Microscopic testicular sperm extraction (Micro-TESE) is a specialised surgical procedure used to retrieve sperm directly from the seminiferous tubules within a man’s testicles using high-magnification microscopy.
It is primarily performed in men with non-obstructive azoospermia, a condition in which the body produces very little or no sperm, resulting in the absence of detectable sperm in the semen. This condition is a significant cause of male infertility, and Micro-TESE offers a valuable option for sperm retrieval in such cases.
This procedure is recommended when no sperm is present in the ejaculate, or when the quantity and/or quality of sperm is too low to allow successful assisted reproductive treatment (ART).
Men diagnosed with azoospermia
Cases of severe male factor infertility
Obstruction of the vas deferens due to prior surgery (such as vasectomy)
Congenital absence of the vas deferens caused by genetic factors (e.g., cystic fibrosis gene mutations)
Infectious blockage of the vas deferens
Men with normal blood testosterone levels but diagnostic tests indicating inadequate sperm production in the testes
Persistent azoospermia despite treatment, even after maintaining normal testosterone levels for at least four months
Micro-TESE is primarily indicated for men with non-obstructive azoospermia, particularly in cases where previous procedures such as fine needle aspiration or testicular biopsy have failed to retrieve sperm. However, growing scientific evidence suggests that performing aspiration or biopsy before Micro-TESE may not be beneficial and is often not recommended for men with non-obstructive azoospermia.
The success rate of Micro-TESE is encouraging, with sperm retrieval possible in approximately 60% of cases. Research has consistently shown that Micro-TESE offers the highest sperm retrieval rates while causing minimal damage to testicular tissue, making it one of the safest and most effective surgical sperm retrieval techniques.
When combined with ICSI (Intracytoplasmic Sperm Injection), Micro-TESE provides a solution for many cases of azoospermia and severe male factor infertility, enabling couples to overcome the absence of sperm in the ejaculate and significantly improving their chances of achieving parenthood.
Micro testicular sperm extraction (Micro-TESE) is generally considered the final treatment option for men with azoospermia when other medical and surgical methods have failed to achieve sperm retrieval.
While Micro-TESE is a safe and advanced surgical procedure, like all surgeries, it carries some potential risks, including:
Mild bleeding or infection at the surgical site
Post-operative pain or discomfort, typically lasting 2–3 days
Scrotal swelling, inflammation, or bruising, which usually resolves within a few days
Skin or testicular infections
Rare risk of testicular tissue damage
These risks are generally minimal when the procedure is performed by trained specialists using microsurgical techniques and proper post-operative care.
Some men may not have sufficient sperm in their ejaculate to achieve successful fertilisation through conventional IVF. However, with the use of ICSI (Intracytoplasmic Sperm Injection), many of these individuals can still pursue IVF treatment.
When viable sperm are present within the testicular tissue, they can be surgically retrieved and individually injected into the partner’s (or donor’s) eggs using ICSI. This advanced technique enables fertilisation even in cases of severe male factor infertility.
Below is a step-by-step overview of the Micro-TESE (Microscopic Testicular Sperm Extraction) procedure to help you better understand the process.
The Micro-TESE (Microscopic Testicular Sperm Extraction) procedure is performed when natural conception is not possible and medical assistance is required to achieve pregnancy. It is recommended for men who have very low or absent sperm in their semen, as well as for those who are unable to ejaculate.
In such situations, sperm can be surgically retrieved directly from different parts of the male reproductive tract. To maximise the chances of successful fertilisation and pregnancy, the Micro-TESE technique is commonly combined with in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).
If all available sperm are required for IVF treatment, more than one Microscopic Testicular Sperm Extraction (Micro-TESE) procedure may sometimes be necessary. Whenever possible, any additional sperm retrieved during the procedure should be cryopreserved (frozen) to preserve fertility potential and reduce the need for repeat surgeries.
In certain cases of severe male factor infertility, sperm may not be successfully retrieved during a Micro-TESE procedure. If the procedure is repeated under such circumstances, the likelihood of successful sperm retrieval is generally low, with reported success rates of approximately 7–10%.
Microsurgical Testicular Sperm Extraction (Micro-TESE) is widely regarded as the most effective treatment option for men with extremely low or absent sperm production. During the procedure, sperm are carefully retrieved directly from the testicular tissue using microsurgical techniques.
Micro-TESE offers sperm retrieval success rates of up to 60%, making it significantly more effective than other surgical sperm retrieval methods, which typically achieve success rates of 20–45%. This makes it a preferred approach for men with non-obstructive azoospermia and severe male factor infertility.
Due to its higher success rates, precision, and lower risk of testicular damage, many patients opt for Micro-TESE as the most reliable option for sperm retrieval and fertility treatment.
The Micro TESE cost may vary depending on certain factors. These include-
Frequently Asked Questions about Micro-TESE are as follows-
Micro-TESE surgery is typically performed as an outpatient procedure. The operation usually lasts between 1.5 to 3 hours, depending on intraoperative findings. Patients are generally discharged within 4 hours after the procedure.
Due to the effects of anesthesia, patients are advised not to drive, operate machinery, or participate in traffic for at least 24 hours following the surgery to ensure safety and proper recovery.
The surgery is performed under general anesthesia, ensuring that you feel no pain during the procedure.
After surgery, you may experience mild discomfort, pressure, or tightness in the operated area—especially while walking or during physical activity. Severe pain is uncommon following this procedure.
Any post-operative discomfort can usually be managed effectively with rest, scrotal support, cold compresses, and occasional use of prescribed pain relief medication.
After the surgery, you will need to rest for at least one week to allow proper healing. During this period, physical strain should be minimized.
Heavy physical activity, exercise, and sports should be strictly avoided for up to four weeks following the procedure to prevent complications and ensure optimal recovery.
A follow-up visit is usually scheduled 1–2 days after surgery for a post-operative check-up and to monitor healing progress.
Before undergoing the process of testicular sperm extraction Micro-TESE, you should-
