How it works
The testis is explored under an operating microscope and visually more promising tubules are selectively sampled.
Male Infertility · Microsurgical Testicular Sperm Extraction
Micro-TESE Treatment
Micro-TESE is a microsurgical sperm-retrieval procedure used in selected cases of non-obstructive azoospermia, in which seminiferous tubules more likely to contain focal sperm production are identified under an operating microscope and examined.
- Non-obstructive azoospermia is confirmed with repeat semen analyses
- Genetic findings are reviewed before surgery
- The surgeon and embryology laboratory work in real time
Understand the topic in one minute
Micro-TESE Quick Summary
Who may be suitable?
It is considered particularly in selected cases of non-obstructive azoospermia.
Laboratory
Each tissue sample is processed immediately and examined for sperm.
Next step
Retrieved sperm may be used for ICSI or cryopreserved when appropriate.
Key information
What Is Micro-TESE?
Micro-TESE is a surgical method that uses an operating microscope to search for focal areas of sperm production within the testis.
In brief:
A systematic search of seminiferous tubules is performed under an operating microscope, while the embryology laboratory examines small tissue samples for sperm.
In non-obstructive azoospermia, sperm production may not be uniform throughout the testis. Micro-TESE aims to identify focal areas of production by selectively examining tubules that appear more promising microscopically.
Compared with conventional TESE, more targeted sampling may reduce unnecessary tissue removal, although the operation is technically more demanding and may take longer.
Karyotype and Y-chromosome microdeletion results are important before surgery. With complete AZFa or AZFb deletions, surgical sperm retrieval is generally not recommended because sperm retrieval is not expected.
- The diagnosis of NOA is confirmed
- Karyotype and Y-chromosome microdeletion results are reviewed
- Testosterone and FSH are assessed
- Alternative plans are discussed in case no sperm are retrieved
Treatment options
The Difference Between Micro-TESE and Conventional TESE
Micro-TESE is a more targeted technique designed particularly for selected cases of non-obstructive azoospermia.
TESE
Tissue samples are taken from selected areas.
- The procedure may be shorter
- It may be used in obstructive azoospermia
- It may miss focal areas of sperm production in NOA
Micro-TESE
Seminiferous tubules are examined under an operating microscope.
- It is commonly preferred for selected NOA cases
- It targets focal sperm production
- It requires specialised microsurgical and laboratory expertise
Why is Micro-TESE not used for every patient?
In obstructive azoospermia, sperm production is usually preserved, so simpler sperm-retrieval methods may be sufficient.
Who should be assessed?
Who May Be Suitable for Micro-TESE?
The main group considered for Micro-TESE is men with confirmed non-obstructive azoospermia who are planning ICSI.
Non-obstructive azoospermia
Absence of sperm in the ejaculate because of severely impaired sperm production.
Klinefelter syndrome
Selected cases after appropriate hormonal and genetic counselling.
Azoospermia after chemotherapy
After considering oncology history, treatment exposure and appropriate timing.
Previous unsuccessful TESE
Reassessment based on previous surgical and pathology findings.
Severe impairment of sperm production
When no sperm are found in the ejaculate.
ICSI plan
When a small number of retrieved sperm may be used through intracytoplasmic sperm injection.
When may Micro-TESE not be appropriate?
It is generally not recommended with complete AZFa/AZFb deletions or when surgical risk is considered unacceptable.
Diagnosis and preparation
What Is Assessed Before Micro-TESE?
Genetic, hormonal, surgical and IVF planning should be completed before the procedure.
Confirmation of azoospermia
Repeat semen analyses including pellet examination.
Genetic assessment
Karyotype and Y-chromosome microdeletion testing.
Hormone profile
FSH, LH, testosterone and additional hormone tests when indicated.
Scrotal assessment
Clinical examination and ultrasound in selected cases.
Anaesthesia plan
General health, current medication and bleeding risk are reviewed.
ICSI strategy
Fresh coordinated use or cryopreservation in advance, depending on the treatment plan.
Step-by-step process
How Is Micro-TESE Performed?
Microsurgery proceeds with real-time feedback from the embryology laboratory.
Identity and surgical consent
The planned procedure, relevant genetic findings and backup plan are confirmed.
Anaesthesia
The procedure is performed under appropriate anaesthesia.
Microscopic access to the testis
The testis is opened in a controlled microsurgical manner.
Tubule selection
Tubules that appear more promising under magnification are selectively sampled.
Laboratory sperm search
Each tissue sample is processed promptly and examined for sperm.
Guiding further sampling
Laboratory findings help guide further surgical sampling.
Tissue preservation and closure
The aim is to minimise unnecessary tissue removal.
ICSI or cryopreservation
Retrieved sperm are used or stored according to the treatment plan.
Timeline
How Long Does Micro-TESE Take?
Procedure duration varies according to testicular tissue and laboratory findings and may be longer than conventional TESE.
Pre-treatment tests
Genetic and hormone results are usually completed in advance.
Surgery
Duration depends on the extent of microscopic exploration required.
Laboratory
Tissue is examined by the laboratory during surgery.
Observation
Short post-operative observation may be required.
Recovery
Pain and swelling can persist for several days.
Hormonal follow-up
Testosterone follow-up may be required in selected patients.
How many days do I need to stay in Cyprus?
A few days may be planned for the procedure and short follow-up. A coordinated IVF programme may require a longer stay.
Factors affecting outcomes
What Factors Affect Sperm Retrieval During Micro-TESE?
No single test can predict sperm retrieval with certainty.
Genetic cause
Y-chromosome AZF findings provide important prognostic information.
Testicular histology
The presence of focal spermatogenesis is a key determinant.
Previous surgery
Previous surgery may affect tissue structure and blood supply.
Microsurgical and laboratory expertise
Microscopic selection of tubules is important.
Laboratory sperm search
The laboratory must identify very limited numbers of sperm and assess viability when required.
Female partner
ICSI outcomes after sperm retrieval also depend on oocyte age and quality.
Important distinction:
FSH, testicular volume or age alone cannot determine with certainty whether sperm will be found.
Personalised cost planning
Micro-TESE Costs
Costs vary according to microsurgery, anaesthesia, laboratory sperm search and the coordinated IVF plan.
Microsurgery
Operating microscope and microsurgical team.
Anaesthesia
Type of anaesthesia and hospital/operating-theatre use.
Laboratory sperm search
Detailed laboratory examination of testicular tissue.
Cryopreservation
Cryopreservation of limited retrieved sperm when appropriate.
ICSI
Oocyte retrieval and intracytoplasmic sperm injection.
Genetic counselling
Counselling about the implications of genetic findings for the family.
Find out what your individual plan may include
Share your genetic and hormone results so suitability for Micro-TESE and whether fresh use or prior cryopreservation is more appropriate can be reviewed.
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Real-Time Laboratory Sperm Search During Micro-TESE
A key component of Micro-TESE is immediate laboratory assessment of each tissue sample obtained by the surgeon during the procedure.
Site coding
Each tissue sample is recorded with its anatomical sampling location.
Prompt tissue processing
Tubules are processed using controlled mechanical methods.
Systematic microscopic search
Very small numbers of sperm are searched for systematically.
Viability methods
Selected viability-assessment techniques may be used for immotile sperm.
Micro-aliquot cryopreservation
Small numbers of sperm may be stored in very small aliquots to reduce loss during future use.
ICSI preparation
Retrieved viable sperm are matched with the correct oocyte source through the laboratory identity chain.
Multidisciplinary approach
Micro-TESE Clinical and Laboratory Team
Microsurgery, IVF timing and embryology laboratory work are coordinated within one treatment plan.
Obstetrics, Gynaecology and IVF Specialist
Op. Dr. Beril Yüksel
Coordinates the female partner’s oocyte retrieval and ICSI schedule with surgical sperm retrieval.
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Scientific Director
Prof. Dr. Münevver Serdaroğulları
Coordinates genetic counselling, treatment decisions and alternative plans.
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Embryology Laboratory Director
Zafer Atayurt
Manages systematic sperm search in tissue samples, viability assessment, ICSI and cryopreservation.
View profile →Urology and andrology assessment
Micro-TESE should be performed by an appropriately trained urology/andrology specialist with microsurgical experience.
Balanced information
Risks and Limitations of Micro-TESE
The procedure should be considered together with its potential benefits, surgical risks and the possibility that no sperm will be found.
No sperm retrieved
This is the most important limitation.
Reduction in testosterone
Follow-up may be required, particularly in patients with low testosterone before surgery.
Bleeding and haematoma
These are recognised surgical risks.
Infection
Uncommon but possible.
Testicular tissue damage
The targeted approach aims to reduce tissue loss but cannot eliminate this risk entirely.
Repeat surgery
Reassessment may be required after an unsuccessful procedure or when only a very limited number of sperm are found.
Common questions
Frequently Asked Questions About Micro-TESE
Key information about NOA, the chance of retrieving sperm and recovery after the procedure.
What is Micro-TESE?
It is a microsurgical technique that uses an operating microscope to identify testicular tubules more likely to contain focal sperm production.
Who may be suitable for Micro-TESE?
It is considered particularly for men with confirmed non-obstructive azoospermia who are planning ICSI.
Will Micro-TESE find sperm?
Sperm may be found in some patients, but retrieval cannot be guaranteed.
What is the difference between Micro-TESE and TESE?
Micro-TESE uses an operating microscope for a more targeted and systematic search of testicular tissue.
Can Micro-TESE be performed when FSH is high?
High FSH alone is not an absolute contraindication; the full clinical and genetic assessment is required.
Can Micro-TESE be used in Klinefelter syndrome?
It may be considered in selected cases after genetic and hormonal counselling.
Do Y-chromosome microdeletions affect Micro-TESE planning?
Yes. Surgery is generally not recommended with complete AZFa/AZFb deletions; sperm may still be retrieved in some cases with AZFc deletions.
Is Micro-TESE painful?
It is performed under anaesthesia; tenderness and discomfort may persist for several days afterwards.
Can sperm retrieved by Micro-TESE be frozen?
Yes, suitable retrieved sperm may be cryopreserved in very small aliquots.
Can Micro-TESE be coordinated with oocyte retrieval on the same day?
It can be performed in coordination with oocyte retrieval for fresh use, or sperm may be retrieved in advance and cryopreserved.
Can testosterone decrease after Micro-TESE?
A temporary or persistent decrease can occur, and follow-up is arranged when indicated.
How long do I need to stay in Cyprus for Micro-TESE?
A few days may be sufficient for the procedure and short follow-up; a coordinated IVF programme may require a longer stay.