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Surgical sperm retrieval before cancer treatment | CION Cancer Clinics
TESE is a short procedure where a urologist takes a tiny piece of testis tissue and searches it for sperm. It is used before cancer treatment when a man cannot give a sample, or his sample has no sperm. PESA and TESA use a needle instead of a cut. Any sperm found is frozen for later use with ICSI. This page explains each method, the day itself, and its limits. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is TESE, and when is it used before cancer treatment?
- What is the difference between PESA, TESA, TESE and micro-TESE?
- What happens on the day of sperm retrieval?
- What do men worry about that is not true?
- What do the words on a semen or retrieval report mean?
- Who is surgical sperm retrieval not suitable for?
- Common questions about TESE and sperm retrieval
The short answer
What is TESE, and when is it used before cancer treatment?
TESE, testicular sperm extraction, is a short procedure where a urologist takes a tiny piece of tissue from the testis and looks for sperm inside it. It is used before cancer treatment when a man cannot give a semen sample, or when his sample has no sperm in it.
Why a sample sometimes has no sperm
Some cancers lower sperm production before any treatment is given. Testicular cancer, lymphoma and leukaemia are the ones most often linked with this. In other men, a blockage stops sperm reaching the semen even though the testis is still making them. In both cases, sperm may still be found inside the testis itself.
What the retrieved sperm is used for
Any sperm found is frozen straight away. Later, it can only be used with ICSI, where one sperm is placed directly into one egg in the laboratory. The numbers found are usually too small for other methods.
This page explains the procedures. It cannot tell you whether sperm will be found in your case. Nobody can know that until the tissue is examined.The options
What is the difference between PESA, TESA, TESE and micro-TESE?
The names describe where the sperm is taken from and how. The urologist chooses based on why the sample has no sperm.
PESA
A fine needle draws fluid from the epididymis, the coiled tube that sits behind the testis and stores sperm. There is no cut.
Usually used when
- The testis makes sperm but a blockage stops them leaving
TESA
A needle is passed into the testis itself to draw out a small amount of tissue. Like PESA, it is done without a cut.
Usually used when
- PESA finds no sperm
- A quick needle attempt is preferred first
TESE
A small cut is made in the skin of the scrotum and one or more small pieces of testis tissue are removed and examined for sperm.
Gives more tissue to search than a needle.Micro-TESE
The same approach as TESE, but using an operating microscope to pick out the small areas most likely to hold sperm. It takes longer and needs a surgeon trained in it.
Ask your centre whether it is available there.Not sure whether this applies to you?
Ask an oncologistOn the day
What happens on the day of sperm retrieval?
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Before you arrive
You will have blood tests, including infection tests needed before anything is stored. You will be told whether to stop eating, which depends on the kind of anaesthetic used.
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Anaesthetic
Needle methods are often done with local anaesthetic, which numbs the area while you stay awake. TESE and micro-TESE are more often done with sedation or a general anaesthetic.
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The procedure
A needle procedure is short. An open TESE takes longer, and micro-TESE longer still. The tissue goes straight to the laboratory, where an embryologist, a scientist who handles eggs and sperm, searches for sperm under a microscope.
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Going home
Most men go home the same day. You will need someone to take you home after sedation. Supportive underwear and simple pain relief prescribed by the team help with the soreness.
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The result
You are usually told whether sperm was found on the same day or soon after. Anything found is frozen for later use.
!
After the procedure, do not wait on these
Some soreness and bruising is expected for a few days. Call the team or go to the nearest emergency department the same day if the scrotum swells quickly and becomes very large or tense, if the wound keeps bleeding, or if you develop a fever with increasing pain or redness. If chemotherapy is about to start, tell them that too, because an infection then needs faster care.
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Commonly believed
What do men worry about that is not true?
"No sperm in the sample means I can never be a father."
A semen test looks at what reaches the outside. Sperm can still be present inside the testis. Retrieval is how that is checked, and in some men it finds enough to freeze.
"Taking tissue from the testis will make me impotent."
Erections depend on nerves and blood flow, not on the small area of tissue removed. Hormone levels can dip for a while after larger procedures, and your team may check them.
"It is a big operation that will delay chemotherapy for weeks."
These are short day procedures. Recovery is usually measured in days. Your oncologist and urologist agree the timing so cancer treatment is not put at risk.
"If they find sperm, a pregnancy is certain."
Finding sperm keeps the door open. A pregnancy later still depends on ICSI, the partner's age and health, and how the sperm survive thawing. Nobody can promise it.
On your report
What do the words on a semen or retrieval report mean?
- Azoospermia
- No sperm seen in the semen sample. It does not always mean no sperm are being made.
- Obstructive
- Sperm are being made but a blockage stops them reaching the semen. Retrieval is often more successful in this group.
- Non-obstructive
- The testis is making very few sperm or none. Retrieval may still find small pockets of sperm.
- ICSI
- A laboratory method where one sperm is injected into one egg. It is how retrieved sperm is used later.
- Cryopreserved
- Frozen and stored at very low temperatures for later use.
Honest limits
Who is surgical sperm retrieval not suitable for?
Retrieval is not the first step for a man who can give a sample with sperm in it. Sperm banking is simpler, needs no procedure and is tried first.
When the body or the cancer says no
A man with a very low platelet count, a bleeding problem or a serious infection may not be safe for even a small procedure right now. A man who needs cancer treatment at once may have no time for it. In some men with testicular cancer, retrieval can be done during the operation to remove the affected testis, and that is worth asking about.
What the team weighs
The urologist and oncologist look at the reason for the missing sperm, your blood counts, the treatment date and your wishes. They can tell you what they recommend and why. The decision about whether to go ahead is made with them, not from a page.
Boys who have not reached puberty
Before puberty there is no sperm to retrieve. Freezing testicular tissue for these boys is still being studied.
Questions we are asked
Common questions about TESE and sperm retrieval
Does TESE hurt?
You should not feel pain during it, because the area is numbed or you are asleep. Afterwards, soreness, bruising and some swelling are common for a few days. The team will tell you which pain relief to take and when. Tell them if the pain keeps getting worse rather than better.
How soon can I start chemotherapy after retrieval?
That timing is agreed between your urologist and oncologist, because it depends on how the wound is healing and how urgently treatment is needed. Needle procedures usually need less recovery than an open TESE. Ask both doctors to confirm the date together before you go home.
What if no sperm is found?
It is very hard news, and it is worth hearing it with someone beside you. Options for having a family later still exist, including donor sperm and adoption. Some men also recover sperm production after treatment, which can be tested for later. A counsellor can help you think this through.
Can retrieval be done during my cancer operation?
Sometimes. In testicular cancer, sperm can occasionally be searched for in the testis being removed, or in the other testis, during the same anaesthetic. This needs planning with the laboratory in advance. Ask your surgeon before the date is fixed.
How long does recovery take?
Most men are back to light daily activity within a few days. You will usually be advised to avoid heavy lifting, sport and sex for a short while. Your team will give you specific instructions for the procedure you had, and they are the ones to follow.
Will it affect my hormones?
Needle procedures are unlikely to. After larger procedures, especially repeated ones, testosterone levels can fall for a time. Signs include low energy and low sex drive. Your team can check a blood level if you notice these.
Can retrieved sperm be used for IUI?
Usually not. The number of sperm retrieved is normally too small, so it is used with ICSI, where a single sperm is placed into each egg. That means your partner would need egg collection as part of IVF when you are ready to try for a child.
Does a teenager need a parent's consent?
Yes. For anyone under eighteen, a parent or guardian signs consent. The boy should still be told what is being done and why, in words that fit his age. The team will usually speak to him on his own for part of the conversation.
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Sources
- National Cancer Institute — Fertility issues in boys and men with cancer
- American Cancer Society — Fertility and sexual side effects
- Macmillan Cancer Support — Fertility and cancer
- NICE — Fertility problems: assessment and treatment (CG156)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Sperm Banking: The Process and What It CostsThe simpler first step when a sample can be givenWhy the Window Closes Before Treatment StartsWhy retrieval has to happen before the first doseAnaesthesia for Cancer SurgeryLocal, sedation and general anaesthetic explainedCost of Fertility Preservation in HyderabadWhat retrieval and storage add to the bill
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