Sperm Collection by Testicular Sperm Extraction (TESE)

This information will help you prepare for your sperm collection by testicular sperm extraction (TESE) procedure at Memorial Sloan Kettering (MSK).

TESE is a procedure to collect sperm directly from your testes. It’s done if there are no sperm found in your semen, the milky white substance where sperm live. You may have this procedure because:

• Your testes aren’t making enough sperm in your semen.
• A blockage is preventing your sperm from passing out of your penis during ejaculation. Ejaculation is when semen comes out of your penis after reaching orgasm (an intense feeling of pleasure).

Samples of tissue will be taken from your testicles and sent to a sperm bank. Sperm banking is the collection, freezing, and storage of sperm for possible use in the future. Sperm banking before cancer treatment will increase your chance of having a biological child in the future using your own sperm. 

After your procedure, your tissue samples will be brought to the Sperm Bank of New York to be analyzed. If they find sperm, the tissue will be be transferred to their affiliated sperm bank in New Jersey for freezing and storage. The address is:

908-654-8836

Some sperm banks may have less expensive storage fees. Talk with your healthcare provider if you want your sperm moved to a different sperm bank, or if you have questions. For more information, read Sperm Banking and and Building Your Family After Cancer Treatment: For People Born With Testicles.

Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your healthcare provider about which medications are safe for you to stop taking.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

Tell us if you’re sick

If you develop any illness (fever, cold, sore throat, or flu) before your procedure, call the healthcare provider who scheduled it for you. After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask for the healthcare provider on call for your healthcare provider.

The Day Before Your Procedure

Note the time of your appointment

A clerk from the Admitting Office will call you after 2:00 p.m. the day before your procedure. If you’re scheduled for your procedure on a Monday, you will be called on the Friday before.

The clerk will tell you what time you should arrive for your procedure. They will also tell you where to go. If you don’t receive a call by 7:00 p.m., call 212-639-5014.

If you need to cancel your procedure for any reason, call the healthcare provider who scheduled it for you. 

Instructions for eating

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Stop eating at midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.

If your healthcare provider told you to stop eating earlier than midnight, follow their instructions. Some people need to fast (not eat) for longer before their surgery.

Your healthcare provider may give you more instructions for eating and drinking before your procedure.

The Day of Your Procedure

Instructions for drinking

Between midnight (12 a.m.) and 2 hours before your arrival time, only drink the liquids on the list below. Do not eat or drink anything else. Stop drinking 2 hours before your arrival time.

• Water.
• Clear apple juice, clear grape juice, or clear cranberry juice.
• Gatorade or Powerade.
• Black coffee or plain tea. It’s OK to add sugar. Do not add anything else.
  • Do not add any amount of any type of milk or creamer. This includes plant-based milks and creamers.
  • Do not add honey.
  • Do not add flavored syrup.

If you have diabetes, pay attention to the amount of sugar in these drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.

It’s helpful to stay hydrated before surgery, so drink if you are thirsty. Do not drink more than you need. You will get intravenous (IV) fluids during your surgery.

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Stop drinking 2 hours before your arrival time. This includes water.

Things to remember

• Take your medications the morning of your procedure as instructed by your healthcare provider. Take them with a few sips of water.
• Don’t put on any lotions, creams, powders, deodorant, makeup, or cologne.
• Remove any jewelry, including body piercings.
• Leave all valuables, such as credit cards and jewelry, at home.
• If you wear contact lenses, if possible, wear your glasses instead. If you don’t have glasses please bring a case for your contacts.

What to bring with you

• A list of the medications you take at home, including patches and creams.
• Medications for breathing problems (such as inhalers), medications for chest pain, or both.
• A case for your glasses or contacts.
• Your Health Care Proxy form, if you have completed one.

What to expect

Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to say and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.

You will get general anesthesia (medication to make you sleepy) to put you to sleep during the procedure. Your healthcare provider will make a very small incision (surgical cut) in your scrotum (the pouch of skin holding your testes). They will examine your testes using a tiny microscope and remove small pieces of tissue from your testes. Then, your healthcare provider will close the incision with sutures (stitches).

You will have a bandage (mummy wrap) around your scrotum and a scrotal support to hold the dressing in place. The scrotal support is a special type of underwear. You will also be given extra gauze to put between your bandage and scrotal support to use as compression.

After Your Procedure

In the recovery room

You will recover in the Post Anesthesia Care Unit (PACU). When you wake up, you will be discharged home or brought back to your hospital room, if you’re in the hospital for other reasons.

At home

You’re healthcare provider may prescribe antibiotics. You should take them as instructed until the bottle is empty, even if you are feeling better.

You may have mild pain and tenderness in your scrotum for a few days. You will get a prescription for pain medication. Take it as directed by your healthcare provider.

Pain medication may cause constipation. Both over-the-counter (medication you get without a prescription) and prescription medications are available to treat constipation. Start with one of the following over-the-counter medications first:

• Docusate sodium (Colace®) 100 mg. Take _____ capsules _____ times a day. This is a stool softener that causes few side effects. Do not take it with mineral oil.
• Polyethylene glycol (MiraLAX®) 17 grams daily.
• Senna (Senokot®) 2 tablets at bedtime. This is a stimulant laxative, which can cause cramping.

If you have not had a bowel movement (pooped) within 3 days after your procedure, contact your healthcare provider.

You may also have mild bruising (a “black and blue” appearance) on your scrotum. Your penis and scrotum may be swollen. This is normal and should go away over the next week.

How to care for your scrotum

• Apply cold packs against your bandage. Put them outside your bandage and not directly on your skin, but inside your scrotal support. Keep the cold packs on for 48 hours (2 days), except for when you sleep. Remove the cold packs before going to bed.
• Keep your bandage in place around your penis and scrotum for 2 days after your procedure.
• Stay off your feet as much as you can for 3 days after your procedure. You can take short walks and climb stairs, if you need to.
• Apply extra gauze inside your scrotal support for 4 days after your procedure.
• Use the scrotal support for 1 week after your procedure.
• When sitting, raise your legs on a chair or pillow.
• When sitting, raise your scrotum on a small pillow or rolled up towel.

Activity

• You can shower 3 days after your procedure. Do not soak in a pool, bath tub, or hot tub for 2 weeks after your procedure.
• You can resume your normal activity 3 days after your procedure. If you develop new pain, or your pain gets worse, as you do more activities, limit your activity until your pain gets better.
• Do not drive while you’re taking pain medication. The pain medication can make you drowsy.
• Do not lift any objects heavier than 10 pounds (4.5 kilograms) for at least 2 weeks after your procedure.
• You can resume sexual activity 1 week after your procedure.

Call Your Healthcare Provider if You Have:

• A fever of 101°F (38.3°C) or higher
• Pain that doesn’t go away with pain medication
• Chills
• Swelling in your scrotum or penis that’s getting worse
• Drainage (leaking) or pus coming from your incision