What Is Micro-TESE? A Guide to Microdissection Testicular Sperm Extraction
Microdissection testicular sperm extraction (Micro-TESE) is a specialised surgical procedure used to retrieve sperm directly from the testicular tissue. It is primarily used in men with non-obstructive azoospermia (NOA), a condition in which no sperm are detected in the ejaculate because sperm production in the testes is severely impaired.
Micro-TESE uses a surgical microscope to help identify areas of the testicular tissue that may contain sperm-producing tubules. The sperm retrieved may be used in assisted reproductive treatments, particularly intracytoplasmic sperm injection (ICSI), if suitable sperm and eggs are available.
The procedure may offer a fertility option for selected men who have no sperm in their semen, but sperm retrieval is not guaranteed.
When Is Micro-TESE Recommended?
A fertility specialist or urologist specialising in male reproductive health may consider Micro-TESE after a thorough evaluation of the cause of azoospermia.
It may be recommended in situations such as:
- Non-obstructive azoospermia: When the testes produce very few sperm or sperm production is limited to small areas of testicular tissue.
- Severe male factor infertility: When investigations indicate significantly impaired sperm production and surgical sperm retrieval may be appropriate.
- Previous unsuccessful sperm retrieval: When an earlier procedure did not identify sperm, a specialist may assess whether Micro-TESE is suitable.
- Selected complex fertility cases: When clinical examination, hormone tests, genetic investigations, and other findings support considering surgical sperm retrieval.
It is important to distinguish non-obstructive azoospermia from obstructive azoospermia. In obstructive azoospermia, sperm may be produced normally but cannot enter the ejaculate because of a blockage or a structural problem. Depending on the cause, a different sperm-retrieval procedure may be more appropriate.
Men with a history of vasectomy, absence of the vas deferens, or suspected reproductive tract obstruction should receive an individual assessment before a procedure is selected.
What Are the Benefits of Micro-TESE?
Micro-TESE is designed to help identify and retrieve sperm from areas of the testes where sperm production may still occur, even when sperm are absent from the semen sample.
Potential benefits include:
- Microscopic examination: A surgical microscope helps the surgeon examine the seminiferous tubules and identify areas that may be more likely to contain sperm.
- Targeted sperm retrieval: The surgeon can select specific areas of testicular tissue rather than removing tissue without microscopic guidance.
- Potential access to ICSI: If viable sperm are retrieved, they may be used for ICSI, in which a single sperm is injected directly into an egg.
- A fertility option for selected patients: The procedure may make biological parenthood possible for some men with non-obstructive azoospermia.
Micro-TESE is often preferred over conventional testicular sperm extraction for appropriately selected men with non-obstructive azoospermia. However, the most suitable method depends on the individual diagnosis, previous procedures, and specialist assessment.
What Is the Sperm Retrieval Success Rate?
Sperm retrieval rates vary considerably depending on the underlying cause of azoospermia, the condition of the testicular tissue, genetic factors, previous treatment, and the experience of the surgical team.
Sperm may be retrieved in a substantial proportion of appropriately selected men with non-obstructive azoospermia, but no single success rate applies to everyone. It is also important to distinguish successful sperm retrieval from fertilisation, pregnancy, and live birth, as these are separate outcomes.
Your specialist can explain the expected likelihood of sperm retrieval based on your investigation results and medical history.
How Is the Micro-TESE Procedure Performed?
Micro-TESE is generally performed by a specialist under anaesthesia in a surgical setting. The precise approach depends on the patient’s condition and the treating team’s protocol.
1. Preoperative evaluation
The doctor reviews the patient’s medical history, physical examination, hormone levels, and previous fertility investigations. Genetic testing may be recommended in certain cases to help identify the cause of azoospermia and guide counselling.
2. Anaesthesia and surgical access
After anaesthesia is administered, the surgeon makes an incision to access the testicle and examine the testicular tissue.
3. Microscopic examination
A surgical microscope is used to examine the seminiferous tubules. The surgeon identifies areas that may contain sperm-producing tissue and selects suitable samples.
4. Laboratory examination
The collected tissue is examined by an embryologist or laboratory specialist to determine whether sperm are present. If sperm are retrieved, they may be prepared for immediate use or cryopreserved for future fertility treatment, depending on their suitability and the clinic’s protocol.
5. Recovery and follow-up
The surgical site is closed, and the patient is monitored during recovery. The doctor provides instructions for wound care, pain management, activity restrictions, and follow-up appointments.
Micro-TESE and ICSI: How Do They Work Together?
Micro-TESE and ICSI are different procedures that may be used together in fertility treatment.
Micro-TESE retrieves sperm directly from the testicular tissue. ICSI is a laboratory fertilisation technique in which a single sperm is injected into an egg.
If suitable sperm are retrieved, ICSI may be considered as part of an IVF cycle. However, sperm retrieval does not guarantee fertilisation, embryo development, pregnancy, or live birth. The treatment plan also depends on the reproductive health of the female partner and other clinical factors.
What Are the Risks and Complications of Micro-TESE?
Micro-TESE is a surgical procedure, so some risks are involved. Possible complications include:
- Pain or discomfort after surgery.
- Swelling or bruising of the scrotum.
- Bleeding or formation of a haematoma.
- Infection at the surgical site.
- Injury to or changes in testicular tissue.
- Temporary or, in some cases, longer-lasting changes in testosterone production.
The extent of these risks varies according to the patient’s condition, the amount of tissue removed, and the complexity of the procedure. Your surgeon should explain the potential complications and how they will be monitored.
Contact your healthcare team promptly if you experience increasing pain, significant swelling, fever, wound discharge, or other concerning symptoms after surgery. Severe or rapidly worsening symptoms require urgent medical assessment.
Recovery After Micro-TESE
Recovery time depends on the procedure and the individual’s health. Some patients experience mild discomfort for several days, while others may need more time before returning to their usual activities.
Your doctor may recommend:
- Taking prescribed medication as directed.
- Keeping the surgical area clean and following wound-care instructions.
- Avoiding heavy lifting, strenuous exercise, and sexual activity for the period advised by the surgeon.
- Wearing supportive underwear if recommended.
- Attending follow-up appointments to review healing and discuss the results.
Do not resume strenuous activities until your treating surgeon confirms that it is appropriate.
Micro-TESE at Jyoti IVF
At Jyoti IVF, patients can discuss male infertility investigations and suitable fertility treatment options with their healthcare team. If azoospermia has been diagnosed, the next step is to determine whether the cause is obstructive or non-obstructive and whether surgical sperm retrieval may be appropriate.
A specialist can explain the potential benefits and limitations of Micro-TESE, the likelihood of sperm retrieval, and how the findings may influence options such as ICSI.
Looking for guidance on male infertility? Consult Jyoti IVF to discuss your test results and explore suitable next steps with a qualified fertility specialist.
Medical disclaimer: This article is for general informational purposes and does not replace a medical consultation. Micro-TESE is not appropriate for every case of azoospermia, and sperm retrieval is not guaranteed. Confirm the availability of this procedure with Jyoti IVF and discuss its risks, benefits, and alternatives with your treating clinician.