After a vasectomy
If a sterilisation has been performed and a reversal operation is not desired or not promising, sperm cells can be obtained directly from the testicle or epididymis.
Testicular biopsy – retrieving sperm directly from the testicle.
If no sperm cells are detectable in the ejaculate, fertilisable sperm can in many cases be obtained directly from the testicular tissue.
Indication
When and how is a testicular biopsy performed?
If no sperm cells are detectable in the ejaculate (azoospermia), an attempt can be made to obtain fertilisable sperm by means of PESA (percutaneous sperm aspiration) or an open testicular biopsy.
With the – often only few – sperm cells or their precursor cells obtained, fertilisation of the eggs can be carried out exclusively with the ICSI method.
Medical background
Azoospermia: when no sperm cells can be found in the ejaculate
Azoospermia is the term used when not a single sperm cell is detectable in semen analyses. This diagnosis always requires at least two independent examinations several weeks apart, because infections, fever, medication or heavy physical strain can temporarily change a semen analysis considerably.
Important to know: azoospermia does not automatically mean that no sperm are produced in the testicle. In many cases, sperm cells do develop in the testicular tissue – they simply do not reach the ejaculate, or only in such small numbers that they cannot be found there. This is exactly where the testicular biopsy comes in: it collects the sperm cells where they are produced.
Obstructive azoospermia
In the obstructive form, sperm production in the testicle is intact, but the transport route is interrupted. Causes can be a vasectomy, congenital changes of the seminal ducts, scarring after inflammation or operations in the groin area. In these cases, well-usable sperm cells can usually be obtained.
Non-obstructive azoospermia
Here, sperm production itself is impaired – for example due to hormonal causes, after chemotherapy or radiotherapy, in cases of undescended testicles that were not treated or treated late, or due to genetic factors such as an altered chromosome set or microdeletions on the Y chromosome. Even then, individual areas of the testicle with active sperm maturation can often still be found. Whether and to what extent this is the case can only be reliably assessed through the tissue retrieval itself.
For whom
When a testicular biopsy is an option.
Whether the procedure makes sense for you is always a decision we make together with you and on the basis of your complete findings.
Blocked seminal ducts
With congenital changes or scarring after inflammation and operations, sperm production is usually normal – only the way out is missing.
Impaired sperm production
In non-obstructive azoospermia, several tissue samples are taken in a targeted way to find areas with active sperm maturation.
Before cancer therapy
If no ejaculate can be obtained, testicular tissue can be retrieved and frozen before the start of chemotherapy or radiotherapy.
Preparation
What we clarify before a testicular biopsy.
Urological and hormonal assessment
Careful diagnostics precede the procedure: repeated semen analyses, a hormone assessment (including FSH, LH and testosterone), a physical examination and an ultrasound examination of the testicles. Added to this are the usual infection serologies, as required before any fertility treatment.
These findings help us assess whether the azoospermia is more likely obstructive or non-obstructive – and thus which technique and which extent of tissue retrieval makes sense.
Genetic counselling in our own laboratory
If sperm production is severely reduced or absent, we recommend human genetic counselling. Some forms of azoospermia have genetic causes, and the result can influence both the prospects of the procedure and the counselling for a later pregnancy.
The Wunschbaby Institut Feichtinger has its own on-site genetics laboratory. Findings therefore stay in-house, distances are shortened and you receive your results with a personal explanation – not as an anonymous lab report.
The procedure
How a testicular biopsy works.
The procedure itself is only one building block. What matters is that the laboratory, cryopreservation and the partner's treatment cycle are well coordinated.
1
Consultation
We review your findings, discuss the diagnosis and realistic expectations, and clarify which technique – PESA, TESA or open testicular biopsy (TESE) – makes the most sense in your situation.
2
Assessment and informed consent
This is followed by the supplementary examinations and the medical consent discussion about the procedure, possible risks and the alternatives. Your partner's treatment path is also planned now.
3
The procedure
The tissue retrieval is performed on an outpatient basis under brief anaesthesia or local anaesthetic. Only small tissue samples are taken; the wound is closed with self-dissolving sutures.
4
Processing in the laboratory
Our embryologists break up the tissue and systematically search under the microscope for sperm cells and their precursor cells. You learn the result promptly.
5
Cryopreservation
Sperm cells that are found are – as far as the quantity allows – frozen in several portions. This means no further procedures are needed for later treatment cycles.
6
Fertilisation by ICSI
In the partner's treatment cycle, each egg is injected directly with a single sperm cell. Only the ICSI method copes reliably with few and often immotile sperm.
Afterwards
After the procedure and what you can expect
The testicular biopsy is a small but real surgical procedure. In the first few days, a feeling of tension, slight swelling and tenderness are normal. Cooling, well-supporting underwear and physical rest – no sport, no heavy physical work, no sauna or swimming – help during the healing phase. The possible, overall rare complications include secondary bleeding, bruising and infections; we inform you about these personally and in detail before the procedure.
Whether sperm cells will be found cannot be guaranteed in advance – and we do not promise you any figures here. In obstructive azoospermia, the prospects are fundamentally more favourable than in non-obstructive azoospermia. If sperm cells are found, the probability is high that they can be used for an ICSI after thawing.
If no usable sperm cells can be obtained, your path does not end here. We then discuss the further options calmly and without time pressure – including sperm donation via our sperm bank.
Legal framework
The situation in Austria
Medically assisted reproduction in Austria is governed by the Reproductive Medicine Act. For couples planning a testicular biopsy, these points are particularly relevant:
- Treatment is permitted within a marriage, a registered partnership or a cohabiting relationship.
- Sperm cells and testicular tissue may be frozen and stored – until revoked, but for a maximum of ten years.
- If no sperm cells of the man's own can be obtained, the use of donor sperm is permitted. Notarial counselling and consent are provided for this.
- Anonymous donation is not permitted in Austria: from the completed 14th year of age, the child can receive information about the identity of the donor.
- Surrogacy is prohibited in Austria.
As of 2026. Legal requirements and details of their implementation change – in the consultation we clarify together what specifically applies to your situation. You can also find an overview on our page about the legal framework.
Everything under one roof
We have been a pioneer of reproductive medicine in Austria since 1982/83 and co-developed the technique of cryopreservation in 1991. The procedure, laboratory processing, freezing and storage all take place on site – with our own genetics laboratory and our own sperm bank. More than 30,000 children have been born with our support.
FAQ
Frequently asked questions about testicular biopsy.
What is the difference between PESA, TESA and TESE?
In PESA (percutaneous epididymal sperm aspiration), fluid is aspirated from the epididymis with a fine needle – this is particularly useful in blockages of the seminal ducts. In TESA, tissue is aspirated from the testicle. TESE is the open testicular biopsy: through a small incision, tissue samples are taken in a targeted way, if necessary at several sites. Which technique we choose depends on the cause of your azoospermia and is decided together with you beforehand.
Is the procedure painful?
The procedure itself is performed under brief anaesthesia or local anaesthetic and is therefore painless. In the days afterwards, a feeling of tension and tenderness are common and can be managed well with standard painkillers. Cooling, supporting underwear and rest also help.
How long does recovery take after a testicular biopsy?
Most men can return to their normal activities after a few days. You should avoid sport, heavy physical work, sauna and full baths for somewhat longer. We give you individual recommendations and a contact option in case questions arise.
Does the procedure have to be repeated for every treatment cycle?
Usually not. If enough sperm cells are found, we freeze them in several portions. For later treatment cycles – including for a sibling – only one portion is then thawed. Under the Reproductive Medicine Act, storage is possible until revoked, but for a maximum of ten years (as of 2026).
Can the eggs also be fertilised by classic IVF?
No. Sperm cells obtained from testicular tissue are usually few in number and often immotile, because they lack the maturation journey through the epididymis. That is why only ICSI is possible, in which a single sperm cell is injected directly into the egg. Classic IVF, in which eggs and sperm are simply brought together, is not suitable in this case.
Does the tissue retrieval affect my hormone production or potency?
Only small amounts of tissue are taken. Potency is not affected by the procedure. With multiple or extensive biopsies, especially where testicular function is already reduced, an effect on testosterone levels is possible – we therefore always weigh up the extent of the retrieval carefully and discuss it with you in advance.
What happens if no sperm cells are found?
Then we take time for a detailed conversation. Depending on the findings, a new attempt with a different technique may make sense. Alternatively, treatment with donor sperm is open to you – we have our own sperm bank on site and cooperate with renowned European banks. This decision needs time, and we give it to you.
Can a testicular biopsy be performed before cancer therapy?
Yes. If no ejaculate can be obtained, the retrieval and cryopreservation of testicular tissue is an option for fertility preservation before chemotherapy or radiotherapy. Here in particular, every day counts: please contact us quickly, we arrange appointments at short notice. You can read more on our page Fertility and cancer.
Your next step
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We are happy to advise you personally on your options.
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