TESE (Testicular Sperm Extraction) in Turkey: what it is and how it works
TESE (testicular sperm extraction) is a surgical procedure in which a small piece of tissue is removed from the testis so that an embryologist can search it for sperm. Any sperm found are used fresh or frozen for ICSI, in which a single sperm is injected into an egg. TESE is mainly offered to men with non-obstructive azoospermia, meaning there are no sperm in the ejaculate because the testis makes very few or none, a condition that affects about one in a hundred men and is behind a sizeable share of severe male infertility.
This guide explains how conventional TESE and micro-TESE work, who needs them, how they compare with TESA, what the evidence says about success, the approximate cost in Turkey against the UK, US and Germany, recovery and risks. For the full range of care see our overview of IVF and fertility treatments in Turkey.
Who needs TESE?
The main group is men with non-obstructive azoospermia, where hormone tests and ultrasound suggest that sperm production is impaired. Causes include genetic conditions such as Klinefelter syndrome and some Y-chromosome microdeletions, undescended testes in childhood, damage from chemotherapy or radiotherapy, mumps orchitis, torsion and, in many men, no cause that can be found. TESE is also used when needle retrieval (TESA or PESA) has failed in a man with a blockage, and in men with very severe oligozoospermia whose ejaculated sperm are unusable.
Before surgery most doctors ask for two semen analyses, hormones (FSH, LH, testosterone), a karyotype and Y-chromosome test, and a scrotal ultrasound. A testicular biopsy sometimes helps clarify the pattern of production before retrieval is planned.
How is conventional TESE performed?
The operation is normally done under general anaesthesia or sedation with local anaesthesia. The surgeon makes a small cut in the scrotal skin, opens the covering of the testis and removes one or more small pieces of tissue, often from different areas. The incision is closed with dissolvable stitches. The tissue goes to the laboratory at once, where it is shredded and examined for sperm; this can take from 30 minutes to a few hours. If sperm are found, they are used or frozen; if not, the surgeon may take more samples before closing. Operating time is usually 30 to 60 minutes.
What is micro-TESE and how does it differ?
Micro-TESE uses an operating microscope. The surgeon opens the testis wider and inspects the seminiferous tubules at high magnification, because tubules containing sperm are usually plumper and more opaque than empty ones. Only those tubules are taken, so less tissue is removed and the chance of finding sperm is higher than with blind sampling, especially when production is patchy. The operation takes longer, often 1 to 3 hours, and requires a surgeon trained in microsurgery and an embryologist working alongside in the theatre.
| Method | Best suited to | Typical limits |
|---|---|---|
| TESA (needle) | Obstructive azoospermia | Low yield when production is patchy or very low |
| Conventional TESE | Non-obstructive azoospermia; centres without microscope capability | More tissue removed for each unit of sperm found |
| Micro-TESE | Non-obstructive azoospermia, Klinefelter syndrome, failed earlier retrieval | Longer operation; needs specialist surgeon and laboratory |
Guidelines from the European Association of Urology treat micro-TESE as the preferred technique in non-obstructive azoospermia, because it removes less tissue for a similar or higher retrieval rate. Ask which method is proposed in your case and why.
Does TESE work? Realistic chances of finding sperm
In obstructive azoospermia sperm are found in almost all men. In non-obstructive azoospermia, published retrieval rates vary widely, roughly from one in five to just over half, depending on the cause, the technique and the laboratory. They are generally higher in men with Klinefelter syndrome or hypospermatogenesis and lower in those with Sertoli cell only pattern or certain Y-chromosome deletions. Hormone treatment before surgery, sometimes used in selected men, may help, but the evidence is limited and the decision is individual. If sperm are found, ICSI results depend largely on the woman's age and egg reserve. Be cautious about any clinic that gives a precise success percentage without reviewing your tests.
TESE (Testicular Sperm Extraction) cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for the extraction operation with laboratory sperm search, not clinic quotes. They exclude the ICSI cycle, the partner's medication and egg collection. Price depends on conventional or micro-TESE, the length of the operation, the anaesthesia, hospital stay and sperm freezing. Each clinic confirms its own price in writing.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,200 – €4,500 |
| United Kingdom | €3,000 – €7,500 |
| United States | €5,000 – €14,000 |
| Germany | €3,000 – €8,000 |
Micro-TESE sits at the upper end of each range because of the longer operation and the microsurgical team. Ask whether the quote includes sperm freezing and storage, one repeat laboratory search, medication and a post-operative review, and what is charged if no sperm are found.
How does TESE fit with ICSI and your partner's cycle?
Clinics use one of two plans. In a fresh plan, TESE is done on the day of the woman's egg collection or the day before, so sperm are injected immediately. The risk is that if no sperm are found, the eggs have already been collected. In a frozen plan, TESE is done first, sperm are frozen and the woman's stimulation starts only after sperm are confirmed; this is the safer plan for non-obstructive cases, although sperm may not always survive thawing and a few men need a second operation. Our page on pharmacological stimulation for IVF explains the female side, and our guide to ICSI explains fertilisation.
What does TESE feel like, and how long is recovery?
Because the operation is done under anaesthesia you feel nothing during it. Afterwards the scrotum is sore, swollen and bruised for several days; stronger painkillers are sometimes given for the first one to two days, then simple painkillers are enough. Ice packs wrapped in cloth and snug supportive underwear help. Most men go home the same day or after one night. Desk work is usually possible after three to five days; avoid heavy lifting, running, cycling and sex for about two weeks, longer after micro-TESE if the surgeon advises. Bruising can spread to the groin and thighs and fades within two weeks.
Risks of TESE and what happens to testosterone
Immediate risks are pain, bruising, swelling, a blood collection in the scrotum and infection. Removing testicular tissue can reduce testosterone temporarily, and in a minority of men, particularly after extensive conventional sampling, hormone levels may stay low and need monitoring; the European Association of Urology and the American Urological Association both note this as a reason for the microsurgical approach. A few men develop scarring or a small area of calcification that appears on later ultrasounds. Sperm may not be found, which is a disappointment rather than a complication, but it is the most important risk to discuss in advance. Genetic counselling is advised, because some conditions can be passed on to children.
Trip length and how to choose a clinic
For a standalone TESE most patients stay three to four nights, including consultation, surgery and a check. If the retrieval is tied to your partner's egg collection, the stay follows the stimulation schedule, normally 10 to 14 days. Choose a urologist or andrologist who performs micro-TESE regularly, working with an embryology laboratory that can search tissue, freeze sperm and perform ICSI on site. Red flags include a guaranteed success rate, no genetic and hormone work-up, no named surgeon and no plan for the case where no sperm are found. Read how our process works and request a plan through our free quote page.
- Is micro-TESE planned, or conventional TESE, and why?
- How many micro-TESE operations has the surgeon done for my diagnosis?
- Will sperm be used fresh or frozen, and is storage included?
- What is charged if no sperm are found, and can the operation be repeated?
- How will testosterone be checked afterwards?
Hospitals with IVF & Fertility in Turkey
Frequently asked questions
TESE is testicular sperm extraction: small pieces of tissue are removed from the testis and searched for sperm that can be used or frozen for ICSI. It is mainly used when production is too low for sperm to appear in the semen.
Micro-TESE uses an operating microscope to pick out tubules most likely to contain sperm, so less tissue is removed and the chance of finding sperm is higher than with conventional sampling.
Approximate ranges are €1,200 to €4,500 in Turkey against about €3,000 to €7,500 in the UK. Micro-TESE costs more, and the ICSI cycle is priced separately. The clinic confirms its fee in writing.
It depends on the cause. In obstructive cases sperm are almost always found. In non-obstructive azoospermia published rates range widely, and no honest clinic can give a figure before reviewing your tests.
The operation is done under anaesthesia. Afterwards the scrotum is sore, swollen and bruised for several days, usually managed with painkillers, ice packs and supportive underwear.
Desk work is usually possible after three to five days. Heavy exercise and sex are avoided for about two weeks, or longer after micro-TESE if the surgeon advises.
TESA uses a needle without a cut and suits blockages. TESE removes tissue through an incision and suits men whose testes produce very few sperm.
Removing tissue can temporarily lower testosterone, and in a minority of men levels stay low. Micro-TESE removes less tissue, and doctors often check hormones afterwards.
Options include a repeat attempt after some months, donor sperm or adoption. A good clinic explains this and its charges in advance.
Three to four nights for a standalone operation. If it is combined with your partner's IVF cycle, plan for 10 to 14 days, as the clinic advises.