For some men experiencing infertility, sperm may be absent from the ejaculate because the testicles produce very few sperm or sperm production is severely impaired. This condition is known as non-obstructive azoospermia. In selected cases, sperm may still be present in small areas of the testicular tissue and can be sought through a specialised surgical procedure.
Microdissection Testicular Sperm Extraction (mTESE) is a surgical sperm retrieval technique that uses an operating microscope to help identify areas of testicular tissue that may contain sperm. It may be considered for selected men with non-obstructive azoospermia when sperm are not detected in the semen.
At Birla Fertility & IVF, Noida, Dr. Megha Jindal, Center Head, provides fertility-related care and supports patients in understanding male infertility evaluation and treatment options. Whether mTESE is appropriate depends on the underlying diagnosis, investigation findings and the reproductive goals of both partners.
mTESE stands for Microdissection Testicular Sperm Extraction. It is a specialised surgical procedure in which the testicular tissue is examined under an operating microscope to help identify areas that may contain sperm.
Unlike needle-based sperm aspiration, mTESE involves surgically opening the testicle and carefully examining the tissue. Selected tissue samples are collected and examined by a laboratory team to determine whether sperm are present.
The procedure may be considered when sperm production is severely impaired and conventional semen testing does not detect sperm. However, sperm retrieval is not guaranteed, and the decision to proceed requires careful assessment and counselling.
mTESE may be considered for selected men with male-factor infertility, particularly when sperm are absent from the ejaculate because of impaired sperm production.
Non-obstructive azoospermia occurs when sperm production is severely reduced or absent. In selected cases, small areas of the testicle may still contain sperm, and mTESE may be considered to search for them.
If repeat semen analysis confirms azoospermia, further evaluation helps determine whether the cause is obstructive or non-obstructive. mTESE may be considered when the findings suggest impaired sperm production.
A specialist may consider mTESE after reviewing the patient's medical history, semen analysis, hormone levels and relevant genetic investigations. Previous sperm retrieval attempts may also influence the treatment plan.
If suitable sperm are retrieved, they may be used for IVF with Intracytoplasmic Sperm Injection (ICSI). This involves injecting an individual sperm into an egg in the laboratory.
Important: mTESE is not necessary for every man with azoospermia. The appropriate treatment depends on the cause of the condition and the results of the fertility evaluation.
Non-obstructive azoospermia is associated with impaired sperm production. Possible contributing factors include:
Genetic conditions affecting testicular function
Hormonal disorders
Certain testicular conditions or injuries
Previous medical treatments that affect sperm production
Other conditions affecting the development or function of the testicles
In some cases, the precise cause remains unknown. The specialist may recommend additional investigations to assess the likely cause and determine whether surgical sperm retrieval is a reasonable option.
A detailed assessment helps determine whether mTESE may be appropriate and supports informed treatment planning.
Semen analysis is used to assess whether sperm are present in the ejaculate. Repeat testing and appropriate laboratory examination may be needed to confirm azoospermia.
The clinician may review previous illnesses, surgeries, medications, testicular conditions, reproductive history and relevant family history. A physical examination may provide additional information about testicular health.
Blood tests may include follicle-stimulating hormone (FSH), luteinising hormone (LH) and testosterone. These results can help assess possible hormonal or testicular factors, although no single hormone test can reliably predict sperm retrieval in every patient.
Selected patients may be advised to undergo genetic testing, such as a karyotype or Y-chromosome microdeletion testing, depending on the clinical findings. Genetic counselling may be appropriate when results could influence treatment decisions or reproductive risks.
The fertility team considers whether mTESE is appropriate, how sperm retrieval may be coordinated with IVF-ICSI and what alternatives may be available if sperm are not found.
The exact procedure and preparation depend on the patient's diagnosis and the treating team's plan.
The care team reviews the patient's investigations, medical history, medications and suitability for surgery. The procedure, anaesthesia options, risks and possible outcomes are discussed.
mTESE is performed under an appropriate anaesthesia plan. The surgeon makes a surgical opening to access the testicular tissue.
Using an operating microscope, the surgeon examines the testicular tissue to identify areas that may contain sperm. This magnified view helps guide tissue sampling.
Selected areas of tissue are collected and sent to the laboratory for examination. The laboratory team searches for sperm that may be suitable for assisted reproduction.
If suitable sperm are found, the fertility team discusses their use in IVF with ICSI. Depending on the treatment plan and laboratory arrangements, sperm may be used fresh or cryopreserved for future use when appropriate.
If sperm are not found, the team explains the result and discusses possible next steps.
For appropriately selected patients, mTESE may offer a potential option for sperm retrieval when sperm are not present in the ejaculate.
Possible benefits include:
Microscopic examination of testicular tissue during surgery
Targeted collection of tissue that may contain sperm
A potential sperm retrieval option for selected men with non-obstructive azoospermia
The possibility of using retrieved sperm in IVF with ICSI
The likelihood of retrieving sperm varies between patients. mTESE does not guarantee successful retrieval, fertilisation, pregnancy or live birth.
Both procedures aim to retrieve sperm from the testicle, but they use different techniques and may be suitable for different clinical situations.
| Feature | mTESE | TESA |
|---|---|---|
| Full form | Microdissection Testicular Sperm Extraction | Testicular Sperm Aspiration |
| Technique | Surgical tissue extraction using an operating microscope | Needle aspiration of testicular tissue or fluid |
| Common consideration | Selected cases of non-obstructive azoospermia | Selected cases, particularly some cases of obstructive azoospermia |
| Procedure type | Microsurgical procedure | Needle-based procedure |
| Sperm retrieval | Not guaranteed | Not guaranteed |
The choice depends on the underlying cause of azoospermia, previous investigations and specialist assessment. Neither procedure is suitable for every patient.
mTESE is a sperm retrieval procedure. If suitable sperm are found, they may be used in IVF with ICSI.
During ICSI, an embryologist injects a single sperm into an egg in the laboratory. This technique may be considered when sperm are retrieved surgically or when other male-factor fertility concerns make ICSI appropriate.
The overall outcome depends on factors such as sperm availability, egg quality, embryo development and the reproductive health of both partners. The fertility team will explain the likely treatment pathway based on the findings.
Recovery varies according to the extent of the procedure and the patient's individual health. Temporary pain, tenderness, bruising or swelling may occur.
After surgery, the care team provides instructions about wound care, activity restrictions, pain management and follow-up. The time needed before returning to normal activities depends on the patient's recovery and the surgeon's recommendations.
Seek prompt medical advice if you experience severe or increasing pain, significant swelling, fever, bleeding or other concerning symptoms.
As a surgical procedure, mTESE carries potential risks, including:
Pain and swelling
Bruising or bleeding
Infection
Injury to testicular tissue
Changes in testosterone production in some cases
Failure to retrieve sperm
The potential impact on testicular function and the risk of complications should be discussed with the treating specialist before surgery. The individual risk depends on the patient's condition and the procedure performed.
Some men with non-obstructive azoospermia may have sperm identified through mTESE, while others may not. The likelihood varies according to the underlying condition and individual clinical factors.
Semen analysis, hormone results and genetic investigations can help guide counselling, but they cannot guarantee the result of surgery. Before proceeding, patients should understand the possibility that no sperm may be retrieved and discuss alternative reproductive options with their specialist.
At Birla Fertility & IVF, Noida, Dr. Megha Jindal, Center Head, provides fertility-related care and supports patients in understanding evaluation and treatment planning for male-factor infertility.
Men diagnosed with non-obstructive azoospermia can discuss their test results, possible sperm retrieval options and the role of IVF with ICSI. The recommended approach depends on the diagnosis, individual clinical findings and reproductive goals.
mTESE is a specialised surgical procedure that uses an operating microscope to help identify and retrieve testicular tissue that may contain sperm.
It may be considered for selected men with non-obstructive azoospermia, particularly when sperm are absent from the ejaculate because sperm production is severely impaired.
No. Sperm may not be found in every case. The likelihood depends on the underlying cause and individual clinical factors.
If suitable sperm are retrieved, they may be used in IVF with ICSI. The fertility team will explain the laboratory findings and treatment options.
mTESE uses a surgical approach and an operating microscope to examine testicular tissue. TESA uses a needle to aspirate tissue or fluid. The appropriate procedure depends on the diagnosis.
Testicular surgery may affect testicular function, including testosterone production, in some patients. The individual risk depends on clinical circumstances and should be discussed with the treating specialist.
Recovery varies from person to person. Temporary tenderness, bruising or swelling may occur. Follow your surgeon's instructions regarding wound care, physical activity and follow-up.
No. mTESE aims to retrieve sperm. Even when sperm are found and used in IVF with ICSI, fertilisation, pregnancy and live birth cannot be guaranteed.
If you have been diagnosed with non-obstructive azoospermia or have been advised to consider surgical sperm retrieval, a fertility consultation can help you understand the available options.
At Birla Fertility & IVF, Noida, Dr. Megha Jindal can help guide fertility-related evaluation and treatment planning based on your clinical findings and reproductive goals.
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