Scrotal, Penile & Fertility
Mico TESE (mTESE)
Surgical techniques recover sperm for IVF and ICSI when none are in the ejaculate. mTESE (microsurgical testicular sperm extraction) is used for non-obstructive azoospermia. The most up-to-date operation, mTESE should be offered instead of PESA or TESE.
Key takeaways
- Surgical techniques recover sperm for IVF and ICSI when none are in the ejaculate. mTESE (microsurgical testicular sperm extraction) is used for non-obstructive azoospermia. The most up-to-date operation, mTESE should be offered instead of PESA or TESE.
- Specialty: Scrotal, Penile & Fertility
~40
Chance of finding usable sperm%
Microsurgery
Microscope-guided precision
General
Usually general anaesthetic
Treatment Overview
About Mico TESE (mTESE)
Surgical Sperm Retrieval (SSR) is a way of collecting sperm directly from the male reproductive system when none are found in the semen (a condition called azoospermia). mTESE (Microdissection Testicular Sperm Extraction) is undertaken when the cause for the azoospermia is a problem with production- the testes are not working normally to make sperm.
It is a high-precision surgery where a specialist uses a powerful operating microscope to search for tiny "islands" of sperm production within the testicle itself. This is the "gold standard" for men with non obstructive azoospermia. Any sperm which are found are then frozen and used for IVF with ICSI, which is where individual sperm are injected into individual eggs which have been carefully removed from the female partner under ultrasound guidance.
Safety Information
Benefits, Risks & Side Effects
01
Benefits
For many men who were previously told they would be unable to be biological fathers, these procedures offer the only way to have a biological child.
High Precision: Because mTESE uses a microscope, it is much more successful than old-fashioned "blind" biopsies, as the surgeon can pick out the healthiest-looking areas. The chances of finding sperm which can be used for treatment are, however, approximately 40% in most cases.
Sufficient sperm: Sperm are usually frozen in a number of different tubes, or ampoules. The embryologists would usually try and thaw out one ampoule for a single IVF cycle, so there would hopefully be enough sperm from a single mTESE operation for more than one cycle. This is not always the case, however.
Empowerment: It provides a clear answer and a proactive path forward in your fertility journey. If we do not find any sperm, donor sperm in an option which many couples would chose, although this is not always possible or the right choice for some couples.
02
Risks
While these procedures are evidence-based and follow best-practice clinical standards, it is important to understand the potential risks. We categorize these by frequency to help you make an informed decision.
🟢 Common (More than 1 in 10 patients)
Failure to find Sperm: In 5 to 6 out of 10 patients, no viable sperm are found despite the surgeon's best efforts.
Temporary Testosterone Drop: For mTESE patients, there is a risk of a temporary (or very rarely permanent) drop in testosterone levels because tiny amounts of tissue are removed. Specialists use "micro-sparing" techniques to keep this risk as low as possible.
🟡 Occasional (Between 1 in 10 and 1 in 50 patients)
Hospital-Acquired Infection: There is a 4–6% risk of acquiring an infection such as MRSA while in the hospital.
🔴 Rare (Between 1 in 50 and 1 in 250 patients)
Loss of the Testicle: There is a rare risk (between 1 in 100 and 1 in 250 patients) of complications severe enough to lead to the loss of a testicle.
Chronic Pain: Developing long-term or chronic pain in the testicle following the procedure.
Infection or Hematoma: A risk of a significant blood clot (hematoma) or infection in the scrotum that may require further surgical intervention.
Testicular Atrophy: Shrinkage of the testicle which may occasionally require hormone replacement therapy.
General Medical Issues: Rare complications related to anesthesia or the heart, such as blood clots or chest infections.
03
Side Effects
To help you prepare for your recovery, we use the following traffic light system to outline common after-effects. These are typically temporary and settle as the area heals.
🟢 Common (More than 1 in 10 patients)
Swelling and Bruising: Most men experience some swelling and bruising of the scrotum or groin area.
Discomfort and Aching: Pain or a dull ache is common. After mTESE, the area may be painful for seven to 14 days.
Stitch Irritation: If you have mTESE, small dissolvable stitches are used. These do not need removal but can feel itchy or irritating for two to three weeks as they disappear.
What We Treat
How Mico TESE (mTESE) Can Help You
This treatment is effective for a wide range of health needs. Select a condition below to learn more about how we can support your recovery and improve your daily well-being.
Patient Journey
What to Expect
A step-by-step guide through your Mico TESE (mTESE) journey—from preparation and what happens during the procedure to recovery and aftercare.
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Before Procedure
Before surgery, you will have a full "fertility work-up" including blood tests to check your hormones (FSH and Testosterone) and genetic screening.
Planning: You must be a patient registered with an IVF clinic.
Preparation: You must ensure that you have completed all of your consent forms for the clinic, and adhered to the travel guidelines on Zika. You must have had your blood tests done for virologies (HIV, Hep B and Hep C, or as advised by your individual clinic) within 3 months of your procedure.
Fasting: You must not eat or drink (nil by mouth) for 6 hours before your operation. You may be allowed to drink clear fluids like water up until closer to your surgery, but please follow the instructions given at pre-assessment.
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During Procedure
mTESE: This is done while you are asleep (general anaesthetic). The surgeon uses a high-power microscope to examine the tiny tubes inside the testicle. They look for "fuller" tubes that are more likely to contain sperm. Any samples taken are inspected by the embryologist to see if sperm have been found, and if they are then they are frozen.
If they are not found then the surgeon will continue to look until all areas of the testicle have been examined. Any bleeding is stopped, and the testicle is then closed with some stitches, and returned to the scrotum, which is then also stitched closed.
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After Procedure
After the procedure, you should rest for 72 hours.
Support: Wear tight-fitting underwear or a jockstrap for support—this is very important for reducing pain and swelling.
Ice Packs: Packs: You will be given an ice pack at the time of your operation which will be removed before you go home. If helpful, you can apply a cold or ice pack inside the scrotal support for 15-20 minutes 2-3 times a day, but not directly in contact with the skin.
Activity: Avoid heavy lifting and the gym for up to 3 weeks (after mTESE).
Sex: Avoid sexual activity for 2-3 weeks to allow the internal tissue to heal.
Follow up: If sperms have been found your partner will be to book for IVF treatment. If sperm have not been found then you will be offered the details of a counsellor, information on donor sperm if appropriate to your situation, and a follow up appointment for 6-8 weeks after the surgery.
Specialists
Specialists for Mico TESE (mTESE)
Leading experts for this treatment. View profiles to see clinical backgrounds and current availability.
Our Commitment
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Patient Guidance
Frequently Asked Questions
Common questions about this treatment and what to expect.
3 questions
Obstructive means you are making sperm, but there is a 'blockage' (like a vasectomy or a missing tube) preventing them from getting out; PESA is usually very successful here. Non-obstructive means the testicles have a 'production' problem and are making very few, if any, sperm. mTESE is specifically designed for these more difficult cases because the microscope helps us find the few areas that are still working
Reviewed 2 Mar 2026
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Sperm retrieved directly from the testicle are often less 'mobile' (they haven't learned to swim yet). However, because we use ICSI (where a single sperm is injected directly into the egg), this overcomes this problem. The pregnancy rates using surgically retrieved sperm are very similar to those using ejaculated sperm.
Reviewed 2 Mar 2026
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It is possible, but we generally recommend that is not sperm is found at mTESE by a surgeon who undertakes this procedure regularly, then further attempts are not worthwhile. If however sperm were found, then a further retrieval to get more sperm should this be needed can be undertaken.
Reviewed 2 Mar 2026
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