Microsurgical TESE for Male Infertility
Specialized evaluation and microsurgical sperm retrieval for men with non-obstructive azoospermia and severe male-factor infertility by an experienced andrologist and genito-urinary reconstructive surgeon.
Microsurgical Sperm Retrieval
Fertility-Focused Treatment
13+ Years of Experience
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Overview
What is Microsurgical TESE?
Microsurgical Testicular Sperm Extraction (Micro-TESE) is an advanced microsurgical procedure used to search for and retrieve sperm directly from the testicular tissue of men with severe sperm-production problems, particularly non-obstructive azoospermia.
Non-obstructive azoospermia means that no sperm are detected in the semen because sperm production within the testicles is severely reduced or absent in most areas. However, small isolated areas of the testis may still produce sperm.
During Micro-TESE, the surgeon uses high-powered operating-microscope magnification to identify seminiferous tubules that appear more likely to contain sperm. Selected tissue samples are carefully removed and examined by an embryology laboratory for viable sperm.
If sperm are successfully retrieved, they can usually be used for assisted reproductive treatment, particularly Intracytoplasmic Sperm Injection (ICSI).
Important: Micro-TESE does not guarantee sperm retrieval. The chance of finding sperm depends on the underlying cause of infertility, testicular function, genetic factors and individual clinical condition.
Indications
Who May Need Microsurgical TESE?
Non-Obstructive Azoospermia
Men with no sperm in the ejaculate because of severely impaired sperm production within the testicles.
Previous Failed Sperm Retrieval
Micro-TESE may be considered in selected men who previously underwent conventional TESE or another retrieval procedure without finding sperm.
Severe Testicular Failure
Men with markedly reduced spermatogenesis may require microsurgical exploration to identify small areas where sperm production may still occur.
Genetic Causes of Infertility
Selected patients with certain genetic conditions may be considered for Micro-TESE after appropriate testing and genetic counselling.
Very High FSH With Azoospermia
Elevated FSH may indicate impaired sperm production, but FSH level alone cannot reliably determine whether sperm will or will not be found during Micro-TESE.
Fertility Treatment With ICSI
Micro-TESE may be performed when surgically retrieved sperm are required for assisted reproduction using IVF-ICSI.
Symptoms
When Should You Seek Male Infertility Evaluation?
- No pregnancy occurs despite regular unprotected intercourse
- Semen analysis shows no sperm
- Repeated semen tests confirm azoospermia
- Sperm count is extremely low
- Previous fertility treatment has failed
- There is a history of undescended testis
- Previous chemotherapy or radiation treatment
- History of testicular injury or surgery
Evaluation
How We Evaluate Before Micro-TESE
Before recommending Micro-TESE, Dr. Gautam Banga performs a comprehensive male infertility evaluation to understand why sperm are absent from the semen and whether surgical sperm retrieval is appropriate.
Evaluation may include:
- Detailed Medical & Fertility History – previous pregnancies, infertility duration, childhood conditions, infections, surgeries and medication history.
- Repeat Semen Analysis – azoospermia should be confirmed through appropriate semen testing.
- Physical Examination – assessment of testicular size, consistency, epididymis, vas deferens and genital development.
- Hormonal Profile – may include FSH, LH, testosterone and other hormones when clinically indicated.
- Scrotal Ultrasound – may be advised to evaluate the testicles and surrounding structures.
- Genetic Testing – karyotype and Y-chromosome microdeletion testing may be recommended in appropriate cases.
- Genetic Counselling – particularly important when a genetic cause of infertility is identified.
- Previous Fertility Treatment Review – including previous TESE, TESA, IVF or ICSI attempts.
Treatment
Sperm Retrieval Options
Why Choose Us
Why Choose Dr. Gautam Banga for Microsurgical TESE?
Microsurgical Expertise
Experience in microsurgical and reconstructive procedures involving the male reproductive and genito-urinary system.
Detailed Infertility Evaluation
Treatment begins with identifying whether azoospermia is obstructive or non-obstructive and investigating the possible underlying cause.
Targeted Sperm Retrieval
Microscopic magnification allows careful exploration of testicular tissue while minimizing unnecessary tissue removal.
Complex Male Infertility Cases
Evaluation of patients with non-obstructive azoospermia, previous failed retrieval, genetic abnormalities and other complex fertility conditions.
Dr. Gautam Banga
Consultant Andrologist & Genito-Urinary Reconstructive Surgeon
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Our Client Testimonials
Read experiences shared by patients treated by Dr. Gautam Banga for male infertility, urethral, penile and reconstructive urological conditions.
Frequently Asked Questions
Micro-TESE stands for Microsurgical Testicular Sperm Extraction. It is a surgical sperm-retrieval technique in which testicular tissue is examined under an operating microscope to locate small areas that may still be producing sperm.
Micro-TESE is mainly considered for men with non-obstructive azoospermia, where sperm are absent from semen because sperm production within the testicles is severely impaired.
Non-obstructive azoospermia means sperm are absent from the semen because the testicles are producing little or no sperm.
However, sperm production can sometimes occur in small isolated areas within the testis, which Micro-TESE attempts to identify.
Conventional TESE obtains testicular tissue without extensive microscopic exploration.
Micro-TESE uses an operating microscope to identify seminiferous tubules that appear more likely to contain sperm, allowing more targeted tissue sampling.
Current AUA/ASRM guidance states that men with NOA undergoing sperm retrieval should undergo microdissection TESE, while EAU guidance also identifies it as the treatment of choice for sperm retrieval in NOA.
Even with microsurgical exploration, sperm may not be found. Success depends on the underlying cause of infertility and the presence of any remaining areas of sperm production.
Selected patients who previously had unsuccessful conventional TESE or other retrieval procedures may still be considered for Micro-TESE.
However, previous failure can affect expectations and should be reviewed carefully before repeat surgery.
Retrieved viable sperm are generally used for IVF with ICSI.
Depending on sperm availability and the fertility plan, sperm may be used fresh or cryopreserved for future use.
If viable sperm are retrieved, they can potentially be used for ICSI.
Pregnancy and live-birth outcomes depend on many additional factors, including sperm quality, egg quality, female-partner age, embryo development and the IVF laboratory.
The procedure is performed under anaesthesia, so patients should not experience surgical pain during the operation.
Temporary scrotal pain, swelling or tenderness may occur during recovery.