in that group. The pregnancy outcome after ICSI depends mainly on the woman's age and egg reserve, the number and quality of eggs retrieved, the laboratory and the embryo transfer, not on TESA alone. No clinic can honestly give one success figure without knowing your tests, so be wary of promises.
TESA (Testicular Sperm Aspiration) cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for the aspiration procedure alone, usually with sperm preparation, not clinic quotes. They exclude the ICSI cycle itself, medication for the woman and egg collection, which are priced separately. They depend on the anaesthesia, the laboratory services and whether freezing is included. Each clinic confirms its own price in writing.
| Country | Approximate cost range |
|---|---|
| Turkey | €600 – €2,200 |
| United Kingdom | €1,500 – €4,500 |
| United States | €2,500 – €7,000 |
| Germany | €1,500 – €4,500 |
If TESA is combined with ICSI, ask for one itemised quote that lists the aspiration, sperm freezing, the ICSI cycle, medication and embryo transfer. Packages that look cheap sometimes leave out freezing or storage, which you may need if the retrieval and egg collection are on different days.
How does TESA fit into the IVF and ICSI timeline?
There are two usual schedules. In a fresh schedule, TESA is done on the same day as the woman's egg collection or the day before, so fresh sperm are injected. In a frozen schedule, TESA is done first, sperm are frozen, and the woman's cycle starts later; this is safer when the result is uncertain, because the couple does not begin stimulation unless sperm have been recovered. Our page on pharmacological stimulation for IVF explains how the woman's treatment is planned. The fertilisation method itself is described in our guide to ICSI.
Is TESA painful, and how long is recovery?
Local anaesthesia numbs the area, though some men feel pressure or a short ache while the needle moves. Afterwards expect mild to moderate scrotal tenderness, a little bruising and swelling for two to five days. Simple painkillers, supportive underwear and a cold pack wrapped in cloth are usually enough. Most men go back to desk work the next day or within two to three days. Avoid heavy lifting, strenuous exercise and sex for about a week, or until the doctor says it is fine. Because the needle leaves only a small puncture, wound care is minimal.
What are the risks of TESA?
The procedure is regarded as low risk. Common effects are discomfort, bruising and mild swelling. Less often there is a haematoma (blood collection) in the scrotum, infection or persistent pain. The needle can leave small areas of scarring in the testis; repeated aspiration is therefore avoided where possible. Seek medical help if you develop fever, rapidly increasing swelling, severe pain or redness. Genetic counselling is advised before ICSI in men with congenital absence of the vas deferens, because of the link with cystic fibrosis gene changes that can be passed on to children.
TESA (Testicular Sperm Aspiration) in Turkey: how many days to plan
For a TESA on its own two to three days are enough: consultation and tests, the procedure, and a check before you fly. If TESA is linked to your partner's treatment, the stay follows the egg collection schedule, which usually means about two weeks for a full stimulation and collection cycle if both partners travel together, or a shorter trip for each step if sperm are frozen first. Your coordinator should give you a written timetable. A video check after you return lets the team review pain and any bruising.
How to choose a clinic and questions to ask
Choose a centre with a urologist or andrologist who performs sperm retrieval regularly and an embryology laboratory that can freeze small numbers of sperm and perform ICSI on site. Ask whether the team has treated men in your situation, what happens if no sperm are found, and who covers the cost of a repeat attempt. Red flags include a guaranteed success rate, no hormone or genetic tests beforehand, a package without a breakdown and pressure to pay a deposit before a consultation. Read how our process works and request a plan through our free quote page.
- Is TESA the right method for my diagnosis, or should I have TESE or micro-TESE?
- Will sperm be used fresh or frozen, and is freezing included?
- Which tests do you need before the procedure?
- What happens if no sperm are found, and what is charged?
- How many days do we need to stay, and who follows up after we go home?
Hospitals with IVF & Fertility in Turkey
Frequently asked questions
TESA is testicular sperm aspiration: a fine needle is inserted into the testis to draw out sperm, which are then used or frozen for ICSI. No cut or stitches are needed and it takes about 10 to 30 minutes.
Men with no sperm in the ejaculate because of a blockage, a previous vasectomy or absent vas deferens, and sometimes men who cannot ejaculate. It is less reliable when the testis itself makes very few sperm.
Approximate ranges are €600 to €2,200 in Turkey against about €1,500 to €4,500 in the UK. The ICSI cycle is priced separately, and the clinic confirms all costs in writing.
Local anaesthesia, sometimes with sedation, numbs the area. Afterwards expect tenderness and bruising for two to five days, usually managed with simple painkillers and supportive underwear.
TESA uses a needle to aspirate sperm without a cut. TESE removes small tissue pieces through an incision and is used when sperm production is very low or patchy.
PESA takes sperm from the epididymis behind the testis, while TESA takes them from the testis itself. Both use a needle and both are mainly for obstructive azoospermia.
In obstructive azoospermia sperm are usually found. In non-obstructive azoospermia the chance is much lower. Pregnancy depends mostly on the woman's age and egg quality, so no honest clinic quotes one figure.
Most men return to work within one to three days and avoid heavy exercise and sex for about a week. Bruising and tenderness fade within days.
It can, but repeated needle passes may scar testicular tissue, so doctors usually freeze enough sperm at the first attempt and consider a different method if the result is poor.
Two to three days for the procedure alone. If it is linked to your partner's IVF cycle, the clinic will plan the stay around egg collection.