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Microdissection Testicular Sperm Extraction (Micro-TESE)

Microsurgical procedure performed under operating microscope to identify and remove larger seminiferous tubules from the testis in men with non-obstructive azoospermia, providing the highest sperm retrieval rate for in vitro fertilization with intracytoplasmic sperm injection.

Written by: Saygı Hospital Health Guide Editorial Board
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This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Microdissection Testicular Sperm Extraction (Micro-TESE)?

Microdissection testicular sperm extraction (micro-TESE) is a microsurgical sperm retrieval technique developed by Schlegel for men with non-obstructive azoospermia, in which the testis is widely opened, the seminiferous tubules examined under operating microscope at 15–25× magnification, and only the most distended (most likely sperm-containing) tubules selectively excised for embryologic processing.

The technique provides higher sperm retrieval rates (40–60%) than conventional or multiple TESE biopsies, while removing less testicular parenchyma, preserving Leydig cell function, and reducing risk of testosterone deficiency and devascularization.

Optimal results require coordinated andrology and embryology teams, preoperative hormonal optimization, genetic counseling, and timely synchronization with female partner's IVF/ICSI cycle to maximize fertilization success.

Symptoms

Confirmed non-obstructive azoospermia on at least two semen analyses with normal ejaculation
Failed previous testicular biopsy or conventional TESE
Klinefelter syndrome (47,XXY) with low spermatogenic foci that may benefit from microscopic identification
Y-chromosome AZFc microdeletion or Sertoli-cell-only syndrome with focal spermatogenesis
Postchemotherapy or postradiation azoospermia
Cryptorchidism, severe varicocele, or trauma history with impaired spermatogenesis

Risk Factors

Predictors of unsuccessful retrieval: complete AZFa or AZFb microdeletion, very small testicular volume, history of chemotherapy with high cumulative dose
Klinefelter syndrome may have age-related decline in retrieval success
Surgical risk from anesthesia, hematoma, infection, or testicular damage
Postoperative testosterone decline requiring monitoring and possible replacement
Emotional, financial, and time burden of repeated cycles with female partner
Inadequate embryology coordination decreasing sperm survival and fertilization yield

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Couple with male-factor infertility and confirmed azoospermia — referral to fertility specialist and reproductive urologist for evaluation
  • Patient with prior failed conventional TESE or testicular biopsy — discussion of micro-TESE in a high-volume center
  • Klinefelter syndrome patient considering future fertility — early referral for micro-TESE planning ideally during late adolescence or young adulthood
  • Postchemotherapy or postradiation azoospermia patient — fertility preservation review and micro-TESE candidacy
  • Postoperative low testosterone, hematoma, or wound concerns — urology follow-up

Treatment Methods

01
Preoperative evaluation: hormonal panel (FSH, LH, total testosterone, estradiol), karyotype, Y-chromosome microdeletion analysis, scrotal ultrasound, and genetic counseling
02
Hormonal optimization with selective estrogen receptor modulators (e.g., clomiphene), aromatase inhibitors (anastrozole), or human chorionic gonadotropin in selected men with low testosterone or elevated estradiol
03
Bilateral microsurgical exploration under operating microscope, equatorial testicular incision, systematic inspection of seminiferous tubules, and selective excision of distended tubules with extraction of sperm by embryologist
04
Synchronization with female partner's IVF/ICSI cycle for fresh sperm injection, or cryopreservation of retrieved sperm for future cycles
05
Postoperative care: scrotal support, ice, analgesia, infection prevention, monitoring of testosterone, and counseling about further reproductive options if retrieval is unsuccessful

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.