Testicular biopsy in Switzerland: when semen contains no sperm

Discovering that there is no sperm in one's semen is often a shock for a man and for a couple. This situation, called azoospermia, affects about one man in a hundred and a significant proportion of men consulting for infertility. Yet it does not always mean that having a biological child is impossible: in many cases, sperm can be found directly in the testicle or in the ducts that lead from it, through a procedure called testicular biopsy or extraction, then used for in vitro fertilisation with intracytoplasmic sperm injection. This page explains the causes of azoospermia, the assessment, the different retrieval techniques, their chances, the procedure, recovery, alternatives and how care is organised in Switzerland. For an overview, see our guide to IVF and assisted reproduction.

Azoospermia can be obstructive, when sperm is produced but cannot get out, or non-obstructive, when production is very low. The assessment combines examination, hormone blood tests, ultrasound and genetic tests. Surgical retrieval, carried out by a urologist or andrologist, most often under anaesthesia, removes small fragments of testicle or fluid from the epididymis, which are analysed in the laboratory. The sperm found are frozen or used directly for ICSI. The chances of finding sperm are very high with an obstruction, more variable otherwise. In Switzerland, IVF with ICSI is at the couple's expense. Budget guidelines are on our page on testicular biopsy prices in Switzerland.

In the context of infertility, testicular biopsy means the surgical removal of small fragments of testicular tissue in order to look for sperm. When sperm are found, they can be used to fertilise eggs by intracytoplasmic sperm injection, called ICSI, during in vitro fertilisation. Retrieval also has diagnostic value: analysis of the tissue provides information on sperm production.

Several techniques exist, from simple needle aspiration to micro-dissection under an operating microscope. The choice depends on the cause of azoospermia, assessment results and the team's practice. The procedure is carried out by a urologist or andrologist, in close liaison with a reproductive medicine centre and its laboratory.

Sperm is made in the testicles, inside hundreds of small coiled tubules, the seminiferous tubules. Its production, spermatogenesis, takes about seventy-four days and continues from adolescence onwards. It is controlled by two pituitary hormones: FSH, which directly stimulates the cells that support sperm production, and LH, which stimulates testosterone production in the testicle.

Once formed, sperm leave the testicle for the epididymis, a long duct where they mature and become motile, then travel along the vas deferens to the ejaculatory ducts near the prostate. At ejaculation, they mix with secretions from the prostate and seminal vesicles to form semen. An abnormality at any stage can explain azoospermia.

For a long time, azoospermia meant it was impossible to have a biological child, the only options being sperm donation or adoption. The arrival of ICSI in the early 1990s changed everything: it became possible to fertilise an egg with a single sperm, even immature and immotile. Surgeons quickly developed techniques to retrieve sperm from the epididymis, then from the testicle. In the late 1990s, micro-TESE improved the chances in non-obstructive azoospermia by targeting areas of production under the microscope.

Today, many men once considered sterile can become biological fathers thanks to these techniques, and research continues to advance.

The testicle is an oval organ about four to five centimetres long, wrapped in a tough membrane. Inside, hundreds of lobules contain the seminiferous tubules, where sperm are made, and, between them, the cells that produce testosterone. The tubules converge on a network of small ducts that joins the epididymis, which sits on the testicle like a cap. From there, the vas deferens rises through the cord, crosses the pelvis and joins the seminal vesicles behind the bladder to form the ejaculatory ducts, which open into the urethra at the level of the prostate.

Understanding this route helps explain why an obstruction can occur at different levels, and why sperm may be sought in the testicle or epididymis depending on the cause.

Testicular volume, measured at examination with an orchidometer — a series of ovals of increasing size — or by ultrasound, largely reflects the amount of tissue producing sperm. Normal-sized testicles combined with a normal FSH point towards an obstruction. Small testicles and a high FSH point rather towards reduced production. However, even small testicles may contain areas of production, which justifies micro-TESE in certain situations.

FSH is a hormone produced by the pituitary gland that stimulates the testicular cells supporting sperm production. When the testicle produces few sperm, the pituitary increases FSH production to try to stimulate it further: a high FSH is therefore a sign of reduced production. Conversely, a very low FSH may indicate pituitary deficiency, treatable with hormones. FSH helps guide the diagnosis, but it does not on its own predict the chances of finding sperm at micro-TESE.

Discovering azoospermia, often by chance during the assessment of a couple who are slow to conceive, is a difficult moment. Many men describe a sense of unreality, shame or guilt, especially as nothing suggested this result. It is important to know that this diagnosis is not an end: it opens an assessment that will help understand the cause and, often, find a solution. Taking time to absorb the information, talking to your partner and asking the doctor all your questions are the first steps.

A diagnosis of azoospermia deeply affects many men. Fertility is often wrongly associated with virility, and many feel shame, guilt towards their partner, anger or sadness. Some withdraw and dare not talk about it, even to those close to them. It is important to remember that azoospermia is a medical condition that says nothing about a man's worth, masculinity or ability to be a father.

Talking about what you feel — with your partner, a trusted friend or a professional — helps you through this ordeal. Fertility centre psychologists know these situations well and also support men.

Many men facing azoospermia find it hard to talk about it, even to those close to them, out of reserve, fear of being judged or because male fertility remains taboo. This silence can deepen the sense of isolation. Yet many men live the same situation. Talking with your partner, a trusted friend, a doctor or a psychologist, or joining a support group, often helps lighten the weight of the diagnosis. There is no shame in asking for support.

Male infertility is often experienced as an attack on masculinity, because of a long-standing confusion between fertility and virility. Yet sperm production is a biological process distinct from testosterone production, sexuality and, even more so, a man's identity. An azoospermic man can have a fulfilling sex life, be a caring partner and become a loving father, whether the child is conceived with his sperm, through donation or by adoption.

Azoospermia does not generally change sexuality: erection, desire and ejaculation are most often normal. The shock of the diagnosis may, however, temporarily affect desire or self-confidence. The assisted reproduction journey can also turn the couple's sexuality into a medical matter. Preserving intimacy free of any constraint, talking about it openly and seeking advice if difficulties set in help the couple through this period.

For the couple, azoospermia often changes the plan for a child as they imagined it. The partner may feel sadness, worry and sometimes anger, while also wanting to support her partner. The decisions ahead — biopsy, IVF, sperm donation, adoption — require open dialogue. It is essential that each can express their feelings without feeling judged, and that decisions are made together. Couples counselling can be valuable.

The partner plays a central role in the journey, even though the diagnosis concerns the man: it is she who will undergo stimulation, egg retrieval and transfer in IVF with ICSI. Her own fertility assessment is therefore essential, and her age strongly influences the chances. She can also be a valuable support for her partner, while needing support herself. Recognising that the journey concerns both partners helps you go through it together.

Even when infertility has a male cause, the partner must have a fertility assessment before IVF with ICSI: ovarian reserve assessment, ultrasound of the uterus and ovaries, and serology. Her age and fertility strongly influence the chances of pregnancy. This assessment also allows the right time for retrieval and IVF to be chosen, and the strategy adapted, for example by not delaying IVF if the partner is over 35. See our guide to IVF and assisted reproduction.

If sperm have been found, the partner undergoes ovarian stimulation for about ten days, with daily injections and check-ups, then her eggs are retrieved under sedation. The laboratory then injects one sperm into each mature egg. For the partner, it is a demanding journey, even though the cause of infertility does not always concern her directly; recognising this commitment and supporting her matter for the couple.

Each stage of the journey — whether to have retrieval, the timing of IVF, any use of sperm donation — involves both partners. It is important that these decisions are made together, after full information, and that each can express their wishes and limits. When opinions differ, psychological support can help the couple find a shared path.

Many men prefer to keep the diagnosis within the couple, out of reserve or fear of how others will see them. Others choose to tell a few trusted people, so as not to remain alone. There is no right answer. If you do talk about it, you can choose what you share and ask for confidentiality. If sperm donation is being considered, the question of what to tell those around you and the child deserves particular thought, with the help of the centre's psychologist.

When a couple chooses sperm donation after an azoospermia journey, the question of what to tell those around them is particularly acute. Some couples choose openness, others discretion. It is important to think about consistency between what you tell those close to you and what you will tell the child, who has the right to know their origins on reaching adulthood. The centre's psychologist can help the couple find a position that suits them and that they can stand by over time.

The man's and his partner's parents can be an important support, but sometimes also a source of unintentional pressure, notably around family continuity. If you choose to tell them about the diagnosis or a possible donation, explain what helps you and what hurts you. Many grandparents, once the child is born, care only about the child, whatever the path to their conception.

• "Is it serious?" It is not dangerous to health, but it complicates conception.
• "Can't anything be done?" Often it can: sperm may be found in the testicle.
• "Is it your fault?" No, most causes are medical or genetic.
• "Does it hurt?" Some discomfort for a few days after the procedure.
• "And if it doesn't work?" Other solutions exist, such as sperm donation or adoption.

• "Will the biopsy damage my testicle?" Retrieval is limited and the testicle generally recovers well.
• "Will I lose my virility?" The procedure does not affect erection; testosterone is monitored after micro-TESE.
• "Will it hurt a lot?" Some discomfort for a few days, relieved by simple painkillers.
• "Will my son be infertile?" Only with certain genetic abnormalities, which genetic counselling clarifies.
• "What if nothing is found?" Other paths exist, which you can explore at your own pace.

• "Going to all the important consultations together."
• "Having the genetic assessment before deciding."
• "Choosing a team that often performs micro-TESE."
• "Talking about sperm donation before the procedure, without taboos."
• "Seeing the psychologist after the diagnosis, then after the result."
• "Telling a trusted friend, so as not to remain alone."
• "Keeping time for the two of us, away from the tests."

In obstructive azoospermia, the testicles produce sperm normally, but it cannot reach the ejaculate because of an obstacle. The most common cause is vasectomy. Congenital absence of both vas deferens, often associated with cystic fibrosis gene mutations, is another important cause. After-effects of infections of the epididymis, surgery in the groin area in childhood or obstruction of the ejaculatory ducts near the prostate may also be responsible.

In these situations, the chances of finding sperm by retrieval are very high, and the quantity obtained often allows reserves to be frozen for several ICSI cycles.

Some infections, such as sexually transmitted infections or epididymitis, can leave scars that block the epididymis or ducts, causing obstructive azoospermia. In these situations, sperm production is generally normal, and retrieval from the epididymis or testicle offers very good chances. Microsurgical repair of the obstruction can sometimes be discussed. Preventing sexually transmitted infections protects future fertility.

Inguinal hernia surgery, particularly in childhood, can sometimes damage the vas deferens and cause an obstruction. When both sides are affected, obstructive azoospermia can result. Retrieving sperm from the epididymis or testicle is then an effective solution, and microsurgical repair can sometimes be considered in specialist centres.

In non-obstructive azoospermia, the testicle produces very few or no sperm. The causes vary: genetic abnormalities, an undescended testicle in childhood, after-effects of mumps affecting the testicle, cancer treatments, a significant varicocele, or an unknown cause in a significant proportion of cases. Production is often uneven: some small areas of the testicle may still produce sperm while the rest no longer does.

This is what justifies micro-TESE, which looks for these areas of production under the microscope. The chances of success are more variable than with an obstruction, but real in a significant proportion of men.

The assessment begins by confirming azoospermia on at least two semen analyses, with centrifugation to look for any rare sperm. The urologist or andrologist then asks about medical history: undescended testicle, infections, surgery, trauma, treatments, anabolic steroids and exposure to toxins. They examine the testicles, measure their volume, feel the epididymis and vas deferens, and look for a varicocele.

Blood tests measure FSH, LH, testosterone and sometimes prolactin. A scrotal ultrasound and, where appropriate, a prostate ultrasound complete the examination. Genetic tests are offered depending on the situation. Biochemical analysis of the semen can also point to obstruction of the ejaculatory ducts.

To confirm azoospermia, the laboratory does not simply look at the semen under the microscope: it centrifuges it, spinning it at high speed to concentrate any sperm at the bottom of the tube, then carefully examines this pellet. This technique allows very rare sperm to be detected that would not otherwise be seen. If a few sperm are found, this is called cryptozoospermia, and ICSI can sometimes be carried out with these ejaculated sperm, without a biopsy, after several samples have been frozen.

When semen contains extremely rare sperm, detectable only after centrifugation, this is called cryptozoospermia. In this situation, surgical retrieval can sometimes be avoided: the laboratory freezes several successive samples to build up a reserve of ejaculated sperm usable for ICSI. If the sperm are too rare or disappear, testicular retrieval can be discussed. The specialist and the laboratory assess the best strategy.

When the sperm count is very low but not zero, this is called severe oligospermia. In this case, IVF with ICSI is generally carried out with sperm from the ejaculate, without surgical retrieval. Some centres nevertheless offer testicular retrieval in particular situations, for example after repeated failures linked to very poor DNA quality in ejaculated sperm. This option remains debated and is decided case by case.

Sperm production can vary from one test to another, notably after a fever, significant stress or certain medicines. A man may thus move from severe oligospermia to azoospermia, or the reverse. That is why several semen analyses are needed before drawing conclusions, and why freezing sperm when it is present may be advised, to secure a future plan.

When semen volume is very low or nil, the doctor may request a test of urine collected just after ejaculation. If sperm is found in it, this indicates retrograde ejaculation, in which semen goes into the bladder. This situation, common after certain prostate surgery or with diabetes, can sometimes be treated with medicines, or allows sperm to be recovered from the urine for assisted reproduction, without a biopsy.

Some men have no ejaculation at all, for example after a spinal cord injury, certain pelvic surgery or because of neurological disorders. In these situations, the problem is not sperm production but its release. Stimulation techniques, such as vibratory stimulation or electroejaculation, carried out by specialist teams, often allow semen to be collected. If they fail, retrieval from the testicle or epididymis remains possible. These situations fall to centres with particular expertise.

Sometimes a man cannot provide a sample on the planned day, because of stress or the pressure of the moment, although he has no difficulty usually. This is not unusual and it is not azoospermia. To avoid it, freezing a back-up sample beforehand can be arranged. Mention it to the team in advance; they are used to these situations and can suggest suitable solutions.

Analysing certain substances in semen, produced by the various glands of the reproductive tract, helps locate an obstruction. For example, the absence of substances produced by the seminal vesicles, combined with low volume and acidic semen, suggests absent vas deferens or obstruction of the ejaculatory ducts. This simple analysis complements clinical examination and ultrasound.

Genetic tests play an important role in azoospermia. They may reveal Klinefelter syndrome, a Y chromosome microdeletion or cystic fibrosis gene mutations. These results influence the chances of finding sperm, the choice of technique and the advice given to the couple: some abnormalities can be passed on to children conceived by ICSI, in particular Y chromosome microdeletions, which would be passed on to a son. A geneticist explains these consequences and the possible options, including preimplantation genetic testing in certain situations provided for by law.

When the assessment reveals or suggests a genetic abnormality, the couple is referred to a geneticist. At this consultation, they explain the nature of the abnormality, its consequences for the man's fertility and health, the risk of transmission to children and the possible options. For example, a Y chromosome microdeletion will be passed on to a son conceived by ICSI, who could in turn be infertile; Klinefelter syndrome is rarely passed on; cystic fibrosis gene mutations require the partner to be tested.

Depending on the situation, and within the strict framework of Swiss law, preimplantation genetic testing may be discussed to avoid passing on a serious disease. Genetic counselling helps the couple decide with full knowledge, without pressure.

In congenital absence of the vas deferens linked to the cystic fibrosis gene, the partner is tested to see whether she herself carries a mutation of this gene. If she does not, the risk of having a child with cystic fibrosis is very low. If she does, this risk becomes significant, and the couple can discuss the options with the geneticist: preimplantation genetic testing within the law, prenatal diagnosis during pregnancy, or sperm donation. This simple test is essential before any ICSI.

Since 2017, preimplantation genetic testing has been permitted in Switzerland under conditions, notably for couples at risk of passing on a serious hereditary disease. In certain situations of azoospermia of genetic origin, it may be discussed in order to select unaffected embryos. It requires IVF with ICSI, embryo biopsy and genetic analysis, and adds to the cost of IVF. The geneticist and the fertility centre will tell you what is possible in your case. See our page on in vitro fertilisation in the laboratory.

The choice of technique results from discussion between the urologist or andrologist, the fertility centre and the couple. It takes into account the likely cause, hormonal and genetic results, the partner's age and fertility, the number of children wanted, the couple's preferences and the expertise available. There is no single answer: a good specialist explains the options, their advantages and limits, and helps you choose the one that suits you. Take time to ask all your questions before deciding.

It is important to approach retrieval with realistic expectations. With an obstruction, the chances of finding sperm are very high, but a pregnancy is never guaranteed, as it also depends on IVF and the partner. With a non-obstructive cause, the outcome is more uncertain. Knowing these probabilities in advance, and having thought about the options in case of failure, allows you to go through the journey more calmly, whatever the outcome.

In a conventional testicular biopsy, the surgeon makes a small incision in the scrotum, opens the testicle's covering and removes a few small fragments of tissue, sometimes from several places. The fragments are placed in culture medium and sent to the laboratory, which separates them and looks for sperm under the microscope. Some of the tissue is sent to the pathologist for analysis. The incision is closed with a few dissolvable stitches.

This technique is simple and quick. It is very effective with an obstruction, but less suited to very low production, where areas of production may be missed.

Micro-TESE is carried out under an operating microscope, which magnifies the structures of the testicle up to about twenty times. After opening the testicle, the surgeon methodically examines the seminiferous tubules and identifies those that look more dilated and opaque, a sign of sperm production. They remove tiny targeted fragments, which the biologist examines immediately under the microscope. If no sperm is found, the search continues in other areas, then possibly in the other testicle.

This targeted approach increases the chances of finding sperm in non-obstructive azoospermia, while limiting the amount of tissue removed and preserving blood vessels. It requires microsurgical expertise and close collaboration with the laboratory, and can last several hours.

Micro-TESE is a longer and more delicate procedure than a simple aspiration. To prepare for it, it is useful to have a complete assessment, including hormonal and genetic tests, to have discussed the strategy with the surgeon — in advance or synchronised with egg retrieval — and to have thought together about the options in case of failure. Some surgeons ask you to stop certain medicines, notably blood thinners, a few days beforehand. Arrange for someone to accompany you, two to four days of rest and supportive briefs.

Emotionally, many men find it helpful to talk to a psychologist beforehand, to prepare for the wait and the different possible outcomes.

The length of a micro-TESE depends on how quickly sperm are found. If the biologist spots some in the first fragments, the procedure can be relatively short. If production is very scattered, the surgeon methodically explores the whole testicle, then sometimes the other, which can take several hours. This perseverance increases the chances of finding sperm, at the cost of a longer procedure, always with the aim of preserving the testicle.

When a first micro-TESE has found sperm, but not enough for several cycles, a second procedure may be discussed for a new plan, generally after several months, to allow the testicle to recover. When a complete micro-TESE has found nothing, a second procedure often has little chance of success, except in particular situations. The surgeon advises you according to the tissue analysis results and your situation.

This analysis, carried out by the pathologist, helps understand the azoospermia and discuss any further procedure. A previous biopsy can also guide the strategy for micro-TESE.

In some non-obstructive azoospermia, tissue analysis shows that most seminiferous tubules contain only supporting cells, without cells capable of producing sperm. This pattern, sometimes called Sertoli cell-only syndrome, was once considered hopeless. It is now known that small islands of production may persist in certain areas of the testicle, which micro-TESE can find. The chances are lower than in other situations, but not nil. The surgeon discusses this with the couple before proposing the procedure.

In other cases, germ cells are present but their development stops before reaching the sperm stage. This is called maturation arrest. Depending on the stage at which development stops, and whether it is complete or partial, sperm can sometimes be found in certain areas. Some genetic causes, such as microdeletions in the AZFb region of the Y chromosome, are associated with complete arrest, with almost no chance, which underlines the importance of genetic assessment before the procedure.

When the tissue shows sperm production that is present but very low, this is called hypospermatogenesis. It is the situation in which the chances of finding sperm are best among non-obstructive azoospermias. The sperm found are often few, but sufficient for ICSI, and sometimes for freezing a reserve.

Beyond the search for sperm, testicular retrieval has diagnostic value: microscopic analysis of the tissue by the pathologist describes the state of sperm production and may reveal particular abnormalities. In men who had an undescended testicle, it also allows rare precancerous lesions to be detected. This information helps understand the azoospermia, discuss any further procedure and guide the man's medical follow-up, independently of the plan for a child.

Infertile men have a slightly higher risk of testicular tumour than the general population, particularly if they had an undescended testicle in childhood. That is why ultrasound is part of the assessment, and why regular self-examination of the testicles is advised: any lump or change should prompt a consultation. The infertility assessment is thus also an opportunity to review the man's general health, including hormonal and metabolic health.

Regularly feeling your testicles, for example in the shower, allows you to spot a lump, hardening or change in size. Any abnormality should prompt a prompt consultation. This simple habit is particularly recommended for infertile men and those who had an undescended testicle, who have a slightly higher risk of testicular tumour.

Several studies suggest that male infertility may be associated with certain health problems, such as hormonal, metabolic or cardiovascular disorders. Without being alarming, this finding invites you to use the assessment to check blood pressure, weight, blood sugar and hormone balance, and to adopt a healthy lifestyle. The GP can provide this follow-up beyond the plan for a child.

Beyond the plan for a child, a diagnosis of azoospermia is an invitation to look after your health in the long term: hormone follow-up if needed, notably after micro-TESE or with Klinefelter syndrome, testicular self-examination, and attention to weight, blood pressure and metabolism. The GP can provide this follow-up. For men carrying a genetic abnormality, genetic counselling may also concern other family members, who could be informed if they wish.

This information allows an unnecessary procedure to be avoided when the chances are almost nil, and informs the couple that a son conceived by ICSI will inherit the microdeletion.

The testicle also produces testosterone, an important hormone for energy, libido, muscle mass and bones. Extensive micro-TESE, especially in men with small testicles, can cause a fall in testosterone, sometimes temporary, sometimes lasting. A test a few months after the procedure is often offered. If there is a deficiency, treatment may be discussed, bearing in mind that testosterone suppresses sperm production and could therefore compromise a new retrieval.

With an obstruction, sperm accumulate in the epididymis, where they are more mature and often more motile than those in the testicle. Retrieving them, by needle through the skin or by microsurgery, often allows a large number of sperm to be collected, easy to freeze for several ICSI cycles. Microsurgery of the epididymis is often preferred when a large reserve is wanted.

Microsurgical epididymal retrieval is carried out under an operating microscope, through a small incision in the scrotum. The surgeon exposes the epididymis, identifies a dilated tubule filled with fluid, opens it delicately and aspirates the fluid containing the sperm. This fluid, often rich in motile sperm, is examined immediately by the laboratory, then prepared and frozen in several straws. This technique often allows a reserve sufficient for several ICSI cycles to be built up, avoiding repeating the procedure.

It is mainly indicated with an obstruction, notably congenital absence of the vas deferens or obstruction after infection. Needle aspiration of the epididymis through the skin is a simpler alternative, which generally collects fewer sperm.

Testicular needle aspiration, carried out under local anaesthesia, involves inserting a fine needle into the testicle and aspirating a little tissue. It is quick, minimally invasive and well tolerated. It is mainly suited to obstructive azoospermia, where production is normal and spread throughout the testicle. With reduced production, it risks missing the rare productive areas, hence the value of micro-TESE in these situations.

Once the fragments have been removed, the laboratory places them in culture medium, then separates them mechanically, sometimes with the help of enzymes, to release the contents of the seminiferous tubules. The biologist then examines the suspension under the microscope, drop by drop, looking for sperm, which are sometimes very rare and immotile. This search can take many hours when production is very low. The sperm found are either frozen or used directly for ICSI if egg retrieval takes place the same day.

The laboratory's experience is essential, as an isolated sperm can be difficult to spot among the cells of testicular tissue. See our page on in vitro fertilisation in the laboratory.

The choice depends on the type of azoospermia, the expected chances, the centre's organisation and the couple's wishes. Both strategies are used in Switzerland.

When retrieval is carried out on the day of egg retrieval, organisation must be perfectly coordinated: the partner follows her stimulation, egg retrieval is scheduled, and the man's procedure is planned for the same day or the day before, so that sperm are available at the time of ICSI. The laboratory must be able to carry out the search in parallel. This organisation requires close collaboration between the urologist, gynaecologist and laboratory, and good availability on the couple's part.

When retrieval is carried out in advance, with freezing, IVF can be scheduled more freely, once the presence of sperm has been confirmed.

With a synchronised strategy, the couple goes through an intense day: egg retrieval for her, surgical retrieval for him, then waiting for news from the laboratory on the presence of sperm and fertilisation. It is useful to arrange for someone to accompany both, clear the day and the next, and prepare the different scenarios in advance, including the one where no sperm is found.

When sperm have been found and frozen in sufficient quantity, several ICSI cycles can be carried out without a new procedure for the man. The laboratory thaws part of the reserve for each cycle. If sperm are rare, the reserve may only be enough for one cycle; a new procedure may then be discussed for a later cycle. Surplus embryos obtained during ICSI can also be frozen for later transfers.

Sperm or tissue fragments containing sperm are frozen in liquid nitrogen, using protocols adapted to small quantities. On thawing, some sperm may lose vitality, but generally enough remain for ICSI when the initial quantity is sufficient. Freezing avoids repeating the procedure for each IVF cycle. The storage period is limited by Swiss law, with the possibility of extension on request.

Frozen sperm or testicular fragments can be stored for many years in liquid nitrogen without loss of quality. Swiss law nevertheless limits the storage period, with possible extensions on written request. The centre informs you of deadlines and sends reminders; keep your contact details up to date. Storage fees are generally charged each year. If your plans change, you can inform the centre of your decisions.

If you change fertility centre, frozen sperm can be transported to another authorised centre, in special containers maintaining liquid nitrogen temperature, following secure, traceable procedures. The transfer is organised between the two centres, with your written consent. Transport fees apply.

On the day of ICSI, the laboratory thaws a straw or frozen fragment, assesses the number of living, usable sperm, then injects them into the mature eggs. It is common for some sperm not to survive thawing, especially when they were rare. That is why the laboratory freezes several straws when possible and thaws one at a time as needed.

• Semen analyses and hormone results.
• Genetic test results and the genetic counselling report.
• The operative report of the retrieval.
• The tissue analysis result.
• Information on frozen sperm and its storage period.
• Quotes, invoices and insurance decisions.

These documents are useful for IVF, any change of centre and your medical follow-up.

• Complete the full assessment, including genetic tests if indicated.
• Discuss the strategy as a couple: prior or synchronised retrieval.
• Think in advance about what you would do if no sperm is found.
• Stop smoking, anabolic steroids and excessive alcohol.
• Report all treatments, notably blood thinners.
• Arrange someone to take you home.
• Buy supportive briefs.
• Arrange two to four days of rest.

On the day of the procedure, you arrive fasted if sedation or general anaesthesia is planned. After preparation and anaesthesia, the surgeon carries out retrieval using the chosen technique. A biologist is often present or nearby to examine the fragments in real time. Depending on the technique, the procedure lasts from a few minutes to a few hours. Once finished, a dressing is applied, and you are monitored for one to two hours before going home, accompanied.

The surgeon generally tells you the same day whether sperm have been found, and in roughly what quantity. This moment is often emotionally charged for the couple.

Depending on the technique, retrieval is done under local anaesthesia, local combined with sedation, spinal or general anaesthesia. Needle aspirations are often done under local anaesthesia, with an injection that numbs the cord and the skin of the scrotum. Micro-TESE, longer and more delicate, is generally done under general or spinal anaesthesia. At the anaesthesia consultation, report your treatments, notably blood thinners, your allergies and your tobacco or alcohol consumption.

• Wear supportive briefs day and night for a few days.
• Apply cold through a cloth, for short periods, for the first few hours.
• Take the prescribed painkillers at fixed times for the first few days.
• Avoid lifting and exertion for a week.
• Shower from the next day; avoid baths until healed.
• Watch for swelling, redness and temperature.
• Call the team if pain increases, if you have a fever or significant swelling.

After retrieval, discomfort is generally moderate: tenderness of the scrotum, a feeling of heaviness, minor pain when walking or sitting, for a few days. After micro-TESE, it may last a little longer. Simple painkillers, cold, rest and support bring relief. Pain that increases instead of decreasing, or significant swelling on one side, may signal a haematoma and should prompt you to contact the team.

The small incision in the scrotum is closed with generally dissolvable stitches, which fall out on their own within one to three weeks. Keep the area clean and dry, change the dressing according to instructions, and avoid baths, swimming pools and saunas until fully healed. The scar becomes very discreet over time, hidden in the folds of the scrotum.

Supportive briefs, cold applied through a cloth for the first few hours and simple painkillers relieve discomfort. Contact the team in the event of significant swelling, increasing pain or fever.

A few weeks after retrieval, a follow-up consultation allows healing to be checked and the tissue analysis result, the number of frozen sperm and the rest of the journey to be discussed. After micro-TESE, a testosterone test may be scheduled a few months later. It is also a time to review how the man and the couple are coping, and to ask questions that have arisen since the procedure. Prepare them in advance and come with your partner if possible, to decide the next steps together, calmly and with full knowledge, with the attentive support of the whole medical team that has followed you from the start.

• Significant or rapid swelling of the scrotum.
• Pain that increases instead of decreasing.
• Fever, redness or warmth of the scar.
• Discharge from the wound.
• Difficulty urinating.

Contact the team without delay; in an emergency, call 144.

A haematoma is a collection of blood in the scrotum, which can occur in the hours or days after retrieval. It shows as swelling, bluish discolouration and pain. A small haematoma generally resolves on its own within a few weeks, with rest, cold and supportive briefs. A large haematoma may require medical review and, rarely, a procedure. Avoiding exertion in the first few days and reporting blood-thinning medicines reduce this risk.

Infection after testicular retrieval is rare, thanks to the sterile conditions of the procedure. It shows as redness, warmth, increasing pain, sometimes fever and discharge. It is treated with antibiotics. Keep the wound clean and dry, and avoid baths and swimming pools until healed.

Rarely, pain in the testicle or scrotum persists beyond a few weeks after the procedure, particularly after extensive or repeated retrievals. It should be reported to the surgeon, who looks for the cause and offers suitable treatment. In the vast majority of cases, discomfort disappears completely within a few days to a few weeks.

These trends are indicative. The surgeon will give you an estimate suited to your situation, taking the whole assessment into account.

Between deciding to have retrieval and the result, the wait can be very difficult, especially in non-obstructive azoospermia, where the outcome is uncertain. Many men swing between hope and fear. On the day of the procedure, waiting for news from the laboratory is often the most intense moment. Preparing for all outcomes, talking about it together, arranging to have people around you and relying on a psychologist if needed help you through this moment. Whatever the result, it calls into question neither the man's worth nor the strength of the couple.

Learning that sperm have been found is often an immense relief, sometimes accompanied by strong emotion, after months of uncertainty. It is the start of a new stage: IVF with ICSI. Uncertainties remain, as fertilisation and pregnancy are not guaranteed, but the couple now knows that a biological child is possible. The centre explains what comes next: the number of sperm frozen, the number of possible cycles and the calendar for the partner's stimulation.

Learning that no sperm has been found is often experienced as a bereavement. It is normal to feel sadness, anger, a sense of injustice and sometimes failure. Allowing yourself time, not making immediate decisions and seeking support are essential. A follow-up consultation with the surgeon allows you to understand the tissue analysis result and discuss the options, including sperm donation for married couples and adoption. These decisions can wait until the couple is ready.

Psychological support is valuable at several points in the journey: after the diagnosis of azoospermia, before micro-TESE, after a negative result, or when considering sperm donation. Fertility centres offer this support, and Swiss law provides for counselling for couples. Men use it less often than women; yet many of those who have tried it say it helped them put words to what they were going through and move forward.

Male infertility remains a little-discussed subject, and many men feel alone with the diagnosis. Yet azoospermia affects about one man in a hundred. Talking with other men, in support groups, patient associations or moderated forums, can help you feel understood and share practical experience. Your fertility centre can tell you about the resources available. Support from your partner and a few trusted people is also valuable.

Information about azoospermia and treatments circulates widely online, with promises of supplements or miracle treatments. No supplement has been shown to make sperm reappear in non-obstructive azoospermia. Favour explanations from your urologist, andrologist, fertility centre and recognised medical sources. Be wary of costly offers with no evidence of effectiveness.

A diagnosis of azoospermia may seem final, but advances in recent decades have opened up many possibilities. Keeping hope is important, while knowing your real chances, which depend on the cause. A complete assessment and the opinion of an experienced team allow you to see clearly. And whatever the outcome of retrieval, the plan to become a parent can take several forms.

An azoospermia journey can take up a lot of space for several months. Keeping other plans — work, personal or as a couple — helps preserve your balance and avoid reducing your life to the plan for a child. These plans are also a valuable resource if the journey does not go as hoped.

When sperm are found, they are used for in vitro fertilisation with intracytoplasmic sperm injection, or ICSI. The partner undergoes ovarian stimulation, then her eggs are retrieved. In the laboratory, the biologist injects one sperm into each mature egg. The embryos obtained are cultured for a few days, then one embryo is transferred to the uterus, and the other good-quality embryos are frozen. To find out more about this journey, see our page on IVF in Switzerland.

Sperm retrieval is only one stage. To understand what comes next, see our page on the IVF pathway in Switzerland, which details stimulation, egg retrieval, transfer and the couple's experience, and our page on in vitro fertilisation in the laboratory, which explains ICSI and embryo development.

Once sperm have been found, the chances of pregnancy with ICSI depend mainly on the partner's age and fertility, as well as sperm quality. With an obstruction, they are generally close to those obtained with ejaculated sperm. With very low production, they may be slightly lower, particularly if sperm are very rare or immature. The doctor will give you an estimate according to your situation.

The man's age does not prevent testicular retrieval, but it influences the couple's overall strategy. After 45 to 50, sperm production gradually declines and certain genetic risks increase slightly. Above all, the partner's age is decisive for the chances of IVF with ICSI. When the partner is over 35, it is often advisable not to delay the journey, for example by preferring retrieval followed quickly by IVF rather than a reversal whose results take months.

After the birth of a child conceived by ICSI with surgically retrieved sperm, many couples consider a second child. If sperm or embryos have been frozen, they can be used without a new procedure for the man. Otherwise, a new retrieval can be discussed, taking into account the results of the first, the condition of the testicle and the time elapsed. It is useful to raise this during the first journey, to consider freezing a sufficient reserve.

The birth of a child after an azoospermia journey is often experienced with particular emotion, after months of uncertainty. Many fathers describe a sense of having overcome the diagnosis, or on the contrary great humility. Remember to inform the centre of the birth and to keep the information on sperm or embryos still in storage. If a genetic abnormality has been identified, suitable follow-up for the child can be discussed with the geneticist.

Children conceived by ICSI with surgically retrieved sperm are, in the vast majority, healthy. Follow-up studies are reassuring, even if some show a slight increase in certain risks, partly linked to infertility itself. Some genetic abnormalities in the father, such as Y chromosome microdeletions, can be passed on to sons, with a risk of infertility in adulthood. Genetic counselling informs the couple of these points before ICSI.

A man who has had a vasectomy and wishes to have another child has two main options. The first is microsurgical reversal, which reconnects the vas deferens and often allows sperm to return to the ejaculate and natural conception, with chances that decrease as the time since the vasectomy increases. The second is sperm retrieval from the epididymis or testicle, combined with IVF with ICSI.

The choice depends on the time since the vasectomy, the partner's age and fertility, the number of children wanted and the couple's preferences. Reversal allows several natural pregnancies but is not always suitable; retrieval with ICSI is quicker but involves IVF for each plan.

Reversal involves reconnecting the two ends of the vas deferens cut during vasectomy, under an operating microscope, with very fine stitches. When the epididymis is itself blocked, a more complex technique connects the vas deferens directly to the epididymis. The procedure takes one to three hours, generally under general anaesthesia. Sperm often reappear in the ejaculate in the following months, with chances that decrease when the vasectomy is old.

Some surgeons retrieve and freeze sperm during the reversal, as a back-up in case of failure. Reversal allows repeated natural pregnancies, which is an advantage for couples wanting several children, provided the partner is fertile and not too old.

Rarely, the obstruction lies at the level of the ejaculatory ducts, near the prostate. It shows as low semen volume with no sperm, with signs on prostate ultrasound. An endoscopic procedure through the urethra can sometimes clear the obstacle and allow sperm to return to the ejaculate. Otherwise, retrieval from the epididymis or testicle remains possible.

Some teams offer, before micro-TESE, hormone treatment intended to stimulate residual sperm production, notably in men with low testosterone. The value of this approach remains debated and depends on the situation. It is not routine. The specialist will explain whether it makes sense in your case, taking into account the hormone assessment and the delay it imposes.

Klinefelter syndrome, the presence of an extra X chromosome, is the most common chromosomal abnormality in infertile men. It shows as small, firm testicles, azoospermia in the vast majority of cases and sometimes testosterone deficiency. For a long time, these men were considered permanently sterile. Today, micro-TESE allows sperm to be found in some of them, enabling ICSI.

Some teams discuss relatively early retrieval, in young adulthood, as production may decline over time. Testosterone treatment, often necessary, must be discussed before a retrieval plan, as it can suppress production. Follow-up by an endocrinologist and genetic counselling accompany the process.

When Klinefelter syndrome is diagnosed in adolescence or young adulthood, the question of future fertility arises. Some teams suggest looking early for sperm in the ejaculate, or even by micro-TESE, and freezing them, as production may decline over the years. This approach is discussed case by case, with an endocrinologist, a specialist urologist and genetic counselling, taking into account the young man's maturity and wishes and those of his family.

Chemotherapy and radiotherapy can reduce or stop sperm production, temporarily or permanently. In some men, production resumes months or years after treatment; a follow-up semen analysis is therefore useful. If azoospermia persists and no sperm was frozen before treatment, micro-TESE can find sperm in some men. That is why freezing sperm before cancer treatment is strongly recommended.

For an adolescent who must receive cancer treatment, sperm freezing is offered as soon as puberty allows. If collection is not possible, testicular retrieval can sometimes be carried out to freeze sperm. For younger boys, before puberty, some specialist centres offer freezing of testicular tissue within research protocols, whose future use remains experimental. These steps are discussed quickly with the oncology team, so as not to delay treatment.

A testicle that had not descended into the scrotum at birth, called cryptorchidism, is operated on in childhood to place it in the scrotum. When the operation was late, or both testicles were affected, sperm production may be greatly reduced in adulthood. Micro-TESE often allows sperm to be found in these situations. Examination of the removed tissue is also useful, as the risk of a precancerous testicular lesion is slightly higher in these men.

Mumps, when it occurs after puberty, can cause painful inflammation of one or both testicles, called orchitis. In some cases, it leads to shrinkage of the testicle and reduced sperm production, rarely azoospermia when both testicles are affected. Vaccination has greatly reduced these situations. When azoospermia persists, micro-TESE can allow sperm to be found in preserved areas.

Significant trauma to the testicle or torsion — the testicle twisting on its cord and cutting off its blood supply — can lead to the loss of a testicle or reduced production. The remaining testicle is generally enough to ensure fertility. Azoospermia may, however, occur if the other testicle was also affected. The assessment clarifies the situation, and retrieval can be considered if needed.

Some men are born without vas deferens, the ducts that carry sperm from the testicle to the urethra. This abnormality is often linked to cystic fibrosis gene mutations, even in men who have no other symptoms of this disease. Ejaculate volume is generally low. As sperm production is normal, sperm can easily be retrieved from the epididymis or testicle for ICSI.

Before any plan, genetic counselling is essential: the partner is tested for mutations in the same gene, as if she is also a carrier, the child could have cystic fibrosis. Depending on the results, preimplantation genetic testing may be discussed within the law.

Taking anabolic steroids or testosterone without a prescription or for bodybuilding strongly suppresses the pituitary hormones that control sperm production. This often results in azoospermia or a sharp fall in sperm count. In most cases, production resumes after stopping, but this can take several months, or even more than a year. Medical treatment can sometimes speed up recovery. A biopsy is generally not the first option in this situation.

After stopping anabolic steroids or testosterone, natural sperm production gradually resumes in most men within a few months, sometimes more than a year after long-term or high-dose use. During this period, reduced libido, energy and mood are common, linked to temporary testosterone deficiency. Medical treatment can help restart production and relieve these symptoms. Follow-up by a specialist and regular semen analyses allow recovery to be monitored.

To understand azoospermia, the doctor needs to know everything, including things that are hard to talk about: use of anabolic steroids, testosterone or drugs, exposure to toxins and a history of sexually transmitted infections. This information is covered by medical confidentiality and is used solely to treat you. It can avoid unnecessary tests and procedures, for example when azoospermia linked to anabolic steroids can resolve on stopping.

More rarely, azoospermia is linked to pituitary deficiency, in which the pituitary does not produce enough FSH and LH to stimulate the testicles. This situation may be congenital or acquired. It is treated with hormone injections that replace those of the pituitary, often allowing sperm to appear in the ejaculate within a few months. It is one of the rare forms of azoospermia for which medical treatment is effective without surgical retrieval.

When azoospermia is due to pituitary deficiency, treatment consists of hormone injections that replace the missing FSH and LH, several times a week. The testosterone produced by the testicle rises first, then, after several months, sperm often appear in the ejaculate. The time taken varies, sometimes more than a year. During treatment, regular semen analyses follow progress; sperm can be frozen as soon as they appear. This treatment is supervised by an endocrinologist or andrologist.

A varicocele, a dilation of the veins surrounding the testicle, is common and can impair sperm production. In some men with non-obstructive azoospermia and a significant varicocele, its correction has allowed a few sperm to appear in the ejaculate or improved the chances of micro-TESE. Results vary, and the value of this treatment is discussed case by case with the urologist, taking the partner's age into account.

Despite a well-conducted micro-TESE, sometimes no sperm is found, particularly in severe non-obstructive azoospermia. This is a very difficult moment for the man and the couple, often experienced as a loss. The surgeon explains the result, the tissue analysis and any options: a new procedure is rarely useful after a complete micro-TESE, but can sometimes be discussed in certain situations.

The other paths to parenthood are then sperm donation, for married couples, adoption, or choosing a life without children. Taking time to go through this grief, with the help of a psychologist, before deciding what comes next is essential.

For married couples, sperm donation allows a child to be carried by the partner, using sperm from a donor selected by an authorised centre. It can be considered if no sperm is found, if the couple does not wish to have a biopsy, or if a serious genetic abnormality risks being passed on. Swiss law establishes legal parentage with the married couple and guarantees the child the right to know the donor's identity at 18. Psychological counselling supports this choice, which often takes time. See our page on artificial insemination.

For married couples, sperm donation is a path to parenthood when no sperm can be found, when the couple does not wish to have surgical retrieval, or when a serious genetic abnormality risks being passed on. The partner can then receive inseminations with donor sperm, or IVF if her own fertility requires it. The donor is selected by an authorised centre, and the child will be able to know his identity at 18, in accordance with Swiss law.

For the man, accepting donation may require significant time for reflection. The psychological counselling offered by centres supports him on this journey, often with his partner.

Men who become fathers through sperm donation often say that their place as a father developed naturally, day to day, through emotional bonds, presence and upbringing. Studies of families formed through donation are reassuring about children's development and their relationship with their parents, particularly when the child is told early about their story. The right to know the donor at 18 takes nothing away from the place of the father who raised the child.

Before micro-TESE, it is useful for the couple to think about what they would do if no sperm were found. Some married couples choose to plan, with their consent, to use donor sperm on the same day as a retrieval synchronised with egg retrieval, if the search is negative. Others prefer to take time to decide afterwards. There is no universally right choice; talking about it with the centre's psychologist helps find what suits the couple.

For some couples, adoption becomes another path to parenthood, with its own procedure and timescales, governed by the Civil Code and cantonal authorities. Others choose, after reflection, to build a life without children. These paths deserve to be explored at the couple's own pace, with support if needed, and respected by those around them.

Adoption is another path to parenthood, governed in Switzerland by the Civil Code and the cantonal authorities. The procedure includes an assessment of suitability to adopt, then waiting for a child, which can take several years. It is different from assisted reproduction, with its own requirements and path. Interested couples can contact the relevant service in their canton. It is generally advised to take time to grieve the biological plan before committing.

In Switzerland, coverage of the azoospermia assessment by basic insurance is generally assured for indicated diagnostic tests. For the surgical retrieval itself, the situation depends on its purpose and insurance rules: a diagnostic or therapeutic procedure may be covered, whereas procedures linked to IVF, including ICSI, embryo culture and freezing, are at the couple's expense. Freezing of retrieved sperm is often charged separately.

Before the procedure, ask the surgeon and the centre how the different procedures will be invoiced, and check with your insurer what will be covered.

In Switzerland, using retrieved sperm for IVF with ICSI falls within the framework of the Federal Act on Medically Assisted Reproduction. It is reserved for couples, married or not, with whom a legal parent-child relationship can be established. Sperm donation, the alternative in case of failure, is reserved for married couples. Storage of sperm and embryos is limited in time, with possible extensions. The gametes of a deceased person cannot be used. The centre informs you of the rules in force and obtains your written consent.

Before retrieval and freezing, the man signs a consent form after receiving information on the technique, risks, chances and storage. Before IVF with ICSI, the couple signs the usual consents, notably for freezing embryos. If sperm donation is used, specific consents are required. Read these documents carefully, ask your questions and keep a copy.

All information about your diagnosis, genetic tests and journey is covered by medical confidentiality. Genetic results are not disclosed to third parties, including insurers, except in cases provided for by law. Sick notes do not state the reason. You remain free to decide with whom you share your story.

For assessment tests to be reimbursed, check the conditions of your basic insurance model: with a family doctor, health network or telemedicine model, you often have to go through your primary care doctor first, who refers you to the urologist. Without this step, the insurer may reduce or refuse reimbursement. Each partner has their own insurance: the man's tests fall under his insurer, his partner's under hers.

Some supplementary insurance policies contribute to costs not covered by basic insurance, such as part of the procedures linked to assisted reproduction, freezing or psychological support. Conditions and ceilings vary greatly between contracts. Read your contract carefully and ask for written confirmation before the procedure.

To estimate the budget for the journey, add up the cost of retrieval and freezing, annual storage, and above all the cost of IVF with ICSI, at the couple's expense, possibly over several cycles. Depending on the situation, genetic counselling and possible preimplantation genetic testing are added. Discussing this budget with the centre from the outset allows the journey to be planned without unpleasant surprises.

These indices are indicative and vary between centres. Details are on our page on testicular biopsy prices.

Sperm retrieval is carried out by specialist urologists or andrologists, often in the urology departments of university and cantonal hospitals, in liaison with a reproductive medicine centre. Micro-TESE, which is more specialised, is mainly performed in centres with microsurgical expertise, notably in Geneva, Lausanne, Bern, Basel and Zurich. Simpler procedures, such as aspiration in the case of obstruction, are more widely available. The assessment can often start near home.

In Switzerland, the azoospermia journey generally follows the same stages: confirmation by the laboratory, consultation with a urologist or andrologist, hormonal, ultrasound and genetic assessment covered by basic insurance under the usual rules, discussion of the strategy, surgical retrieval in liaison with an authorised fertility centre, then IVF with ICSI at the couple's expense. The university centres of Geneva, Lausanne, Bern, Basel and Zurich have particular expertise in complex situations, and many regional centres carry out the assessment and simpler procedures.

Understanding the diagnosis, genetic tests, techniques and chances is essential for making informed decisions. In French-speaking Switzerland, consultations are in French. In the major German-speaking cities, many urologists and fertility centres see patients in French or English; in Ticino, in Italian. Do not hesitate to ask for a written report and to ask your questions until everything is clear.

Micro-TESE is mainly performed in centres with microsurgical expertise. If you live far away, part of the assessment can be carried out near home, with your doctor, a local urologist or a laboratory, then the procedure at the specialist centre. As the procedure is most often done as an outpatient, a return trip in a day is generally possible, with someone to accompany you home. Later check-ups can often be done locally.

Other cantonal hospitals and private clinics also offer retrieval, particularly simpler procedures in the case of obstruction.

A second opinion is useful if you are told that no retrieval can be considered without a complete genetic assessment, if a first conventional biopsy failed and micro-TESE was not discussed, or if you are hesitating between reversal and retrieval after a vasectomy. Bring all your results. A specialist experienced in micro-TESE can give you a more precise estimate of the chances.

• A urologist or andrologist experienced in male infertility.
• Practice of microsurgery, for micro-TESE and reversals.
• Close collaboration with a fertility centre and its laboratory.
• A complete assessment, including genetic tests, before any procedure.
• Honest explanation of the chances in your situation.
• Psychological support offered to the couple.
• Language of consultation and proximity.

For micro-TESE, the experience of the surgical team and the laboratory directly influences the chances. Do not hesitate to ask how many procedures of this type are carried out each year.

The GP is often the first person you talk to after an abnormal semen analysis. They can prescribe a second semen analysis, carry out the first hormone tests and refer you to a specialist urologist or andrologist, and, depending on your insurance model, going through them is necessary for tests to be reimbursed. They also provide long-term follow-up of your general health, notably hormonal, and can support you throughout the journey. Keep them informed of results and decisions made with specialists. They often know your history well, which makes them a valuable person to talk to about your worries, your experience and the choices ahead, in complete confidence and without judgement. Do not hesitate to ask them, even about questions that seem simple or intimate: they are there to support you.

The azoospermia journey involves several specialists: urologist or andrologist, endocrinologist, geneticist, laboratory and fertility centre. Good coordination between them is essential: passing on results, agreeing the strategy, and planning retrieval and IVF. In university centres, these teams often work together day to day. If you are followed by several practitioners, ask them to communicate and keep a copy of all your documents.

• Bring all your semen analyses and test results.
• Note your history: undescended testicle, infections, surgery, trauma.
• List your treatments, including supplements and bodybuilding products.
• Prepare your questions about the cause, tests and chances.
• Come with your partner if possible.
• Ask for a written report of the consultation.

• Is my azoospermia obstructive or non-obstructive?
• What is the likely cause?
• Is medical treatment or surgical repair possible?
• Which retrieval technique do you propose, and why?
• What are my chances of finding sperm?
• Should retrieval be done before IVF or on egg retrieval day?
• What are the risks to my testicles and testosterone?
• What will happen if no sperm is found?

• 1. Confirm azoospermia with several semen analyses.
• 2. Carry out a complete assessment, including genetic tests.
• 3. Identify the cause and possible treatments.
• 4. Choose the technique and strategy with the specialist and the fertility centre.
• 5. Think together about the alternatives in case of failure.

• A couple unable to conceive, assessment of the woman and semen analysis for the man.
• Azoospermia found, confirmed on a second test with centrifugation.
• Consultation with a urologist or andrologist: examination, blood tests, ultrasound.
• Genetic tests and genetic counselling if needed.
• Discussion of the options: medical treatment, repair, retrieval, donation, adoption.
• Surgical retrieval, with freezing or synchronised with egg retrieval.
• IVF with ICSI, one embryo transferred, the others frozen.

This journey often extends over several months. The partner's age is an important factor in setting the pace.

Between discovering azoospermia and retrieval, allow several months: confirming the semen analysis, consultations, tests, genetic tests — whose results can take several weeks — and scheduling the procedure. If the partner is over 35, it is useful to carry out her assessment in parallel and to point out the relative urgency to the teams. Good coordination between urologist, gynaecologist and fertility centre saves time.

After a diagnosis of azoospermia, it is tempting to want to act quickly. Yet taking a few weeks to complete the assessment, understand the cause, meet the geneticist if needed and think together about the different options often leads to better decisions. This time is also needed to absorb the diagnosis emotionally. Only the partner's age may prompt you to speed up certain stages; the doctor helps you find the right pace.

In most cases of azoospermia, lifestyle is not the cause. It nevertheless remains important: stopping smoking, avoiding excessive alcohol, not using anabolic steroids or testosterone without a prescription, maintaining a healthy weight and limiting exposure to heat promote general health and, in some cases, residual sperm production. These measures also benefit the partner and the future pregnancy, and they give the couple a sense of control in a journey that leaves little.

For the man, the journey involves a few consultations, blood and imaging tests, and the procedure itself, followed by two to four days of rest for office work, more for physical work. For the partner, IVF then requires several early-morning appointments and one or two days around egg retrieval. Absences can be justified by a medical certificate without stating the reason. Nothing obliges you to tell your employer about the nature of the process.

After testicular retrieval, it is advisable to avoid sport for one to two weeks, then resume gradually, avoiding sports with a risk of impact to the scrotum or prolonged compression, such as cycling, during healing. Supportive briefs are recommended when resuming. After micro-TESE, the wait may be slightly longer; follow the surgeon's instructions.

The testicles are located outside the body to stay at a slightly lower temperature, needed for sperm production. Prolonged exposure to heat — very hot baths, frequent saunas, a laptop on the knees or certain jobs — can reduce this production. In azoospermia, heat is generally not the cause, but limiting these exposures is advised to preserve residual production.

Not all azoospermia can be prevented, but some measures reduce the risk: having an undescended testicle operated on early in childhood, vaccinating against mumps, protecting yourself from sexually transmitted infections and treating them promptly, avoiding anabolic steroids and testosterone without a prescription, and freezing sperm before cancer treatment. These simple steps protect the future fertility of many men.

• Concluding too quickly that sterility is permanent.
• Operating without a hormonal and genetic assessment.
• Neglecting the partner's fertility and age.
• Continuing anabolic steroids or testosterone.
• Choosing an inexperienced team for micro-TESE.
• Not thinking in advance about the options in case of failure.
• Keeping the diagnosis to yourself without any support.

• Azoospermia: absence of sperm in the ejaculate.
• Cryptozoospermia: very rare sperm, found after centrifugation.
• Obstructive: sperm produced but blocked.
• Non-obstructive: production absent or very low.
• Spermatogenesis: the production of sperm.
• Seminiferous tubules: small tubules in the testicle where sperm are produced.
• Epididymis: the duct where sperm mature.
• TESE: testicular sperm extraction.
• Micro-TESE: TESE under an operating microscope.
• ICSI: injection of a sperm into the egg.
• FSH: hormone that stimulates sperm production.

• Azoospermia does not always prevent having a biological child.
• The assessment distinguishes obstructive and non-obstructive causes.
• Genetic tests guide the chances and counselling.
• Surgical retrieval often allows sperm to be found.
• Micro-TESE is the reference technique when production is reduced.
• The sperm found are used in IVF with ICSI.
• Sperm donation and adoption are alternatives in case of failure.

Studies show that micro-TESE allows sperm to be found in a significant proportion of men with non-obstructive azoospermia, with rates varying by cause and team experience, and that it is generally more effective than conventional biopsy in these situations. With an obstruction, simple techniques are almost always enough. Pregnancies achieved by ICSI with testicular sperm and children's health are broadly reassuring. Research continues to better predict the chances before the procedure and to preserve the fertility of young patients.

Research is exploring several avenues to help men with non-obstructive azoospermia: better prediction of the chances before the procedure using blood or genetic markers, more precise imaging of the testicle, preparatory hormone treatments and, in the longer term, maturing testicular cells in the laboratory or grafting frozen testicular tissue in children. Some of these approaches remain experimental and are not routinely available. Swiss university centres take part in this research.

Couples facing azoospermia often speak of the shock of the diagnosis, the man's difficulty in talking about it, then the relief of learning that solutions exist. The day of micro-TESE is described as a long wait, followed by immense emotion, of joy or sadness. Those for whom sperm were found speak of a second chance; those for whom it was not the case speak of grief, then, over time, building another plan, through sperm donation, adoption or a life as a couple. All stress the importance of having been well informed and supported.

Specialist urologists and andrologists emphasise a few messages: do not conclude too quickly that sterility is permanent, carry out a complete assessment including genetics, choose an experienced team for micro-TESE, coordinate retrieval with assisted reproduction and take the partner's age into account. They also point out the importance of freezing sperm before any cancer treatment, which avoids many difficult situations.

Whether or not to have retrieval, choosing the timing, considering sperm donation or adoption: these decisions belong to the couple, informed by the doctors. There is no single path. The key is to understand your situation, know your real chances and decide together, at the pace that suits you.

If you are facing azoospermia, do not remain alone with the diagnosis: see an experienced specialist, have a complete assessment, talk to your partner and seek support if needed. The possibilities are often more numerous than you imagine at the time of diagnosis. And whatever the outcome, the plan to become a parent can be achieved in different ways, at your own pace.

Medespoir Suisse helps you understand your diagnosis, prepare your questions and find an experienced urologist or andrologist, as well as a reproductive medicine centre, in your region and language. Describe your situation to us in complete confidence; we will direct you free of charge and without obligation.

Azoospermia is a difficult diagnosis, but it does not always mean permanent sterility. A complete assessment allows its cause to be understood, and current techniques, from simple aspiration to micro-TESE, often allow sperm to be found for IVF with ICSI. When this is not possible, other paths exist. The key is to be well informed, well supported and to decide together. To find out more, see our page on in vitro fertilisation in the laboratory and our guide to IVF and assisted reproduction.

Azoospermia is a difficult diagnosis, but not always a final one. A complete assessment distinguishes obstructive causes, where sperm are almost always found, from non-obstructive causes, where micro-TESE offers a real chance. Retrieved sperm allow IVF with ICSI, and when this is not possible, other paths to parenthood exist. Being well informed, well surrounded and supported by an experienced team greatly changes how this journey is experienced.

At the end of an azoospermia journey, many couples highlight three decisive elements: a complete assessment, which allowed the cause to be understood and unnecessary procedures to be avoided; an experienced, coordinated team linking urologist, laboratory and fertility centre; and mutual support within the couple, sometimes strengthened by psychological support. Whether the journey leads to a pregnancy with the man's sperm, through donation or by another path, these elements often make the difference in how each partner experiences it.

Whatever the outcome, an azoospermia journey takes courage: facing a difficult diagnosis, undergoing many tests, having a procedure, waiting for uncertain results and making important decisions. Taking time to recognise this path, alone or as a couple, helps integrate it into your story. Many men say they came out of it stronger, more aware of what really matters to them, and often closer to their partner.

Some thirty years ago, a man with no sperm in his semen could not become a biological father. Today, thanks to advances in microsurgery, the laboratory and ICSI, many men in this situation have been able to have children. For others, sperm donation or adoption has allowed them to start a family. This journey is never simple, but it opens up possibilities that did not exist before. Finding out, seeking support and deciding together remain the keys to getting through it as well as possible, bearing in mind that every story is unique and deserves respect, whatever path the couple chooses to welcome a child or to build their shared future differently. Swiss reproductive medicine, urology and genetics teams are there to support each couple at every stage, with skill and care.

If you have just learned that your semen contains no sperm, know that you are not alone, that this diagnosis says nothing about your worth or your masculinity, and that solutions often exist. Take time to absorb the news, then see a specialist, have a complete assessment and ask all your questions. Talk to your partner, and do not hesitate to ask for help. Many men in your situation are fathers today, by different paths.

To find information and support, several resources exist: your GP, specialist urologists and andrologists, reproductive medicine centres and their psychologists, geneticists, patient associations and support groups. Your centre can refer you to the resources available in your region and language.

If a semen analysis has shown no sperm, the first step is a consultation with a urologist or andrologist specialising in infertility, after the result has been confirmed. Bring your semen analyses and test results, and come with your partner if possible. Medespoir Suisse can refer you to a specialist and a fertility centre in your region and language, confidentially, free of charge and without obligation.

• Marc, 38, vasectomy eight years ago, partner aged 34: reversal, natural pregnancy a year later.
• Julien, 33, absent vas deferens: epididymal retrieval, genetic counselling, successful ICSI.
• Thomas, 29, unknown non-obstructive cause: micro-TESE, sperm found and frozen, ICSI.
• Nicolas, 31, Klinefelter syndrome: micro-TESE, a few sperm, two embryos, one pregnancy.
• Pierre, 35, after chemotherapy, with no prior freezing: negative micro-TESE, sperm donation after reflection.
• Kevin, 27, anabolic steroids for three years: stopped, medical treatment, sperm returned within eight months.
• David, 40, pituitary deficiency: hormone treatment, sperm in the ejaculate after six months.

• "No sperm, no biological child": sperm can often be found in the testicle.
• "It must be lifestyle's fault": most causes are medical or genetic.
• "Azoospermia affects virility": hormone production and sexuality are often normal.
• "A biopsy causes impotence": it does not affect erection.
• "Medical treatment can cure everything": only certain hormonal disorders can be treated this way.
• "A biopsy is always very painful": discomfort is generally moderate and brief.

• Semen analysis: no sperm, confirmed a month later.
• Assessment: high FSH, slightly small testicles, normal karyotype, no microdeletion.
• Consultation: micro-TESE proposed, chances estimated at about one in two.
• Meeting with the psychologist: thinking about possible sperm donation.
• Procedure under general anaesthesia, three hours.
• That same evening: a few sperm found and frozen.
• Three months later: IVF with ICSI for the partner.

• Vasectomy at 36, new relationship at 44, partner aged 35.
• Consultation: reversal or retrieval with ICSI.
• Retrieval chosen, because of the time elapsed and the wish to move quickly.
• Microsurgical epididymal retrieval: many sperm frozen.
• Two ICSI cycles possible with the reserve, pregnancy in the first.

• The diagnosis of azoospermia: shock, then worry for him.
• The tests, the urologist appointments together.
• The day of the micro-TESE: an endless wait, then the surgeon's call.
• Sperm found: immense relief.
• My stimulation, egg retrieval, ICSI: a shared journey, up to the positive test.

• Azoospermia discovered at 34, very low FSH and LH.
• Pituitary MRI and full hormone assessment by the endocrinologist.
• Start of hormone injections two to three times a week.
• Four months: testosterone normalised, energy regained.
• Eight months: first sperm in the ejaculate, frozen.
• Eleven months: natural pregnancy, treatment continued until the first trimester.

• Low semen volume, no sperm.
• Examination: vas deferens not palpable, normal testicles.
• Genetic analysis: two cystic fibrosis gene mutations.
• Partner tested: not a carrier.
• Microsurgical epididymal retrieval: many sperm frozen.
• ICSI: three blastocysts, pregnancy with the first transfer.

• The day the doctor said "no sperm", I felt as if the ground had given way.
• For weeks, I told no one except my wife.
• The consultation with the urologist gave me a little hope again.
• The psychologist helped me talk about my shame, then move beyond it.
• The evening of the micro-TESE, the surgeon's call: a few sperm.
• Today, I share my story with other men, so they do not remain alone.

Budget

Price differences between cities and cantons, the quote breakdown and ways to save are detailed on our page Testicular biopsy: prices in Switzerland.

Related procedures

• In vitro fertilisation in Switzerland
• IVF: the pathway in Switzerland
• Artificial insemination in Switzerland

Our guides

• Guide to IVF and assisted reproduction in Switzerland
• Cosmetic surgery in Switzerland

Answers to the most frequent questions about azoospermia and sperm retrieval in Switzerland.

Understanding azoospermia

What is azoospermia? It is the complete absence of sperm in the ejaculate, confirmed on at least two semen analyses after centrifugation of the sample. It affects about one man in a hundred and a significant proportion of men consulting for infertility.

Does azoospermia mean I will never have a biological child? No, not necessarily. In many cases, sperm can be found in the testicle or epididymis and used in IVF with ICSI. The chances depend on the cause.

What are the two main types of azoospermia? Obstructive azoospermia, in which sperm is produced but blocked on its way out, and non-obstructive azoospermia, in which sperm production in the testicle is absent or very low.

What causes obstructive azoospermia? A vasectomy, congenital absence of the vas deferens, often linked to a cystic fibrosis gene mutation, after-effects of infection, hernia surgery in childhood, or obstruction of the ejaculatory ducts.

What causes non-obstructive azoospermia? Genetic abnormalities such as Klinefelter syndrome or Y chromosome microdeletions, an undescended testicle in childhood, chemotherapy or radiotherapy, hormonal disorders, infections such as mumps affecting the testicle, or an unknown cause.

Does azoospermia cause symptoms? Most often, none. Semen may look normal to the naked eye. Depending on the cause, there may be small testicles, reduced libido or other hormonal signs.

Can tests tell the two types apart? Yes, in most cases. Testicular volume, FSH levels, examination of the vas deferens, biochemical analysis of the semen and ultrasound point towards an obstructive cause or not.

Is azoospermia permanent? Not always. Some causes can be treated: a hormonal disorder can be corrected, an obstruction sometimes repaired surgically, and azoospermia after treatment may improve over time. The assessment clarifies what is possible.

Can lifestyle cause azoospermia? Anabolic steroids and testosterone taken outside medical indications can suppress sperm production and cause azoospermia, often reversible after stopping, over several months. Smoking, alcohol and heat reduce sperm quality without usually causing complete azoospermia.

What is cryptozoospermia? It is the presence of very rare sperm, found only after centrifugation of the sample. These sperm can sometimes be used for ICSI without a biopsy, after several samples have been frozen.

Is azoospermia linked to virility? No. Sperm production and virility are two separate things. Many azoospermic men have a normal sex life and normal hormone production.

Is azoospermia hereditary? Some causes are genetic and can be passed on, such as Y chromosome microdeletions to a son conceived by ICSI, or mutations linked to absence of the vas deferens. Genetic counselling is then offered.

How should I tell my partner about azoospermia? There is no single right way. Many men find it helpful to talk about it quickly, share the doctor's explanations and attend the following consultations together. It is a couple's matter, concerning both partners.

Should the semen analysis be repeated? Yes, azoospermia must be confirmed on at least two tests, a few weeks apart, with centrifugation, before any treatment.

Can a fever distort the result? A high fever can temporarily reduce sperm production for several weeks. Mention any recent illness; the doctor may have the test repeated.

Can retrograde ejaculation look like azoospermia? Yes, if semen goes into the bladder, the ejaculate is very small or absent. A urine test after ejaculation allows the diagnosis to be made, and sperm can sometimes be recovered from it.

The assessment

Which tests are needed? At least two semen analyses, a clinical examination by a urologist or andrologist, hormone blood tests, an ultrasound of the testicles and sometimes the prostate, and genetic tests depending on the situation.

Why measure FSH? FSH is the hormone that stimulates sperm production. A high FSH suggests a testicle that produces poorly, pointing towards a non-obstructive cause; a normal FSH with normal-sized testicles points rather towards an obstruction.

Which genetic tests are offered? A karyotype, which looks for abnormalities in the number or structure of chromosomes such as Klinefelter syndrome, testing for Y chromosome microdeletions and, in the case of absent vas deferens, testing for cystic fibrosis gene mutations, also in the partner.

Why have an ultrasound? To measure testicular volume and look for an abnormality, a varicocele or, more rarely, a tumour, which is slightly more common in infertile men. Prostate ultrasound can look for obstruction of the ejaculatory ducts.

Should the partner also be examined? Yes, her fertility assessment is needed before planning IVF with ICSI, and testing for cystic fibrosis gene mutations is offered if the man has absent vas deferens.

How long does the assessment take? A few weeks to a few months, depending on test and consultation waiting times. It is useful to carry it out in parallel with the partner's assessment.

Is the assessment reimbursed? Diagnostic infertility tests, such as semen analysis, hormone tests, ultrasound and indicated genetic tests, are generally covered by basic insurance, subject to the deductible (franchise) and co-payment (quote-part).

What does a Y chromosome microdeletion mean? It is the loss of a small part of the Y chromosome containing genes needed for sperm production. Depending on the region affected, the chances of finding sperm at biopsy are good, low or almost nil. This result helps decide whether surgery is worthwhile.

What is Klinefelter syndrome? It is a chromosomal abnormality in which the man has an extra X chromosome. It is often accompanied by small testicles, azoospermia and sometimes testosterone deficiency. Sperm can be found by micro-TESE in some of these men.

Should I see a geneticist? Yes, when genetic abnormalities are found or suspected, genetic counselling explains the consequences for fertility, health and any children.

Is genetic testing compulsory? It is not compulsory, but strongly recommended in non-obstructive azoospermia or absent vas deferens, as it influences the chances and the advice given to the couple.

Is an MRI useful? Rarely. It may be offered if a pituitary disorder or a particular abnormality of the reproductive tract is suspected.

Retrieval techniques

What are the retrieval techniques? Needle aspiration of the testicle or epididymis, conventional biopsy with removal of testicular fragments, and micro-TESE, carried out under an operating microscope to identify the areas of the testicle most likely to contain sperm.

What is TESE? It is testicular sperm extraction by surgical removal of small fragments of tissue through a small incision in the scrotum. The fragments are then analysed in the laboratory.

What is micro-TESE? It is TESE carried out under an operating microscope. The surgeon opens the testicle and identifies, at high magnification, the most dilated small tubules, where sperm production is most likely. It increases the chances in non-obstructive azoospermia and limits the amount of tissue removed.

What is epididymal aspiration? It is the aspiration, by needle or microsurgery, of the fluid in the epididymis, where sperm accumulate when there is an obstruction. It is used in obstructive azoospermia.

How does the surgeon choose the technique? According to the type of azoospermia, testicular volume, hormone levels, genetic tests, any previous retrievals and the team's experience. With an obstruction, a simple technique is often enough; with reduced production, micro-TESE is often preferred.

Do both testicles need surgery? Not always. With an obstruction, one side is generally enough. In micro-TESE, the surgeon starts with one side and explores the other if needed, according to the laboratory's findings during the procedure.

Is retrieval done on the same day as egg retrieval? It depends on the centre. Some carry out retrieval before IVF and freeze the sperm; others synchronise it with egg retrieval. Each strategy has its advantages.

Why freeze the retrieved sperm? Freezing allows you to know in advance whether sperm exists before stimulating the partner, and to use it for several ICSI cycles without a new procedure, if there is enough.

Can an obstruction be repaired rather than retrieving sperm? In some cases, notably after a vasectomy, reversal surgery can allow sperm to return to the ejaculate and natural conception. The choice between repair and retrieval depends on the cause, the time elapsed and the partner's age.

What is TESA? It is needle aspiration of the testicle, under local anaesthesia, which draws out a little testicular tissue. It is simple and quick, and mainly used when there is an obstruction.

What is MESA? It is microsurgical retrieval of fluid from the epididymis, which often allows many motile sperm to be collected in the case of obstruction, useful for freezing.

Is the laboratory present during the procedure? Often, a biologist examines the fragments under the microscope during the procedure, which tells the surgeon whether to continue searching.

How much tissue is removed? In micro-TESE, only small, targeted fragments are removed. In conventional biopsy, several small fragments are removed. The quantity is limited to preserve the testicle.

The procedure

Under what anaesthesia is the biopsy done? Depending on the technique, under local anaesthesia, local with sedation, or general. Micro-TESE is generally done under general or spinal anaesthesia.

How long does the procedure take? An aspiration takes a few minutes, a conventional biopsy about half an hour, and micro-TESE one to several hours depending on the search needed.

Is a hospital stay needed? Most often not: the procedure is done as an outpatient, with a return home the same day, accompanied.

Is the procedure painful? During the procedure, anaesthesia prevents pain. Afterwards, discomfort and tenderness of the scrotum are common for a few days, relieved by simple painkillers, cold and supportive briefs.

How long does recovery take? Most men return to office work after two to four days, physical activity after one to two weeks, and sexual intercourse after about a week, according to instructions.

When is the result known? The laboratory examines the fragments during the procedure or in the following hours. The surgeon can often give the result the same day. Microscopic analysis of the tissue by the pathologist is available a few days later.

What are the risks? Haematoma, infection, prolonged pain and, rarely, partial shrinkage of the testicle or reduced testosterone, especially after extensive or repeated retrievals. These complications are uncommon.

Can a biopsy reduce testosterone? Extensive micro-TESE can cause a temporary, sometimes lasting, fall in testosterone, particularly in men with small testicles, as in Klinefelter syndrome. A hormone check is often offered after the procedure.

Can a biopsy be repeated if the first fails? A second procedure is sometimes possible, particularly if the first was not a micro-TESE, but the chances depend on the cause and previous results. The decision is made with the surgeon.

Do I need someone to accompany me? Yes, after sedation or general anaesthesia, you must be taken home and must not drive on the same day.

What should I do after the procedure? Wear supportive briefs, apply cold for the first few hours, take the prescribed painkillers, avoid exertion and baths for a few days, and watch for significant swelling or fever.

Is there a scar? A small scar on the scrotum, generally very discreet, often with dissolvable stitches.

Chances and results

What are the chances of finding sperm? In obstructive azoospermia, sperm is found in almost all cases. In non-obstructive azoospermia, the chances are more variable, often around half with micro-TESE in experienced teams, depending on the cause.

Which factors influence the chances? The cause of azoospermia, certain genetic abnormalities, testicular histology if known, the technique used and the team's experience. Testicular volume and FSH are less predictive than one might think in non-obstructive cases.

Can testicular sperm fertilise an egg? Yes, with ICSI. Even immature and poorly motile, they can fertilise an egg when injected directly into it.

Are the chances of pregnancy the same as with ejaculated sperm? The chances of pregnancy with ICSI using testicular sperm are generally good, especially with an obstruction; they may be slightly lower when production is very impaired. The partner's age and fertility remain decisive.

What happens if no sperm is found? It is a difficult ordeal. The doctor explains the result and the options: a possible new procedure, sperm donation for married couples, adoption or a life without children. Psychological support is strongly recommended.

Are children conceived by ICSI with testicular sperm healthy? Available data are reassuring: the vast majority of these children are healthy. Some genetic abnormalities in the father can be passed on, which justifies prior genetic counselling.

How many ICSI cycles does one retrieval allow? It depends on the number of sperm found. With an obstruction, one retrieval is often enough for several cycles; with low production, the sperm may only be enough for one cycle.

Is embryo quality different? It may be slightly lower when production is very impaired, but many good-quality embryos are obtained with testicular sperm.

Does the partner's age matter? Yes, a great deal. The chances of pregnancy after ICSI depend strongly on the partner's age and fertility, which must be taken into account in the strategy.

Particular situations

After a vasectomy, is a biopsy needed? Not necessarily. Surgical reversal may allow natural conception. If it is not wanted or not possible, sperm retrieval combined with ICSI is an alternative.

After chemotherapy, can sperm be found? Sometimes. Production may resume months or years after treatment. If azoospermia persists, micro-TESE can find sperm in some men. Ideally, sperm should be frozen before treatment.

After an undescended testicle in childhood? A testicle that descended late may produce fewer sperm. Micro-TESE often allows sperm to be found, especially if the childhood operation was done early.

In the case of absent vas deferens? Sperm are generally produced normally and can be retrieved from the epididymis or testicle. Genetic counselling is essential, as this situation is often linked to cystic fibrosis gene mutations.

Can men with Klinefelter syndrome have children? Sperm can be found by micro-TESE in some affected men, allowing ICSI. Some teams discuss earlier retrieval, in late adolescence or young adulthood.

Could anabolic steroids be the cause? Yes. Stopping anabolic steroids or testosterone, sometimes with medical treatment to restart production, often allows sperm to return within a few months. A biopsy is then not always necessary.

Can hormone treatment avoid a biopsy? In certain hormonal disorders, such as pituitary deficiency, hormone treatment can restart sperm production in the ejaculate. In other situations, its value before micro-TESE is debated.

Should a varicocele be treated first? In some men with non-obstructive azoospermia and a significant varicocele, its correction is sometimes discussed. Its benefit varies; the urologist assesses its value in your case.

Can sperm donation be used after a failure? Yes, for married couples, sperm donation is an option. It can be discussed before the biopsy, so that the couple knows what they would do if no sperm is found.

Can donor sperm be held in reserve on egg retrieval day? Some married couples decide in advance, with their consent, to use donor sperm if no sperm is found on the day of a synchronised retrieval. This option is discussed with the centre and the psychologist.

How can we cope with waiting for the result? The wait can be very anxious. Arranging to be accompanied, talking to your partner and preparing the different scenarios together help you through this moment.

Insurance, costs and centres

Is testicular biopsy reimbursed? Diagnostic or therapeutic tests and procedures can be covered by basic insurance depending on the situation. Coverage of retrieval for IVF — and IVF with ICSI itself, which is at the couple's expense — must be checked with your insurer.

How much does a testicular biopsy cost? The cost depends on the technique, anaesthesia and freezing. We express it as relative indices on our prices page. Ask for a detailed quote including the laboratory search and storage.

Is there a charge for freezing sperm? Yes, freezing and annual storage are generally charged. Ask about rates and storage conditions.

Where can a testicular biopsy be done in Switzerland? With specialist urologists or andrologists, often in university and cantonal hospitals, in liaison with a reproductive medicine centre: Geneva, Lausanne, Bern, Basel, Zurich, Lucerne, St. Gallen, Lugano and other cities.

How should I choose the surgeon? Choose a urologist or andrologist experienced in reproductive microsurgery, working closely with an assisted reproduction laboratory. For micro-TESE, the team's experience influences the chances.

Can I consult in French in German-speaking Switzerland? In the major cities, many specialists see patients in French or English. Mention it when booking.

Can Medespoir direct me? Yes. Describe your results and the tests carried out. We will direct you to a urologist or andrologist and a fertility centre in your region and language. Free, confidential and without obligation.

Can frozen sperm be transferred to another centre? Yes, transport to another authorised centre is possible following secure procedures, with your consent.

How long can sperm be stored? Swiss law limits the storage period, with the possibility of extension on request. The centre informs you of the applicable time limits.

Is follow-up needed after the procedure? A check-up a few days or weeks later confirms healing. After micro-TESE, a testosterone test may be offered some time later.

What do you feel on learning of azoospermia? Often shock, incomprehension, sadness, and sometimes shame or guilt. These reactions are normal. Talking about them with your partner, the doctor or a psychologist helps you through them.

Does azoospermia affect self-esteem? For many men, yes, as fertility is often associated with male identity. It is important to remember that it is a medical condition, unrelated to personal worth or virility.

Should I tell those around me? It is a personal choice. Some men tell a few trusted people, others prefer to keep the information within the couple. The key is not to remain alone.

Can a psychologist help? Yes. Fertility centres offer psychological support, useful after the diagnosis, before a biopsy, after a negative result, or when considering sperm donation.

Can the relationship be weakened? A diagnosis of azoospermia can put the relationship to the test. Communicating openly, making decisions together and seeking support if needed help you stay united.

Can I improve my chances before the biopsy? Stopping smoking, anabolic steroids and excessive alcohol, treating any hormonal disorder and maintaining a healthy weight are advised. Their effect on non-obstructive azoospermia is limited, but they benefit general health.

Can I do sport after the procedure? After one to two weeks in general, starting gently. Avoid sports with a risk of impact to the scrotum or compression during healing.

When can I resume sexual intercourse? Generally after about a week, when pain has gone and healing is good, according to the surgeon's instructions.

Can I drive after the procedure? Not on the same day after sedation or general anaesthesia. Afterwards, as soon as sitting and movement are no longer painful.

Can I return to work quickly? Office work can often resume after two to four days; physical work after one to two weeks.

Is the biopsy result final? For that retrieval, yes. But the absence of sperm at a conventional biopsy does not always rule out micro-TESE finding some. The surgeon will discuss this possibility.

Is the biopsy also used for diagnosis? Yes, microscopic analysis of the tissue provides information on sperm production and can, rarely, reveal a precancerous lesion, especially in men who had an undescended testicle.

Can adolescents freeze testicular tissue? For boys who must receive very toxic treatment before puberty, some centres offer freezing of testicular tissue within specialised protocols, whose future use remains experimental.

Is retrieval possible in an older man? Yes, the man's age does not prevent retrieval. The decision mainly takes into account the partner's age, the chances and general health.

Can medical treatment replace a biopsy? Rarely. Only certain hormonal disorders, such as pituitary deficiency, can be treated medically with a return of sperm. In other cases, retrieval remains necessary.

Should the biopsy be done before stimulating the partner? Many centres recommend it, freezing the sperm, to avoid unnecessary stimulation if no sperm is found. Others prefer synchronised retrieval; discuss it with the team.

Does frozen testicular sperm survive well? Some lose vitality on thawing, but generally enough remain for ICSI when the initial quantity is sufficient. The laboratory assesses the situation at each thaw.

Describe your semen analysis results and the tests already carried out. We will direct you to a urologist or andrologist and a fertility centre in your region and language. Free, confidential and without obligation.