For men told they have no sperm in their ejaculate, micro-TESE (microdissection testicular sperm extraction) is one of modern medicine’s most remarkable answers. Under high magnification, a surgeon searches the testicular tissue itself for islands of sperm production — and in a substantial share of cases, finds them.
What Is Azoospermia?
Azoospermia is diagnosed when two consecutive semen analyses show no sperm at all. Crucially, this does not always mean the testicles produce no sperm — production may continue but be blocked from reaching the ejaculate, or continue at very low levels.
- Obstructive azoospermia: sperm production is normal, but the ducts are blocked — by past infection, surgery or congenital anomalies. The chance of retrieving sperm is typically above 90%.
- Non-obstructive azoospermia: production itself is reduced or absent, due to genetic factors (Y-chromosome microdeletions, Klinefelter syndrome), hormonal imbalance, a history of undescended testis, chemotherapy or radiotherapy. Retrieval rates are lower but still reach 40–60% in experienced centres.
Correct classification is critical, which is why hormone testing, genetic analysis and a thorough clinical evaluation come before any operation. For a broader look at the condition, see our overview of azoospermia and the paths to fatherhood.
How Is Micro-TESE Performed?
- 1. Anaesthesia: the procedure is usually done under general anaesthesia.
- 2. Incision: a small cut is made in the scrotum.
- 3. Microscopic examination — the critical step: using a high-magnification operating microscope, the surgeon identifies seminiferous tubules that look wider and fuller than the rest, the visual signature of active sperm production.
- 4. Targeted sampling: tiny tissue samples are taken only from these promising areas.
- 5. Immediate sperm search: the embryology team examines each sample under the microscope in real time, looking for live sperm.
- 6. Closure: the incision is closed with fine, dissolvable sutures.
The great advantage of micro-TESE over conventional biopsy is precision: selective sampling under magnification maximises the chance of finding sperm while minimising damage to testicular tissue and hormone-producing cells.
What Affects the Chance of Success?
- Type of azoospermia — over 90% retrieval in obstructive cases versus 40–60% in non-obstructive ones
- Genetic findings: deletions in the AZFa or AZFb regions of the Y chromosome usually mean sperm cannot be found, while AZFc deletions still leave a real chance
- Testis size and consistency and hormone levels (FSH, testosterone)
- Previous procedures and their outcomes
- The experience of the surgeon and embryologist — at our centre the programme is led by a team with over 30 years of experience in male-factor infertility
- Female factors: the partner’s age and ovarian reserve shape the overall chance of a baby
After the Operation
Patients are observed for a few hours and usually go home the same day. Mild pain and swelling are normal; the first days should be spent resting, with intercourse and heavy exercise postponed for 1–2 weeks. Sutures dissolve on their own, and antibiotics may be prescribed.
When sperm are found, they are used immediately for ICSI (microinjection) with the partner’s eggs, and surplus sperm are frozen for future cycles. Because the process can be emotionally demanding, our team provides support at every stage — and regular follow-up ensures smooth healing.
Thanks to advanced microsurgery, an azoospermia diagnosis no longer closes the door on biological fatherhood. Book a free consultation with our team to learn what micro-TESE could mean in your specific situation.