Microdissection testicular sperm extraction (micro-TESE)
Micro-TESE is an operation to search for and collect sperm directly from the testicles in men whose testicles make so little sperm that none reach the semen. Any sperm found are used with IVF to try for a pregnancy.
Also called Micro-TESE, mTESE, Microdissection TESE, Microdissection testicular sperm extraction, Testicular sperm extraction, TESE, Surgical sperm retrieval, Sperm retrieval surgery
- Where
- Hospital or outpatient surgery center operating room, with an embryology lab team
- Anesthesia
- General anesthesia
- Time in the room
- 2 to 4 hours, sometimes longer if both testicles are explored
- Hospital stay
- Same day
- Back to normal
- 1 to 2 weeks
- Back to work
- Desk work in 3 to 5 days; heavy physical work after 2 to 3 weeks
Overview
About 1 in 100 men has no sperm at all in his semen, a condition called azoospermia. There are two kinds. In obstructive azoospermia, sperm are made normally but a blockage stops them getting out. In non-obstructive azoospermia, the testicles themselves make very little sperm. Micro-TESE is designed for the second kind.
Even when sperm production is very low, the testicle often has small, scattered pockets where some sperm are still being made. In micro-TESE, your surgeon opens the testicle and uses an operating microscope to look for the tiny tubes most likely to contain sperm, taking very small pieces instead of large chunks. An embryologist, a lab specialist, examines the samples during the operation and tells the surgeon when sperm are found.
Micro-TESE is closely coordinated with IVF (in vitro fertilization). Because only a small number of sperm are usually found, each egg is injected with a single sperm, a technique called ICSI. Some centers time the operation with the partner's egg retrieval so fresh sperm can be used. Others freeze the sperm for a later IVF cycle.
It is important to know the odds going in. Overall, sperm are found in about half of men, and no test before surgery can say for sure whether you will be one of them. Certain genetic results make finding sperm very unlikely, and micro-TESE is not recommended in those cases. Many couples talk through a backup plan, such as donor sperm, before the day of surgery.
The parts of your body involved
The inside of each testicle is packed with hundreds of tightly coiled tubes called seminiferous tubules, where sperm are made. They are wrapped in a tough white capsule called the tunica albuginea, with blood vessels running just beneath it. Between the tubules are Leydig cells, which make testosterone. In non-obstructive azoospermia, most tubules are thin and empty, but a few may be fuller, whiter and more opaque because they contain developing sperm. Under high magnification these stand out, which is the whole idea behind micro-TESE.
- Testicle
Makes sperm and testosterone. In men with non-obstructive azoospermia it is often smaller and softer than usual.
- Seminiferous tubules
The tiny coiled tubes where sperm are made. The surgeon looks for the fuller ones.
- Tunica albuginea
The tough white capsule around the testicle. It is opened to reach the tubules and closed at the end.
- Leydig cells
Cells between the tubules that make testosterone. Taking only small samples helps protect them.
- Blood vessels
Run just under the capsule. The surgeon avoids them to protect the testicle's blood supply.
Why it’s done
Micro-TESE offers many men with non-obstructive azoospermia their best chance of having a biological child.
- A chance at a biological child
Without sperm from the testicle, the only routes to parenthood are donor sperm or adoption. Micro-TESE gives a real chance of using your own sperm.
- More sperm found, less tissue taken
Compared with standard testicle biopsies, the microscope helps the surgeon find sperm more often while removing much less tissue.
- After a failed biopsy
Sperm are sometimes found with micro-TESE even when an earlier, simpler biopsy found none.
- After cancer treatment
Men who have no sperm after chemotherapy or radiation can sometimes have sperm retrieved years later.
- Banking for the future
Extra sperm can often be frozen for future IVF cycles, which may avoid repeat surgery.
Other options
- Donor sperm
Using sperm from a donor with insemination or IVF. This avoids surgery but the child is not genetically yours.
- Hormone treatment first
Some men with low testosterone take medicines such as clomiphene, hCG or anastrozole for a few months before surgery to boost the testicle's own hormone levels. The evidence that this improves sperm retrieval is still limited.
- Varicocele repair first
If you have a varicocele that can be felt, repairing it occasionally brings a few sperm back into the semen or may help retrieval.
- Simpler sperm retrieval
A needle aspiration or a standard open biopsy without the microscope is quicker, but in non-obstructive azoospermia it finds sperm less often.
- Adoption or fostering
Some couples choose to build their family this way.
- Choosing not to pursue a pregnancy
After talking it through, some couples decide not to go forward. That is a valid choice.
Getting ready
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Months before
Weeks before
The week before
The day before and the morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You lie on your back on the operating table and the anesthesia team puts you to sleep. The scrotum is cleaned and draped, and the operating microscope is brought into place. The embryology team sets up its microscope nearby.
After the operation
Right afterward
- Recovery room
You wake up with a sore, full feeling in the scrotum and a snug support.
- The first news
Your surgeon usually tells you and your partner the same day whether sperm were found. The lab may confirm the final count later.
- Pain control
You get medicine for pain and nausea as needed. Ice is often started right away.
- Going home
Most men go home 1 to 3 hours after surgery with a driver and written instructions.
At home
- Pain
Soreness is worst for the first 2 to 4 days. Acetaminophen and, when allowed, ibuprofen usually work. A short supply of stronger medicine may be given.
- Ice and support
Ice on and off for 48 hours. Wear snug support day and night for 1 to 2 weeks.
- Swelling and bruising
Swelling and bruising of the scrotum are expected and fade over 1 to 3 weeks. Rest with the scrotum raised on a folded towel.
- The wound
A little oozing is normal for a day or two. Stitches dissolve on their own in 1 to 3 weeks.
- Showering
Usually after 24 to 48 hours. No baths, hot tubs or swimming for 2 weeks.
- Activity
Walk from the first day. Avoid running, cycling and sports for about 2 weeks.
- Lifting
Avoid lifting more than about 20 pounds for 2 to 3 weeks.
- Sex
Usually after 1 to 2 weeks, once comfortable.
- Work
Desk work in 3 to 5 days. Physical work after 2 to 3 weeks.
- Testosterone check
Testosterone often dips after surgery. Your urologist may check it a few months later, especially if you feel tired or have low sex drive.
Recovery timeline
- Day 0Surgery and first news
You go home the same day. Your surgeon tells you whether sperm were found.
- Day 0 to 1Eggs fertilized
If timed with your partner's egg retrieval, the embryologist injects one sperm into each egg.
- Days 1 to 3Most sore
Swelling and aching peak. Rest, ice and pain medicine.
- Days 3 to 6Embryos grow
In an IVF cycle, the lab watches the embryos develop before transfer or freezing.
- Week 1Back to desk work
Most men are moving normally and back at work.
- About 2 weeks after transferPregnancy test
If an embryo was transferred, a blood test shows whether a pregnancy has started.
- Weeks 2 to 3Normal activity
Exercise, lifting and sex are usually back to normal.
- Months 3 to 18Hormones recover
Testosterone often dips after surgery and usually recovers over the following year or so. A repeat micro-TESE, if ever needed, is usually not done for at least 6 months.
What it feels like
Micro-TESE carries a lot of emotional weight. Most men describe the physical recovery as manageable. The hardest parts are the waiting, the uncertainty, and the news on the day.
Learning there are no sperm
Many men feel shock, grief, shame or a sense of having let their partner down. Some feel it touches their sense of being a man.
What helpsAzoospermia is a medical condition that nobody caused. Counseling, either alone or as a couple, helps many people. Ask your fertility team about support groups.
Waiting for genetic results
Waiting to learn whether a genetic cause is present can be very stressful.
What helpsAsk when results will come and plan to hear them with your partner. A genetic counselor can walk you through what they mean.
The day of surgery
There may be a lot of logistics, especially if your partner's egg retrieval is the same day or the next. Nerves are normal.
What helpsMake a simple plan for who drives whom and where everyone needs to be. Let the teams talk to each other.
Waking up and hearing the news
If sperm were found, relief and joy. If not, deep disappointment, sometimes numbness.
What helpsHave your partner or a trusted person with you. It is fine to ask the surgeon to explain the results again later when you are fully awake.
The first few days
The scrotum is swollen, bruised and sore, and sitting is awkward.
What helpsIce, support, pain medicine on schedule, and lying back with the scrotum raised.
If no sperm were found
Grief can come in waves. Couples may cope differently.
What helpsTake time before deciding next steps. Your urologist can explain whether a repeat attempt makes sense, and your fertility team can explain donor sperm and other paths.
The two-week wait
If embryos were transferred, the wait for a pregnancy test can feel very long.
What helpsPlan small distractions and lean on each other.
How well it works
Success at surgery means finding sperm. Success overall means a pregnancy through IVF, which also depends heavily on your partner's eggs.
- The chance of finding sperm
Overall, sperm are found in about half of men with non-obstructive azoospermia. The chance varies with the cause and with what the tissue looks like, and it cannot be predicted for certain beforehand.
- Specific conditions
In men with Klinefelter syndrome or an AZFc deletion, experienced centers find sperm in a substantial share, often around half. With complete AZFa or AZFb deletions, sperm are almost never found.
- How many sperm
Usually only a small number, but ICSI needs just one sperm per egg. Extra sperm are frozen.
- Pregnancy
Once sperm are found, the chance of pregnancy depends mostly on your partner's age and egg quality, as with other IVF cycles.
- The tissue report
The pathologist describes the pattern of sperm production in the samples. This helps if a repeat attempt is ever considered.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Swelling and bruising of the scrotum for 1 to 3 weeks.
Aching for several days, usually controlled with simple pain medicine and ice.
In about half of men, no sperm are found. This is the most common disappointing outcome and is not a surgical complication.
Less common
A tense, painful swelling from blood collecting. Most settle with rest and support; some need draining.
Redness, warmth, drainage or fever, usually treated with antibiotics.
Testosterone usually dips for some months and then recovers. Some men, especially those with Klinefelter syndrome, have lasting low levels and may later need treatment.
Rare
Damage to the blood supply can cause a testicle to shrink. Careful technique makes this rare.
Ongoing pain after healing is rare.
Scar inside the testicle can make a later repeat operation harder.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Swelling that gets rapidly larger, tense and very painful over a few hours
- Bleeding that soaks through the dressing and does not stop after 10 minutes of firm pressure
- Redness spreading across the scrotum, pus, or a bad smell from the wound
- Pain that keeps getting worse, or is not controlled by your medicine
- You cannot pass urine for 8 hours after surgery
Questions to ask your surgeon
- Based on my hormones, genetics and exam, what are my chances of finding sperm?
- Do my genetic results change your advice?
- Should I take hormone medicines before surgery?
- How many micro-TESE operations do you do each year, and how often do you find sperm?
- Will an embryologist check the samples during surgery?
- Will we use fresh or frozen sperm, and how will you coordinate with my partner's IVF team?
- What happens if no sperm are found? Should we have donor sperm ready as a backup?
- Will you explore both testicles if needed?
- How will this affect my testosterone, and will you check it afterward?
- If no sperm are found, could I try again, and when?
- What will it cost, and what is covered?
- Should I see a genetic counselor first?
Words you may hear
- Azoospermia
- No sperm at all in the semen.
- Non-obstructive azoospermia
- No sperm in the semen because the testicles make very little sperm.
- Obstructive azoospermia
- No sperm in the semen because of a blockage, even though sperm are being made.
- Micro-TESE
- Microdissection testicular sperm extraction: searching for sperm inside the testicle with an operating microscope.
- Seminiferous tubules
- The tiny coiled tubes inside the testicle where sperm are made.
- Tunica albuginea
- The tough white capsule around the testicle.
- Leydig cells
- Cells in the testicle that make testosterone.
- Embryologist
- A lab specialist who handles eggs, sperm and embryos.
- IVF
- In vitro fertilization: eggs are taken from the female partner and fertilized in a lab.
- ICSI
- Intracytoplasmic sperm injection: one sperm is injected directly into each egg.
- FSH
- Follicle-stimulating hormone, a brain hormone that drives sperm production. It is often high when sperm production is low.
- Klinefelter syndrome
- A genetic condition in which a man has an extra X chromosome (47,XXY), often with very low sperm production.
- Y chromosome microdeletion
- A small missing piece of the Y chromosome that can stop sperm production. Named by region: AZFa, AZFb and AZFc.
- Cryopreservation
- Freezing sperm, eggs or embryos for later use.
Common questions
Why are there no sperm in my semen?
In non-obstructive azoospermia, the testicles make very little sperm. Causes include genetic conditions such as Klinefelter syndrome or Y chromosome deletions, past chemotherapy or radiation, an undescended testicle in childhood, and often no clear cause.
Will micro-TESE definitely find sperm?
No. Overall, sperm are found in about half of men. Your urologist can give you a better estimate based on your tests, but no test predicts it for certain.
Can I take testosterone to help?
No. Testosterone and anabolic steroids switch off the signals that tell the testicles to make sperm. Stop them and tell your urologist if you are taking them.
Will this affect my testosterone?
Testosterone often dips for several months and usually recovers over a year or so. Some men, especially those with Klinefelter syndrome, may need testosterone treatment later, ideally after any sperm have been banked.
Can sperm be frozen for later?
Yes. Extra sperm are usually frozen and can be used in future IVF cycles, which may avoid another operation.
If no sperm are found, can I try again?
Sometimes. A repeat attempt is usually not done for at least 6 months, and it is most worthwhile when the first operation found some signs of sperm production. Your urologist will advise you.
Could my child inherit my condition?
Some causes can be passed on. For example, a son conceived with sperm from a man with a Y chromosome deletion will carry the same deletion. A genetic counselor can explain the risks for your situation.
Sources this page draws on
- American Urological Association and American Society for Reproductive Medicine, Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020)
- American Society for Reproductive Medicine, Management of nonobstructive azoospermia: a committee opinion
- European Association of Urology, EAU Guidelines on Sexual and Reproductive Health
- Human Reproduction, Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision (Schlegel) (1999)
- Urology Care Foundation, Male Infertility
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.