What is Micro-TESE?

Micro-TESE (Microsurgical Testicular Sperm Extraction) is an advanced surgical sperm retrieval procedure used mainly for selected men with non-obstructive azoospermia (NOA). During the procedure, a surgeon uses an operating microscope to identify areas of the testicle that may contain sperm-producing tissue and carefully retrieve testicular tissue for sperm extraction.

Micro-TESE is designed for men who have no sperm in their semen because sperm production within the testicles is severely reduced.

Unlike obstructive azoospermia, where sperm may be produced but blocked from reaching the semen, non-obstructive azoospermia involves impaired sperm production.

How is Micro-TESE performed?

Micro-TESE is performed as a surgical procedure under anesthesia.

The surgeon:

1. Makes an incision to access the testicle.
2. Opens the testicular tissue to examine it microsurgically.
3. Uses an operating microscope to identify areas that may contain sperm-producing tubules.
4. Carefully removes small samples of tissue.
5. The tissue is examined by an embryology laboratory to identify viable sperm.

The use of microsurgical visualization allows a more targeted search while helping limit unnecessary removal of testicular tissue.

Who may need Micro-TESE?

Micro-TESE may be considered for selected men with:

• Non-obstructive azoospermia (NOA).
• Severe impairment of sperm production.
• Certain cases of persistent azoospermia after medical evaluation.
• Situations where sperm cannot be obtained through ejaculation and surgical retrieval is appropriate.

Not every man with azoospermia requires Micro-TESE. The underlying cause must first be evaluated.

Can Micro-TESE find sperm in azoospermia?

Sperm retrieval is possible in some men with non-obstructive azoospermia, but success is not guaranteed.

The likelihood of retrieving sperm depends on factors such as the underlying cause of azoospermia, testicular function, genetic findings, and other clinical characteristics. AUA/ASRM guidance notes that published sperm-retrieval rates with micro-TESE vary, with estimates around 40–60% in some NOA populations.

What happens if sperm are found?

When viable sperm are retrieved, they may be used for ICSI (Intracytoplasmic Sperm Injection) as part of assisted reproductive treatment. Fresh or appropriately cryopreserved sperm may be used depending on the clinical and laboratory circumstances.

Is Micro-TESE different from conventional TESE?

Yes. Conventional TESE involves removing testicular tissue to search for sperm, whereas Micro-TESE uses an operating microscope to identify potentially sperm-containing areas more precisely.

For men with non-obstructive azoospermia, AUA/ASRM recommends micro-TESE for surgical sperm retrieval.

Are there risks?

As with any surgical procedure, Micro-TESE can have risks and recovery considerations. These may include:

• Pain or discomfort.
• Swelling or bruising.
• Bleeding or infection.
• Temporary changes in testosterone production.
• Failure to retrieve sperm.

AUA/ASRM notes that testosterone deficiency requiring replacement can occur even after micro-TESE, although the effect on testosterone levels is generally less than with conventional TESE.

SCI International Hospital

At SCI International Hospital, New Delhi, Dr. Vishal Dutt Gour, Senior Consultant Urologist and Andrologist, provides specialized evaluation and advanced sperm retrieval treatment for men with azoospermia and severe male infertility. After determining the underlying cause of azoospermia, he evaluates whether procedures such as Micro-TESE, TESE, or TESA are appropriate and coordinates sperm retrieval with assisted reproductive treatment when required.