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Microscopic Testicular Sperm Extraction (TESE)

Microscopic TESE is the most effective sperm retrieval method in non-obstructive azoospermia, applied with a 25x operating microscope.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

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

References (5)

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 Microscopic Testicular Sperm Extraction (TESE)?

Microscopic TESE (mTESE) is the gold standard sperm retrieval method in non-obstructive azoospermia (NOA). The 'Schlegel technique' (1999) replaced conventional TESE; sperm retrieval rate increased from 30% to 50-60%, tissue damage decreased.

Indications: NOA (FSH high, low testicular volume), Klinefelter syndrome, post-chemotherapy/radiation, Sertoli cell only, maturation arrest, mumps orchitis sequelae, cryptorchidism. Pre-op: hormone profile (FSH, LH, T, prolactin), karyotype, Y-chromosome microdeletion, scrotal US.

Surgical technique: 1.5-2 cm transverse scrotal incision → tunica albuginea opening → 25x microscopic examination of seminiferous tubules → identification of large, opaque, dilated tubules (sperm-rich) → minimal sample (1-2 mm³) → cryopreservation. Operative time 2-4 hours. Postop hypogonadism risk; 10-15% require testosterone replacement.

Symptoms

Asymptomatic azoospermia (incidental finding)
Infertility (no pregnancy after 1 year)
Low testicular volume
Hypogonadism symptoms (decreased libido, fatigue)
Gynecomastia (Klinefelter)
Testicular trauma, history of orchitis

Risk Factors

Klinefelter syndrome (47,XXY)
Y-chromosome microdeletion (AZFa, AZFb, AZFc)
Cryptorchidism (delayed orchidopexy)
Mumps orchitis (post-pubertal)
Chemotherapy, radiation (testicular toxicity)
Idiopathic NOA

When to See a Doctor?

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

  • Couple infertility (>1 year)
  • Confirmed azoospermia (2 spermiograms)
  • FSH high, low testicular volume
  • Klinefelter diagnosis (genetic counseling)
  • Pre-chemotherapy fertility preservation
  • Hypogonadism symptoms

Treatment Methods

01
Pre-op hormone optimization (HCG, FSH if needed)
02
Microscopic TESE (25x microscope, gold standard)
03
ICSI on same day (fresh sperm) or after freezing
04
Cryopreservation (if multiple ICSI cycles)
05
Genetic counseling (Klinefelter, AZF)
06
Testosterone replacement (post-op hypogonadism)

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.