What is the success rate of Micro-TESE surgery?

Across studies, sperm is found in about half of men with non-obstructive azoospermia, typically 40 to 60 percent. A meta-analysis of 1,890 men found 52 percent with Micro-TESE against 35 percent with conventional TESE. The individual chance depends mostly on the testicular biopsy pattern, genetics and any previous surgery.

How is Micro-TESE different from TESE or TESA?

TESA draws tissue through a needle without seeing it, and conventional TESE removes small random pieces of testis. Micro-TESE opens the testis under an operating microscope and takes only the few tubules that look likely to contain sperm. It finds sperm about 1.5 times more often and removes far less tissue.

How long does the operation take, and when will I know the result?

The operation usually takes two to three hours under general or spinal anaesthesia. An embryologist examines the tissue during surgery, so in most cases you are told on the same day whether sperm was found. A final report after further laboratory searching may follow within a day.

Is Micro-TESE painful, and how long is recovery?

Most men describe a dull ache for two or three days, controlled with ordinary painkillers and a supportive brief. You usually go home the same day, return to desk work in three to five days, and avoid sex, cycling and heavy exercise for about two weeks.

Does Micro-TESE lower testosterone permanently?

Testosterone usually dips in the first three to six months and returns close to its previous level within 12 to 18 months. Recovery can be slower in Klinefelter syndrome. A small number of men, mostly those with low levels before surgery, need testosterone treatment afterwards, so levels are checked during follow-up.

Can Micro-TESE be repeated if no sperm is found?

Yes. A second operation is usually planned six to twelve months later, after the testis has healed and any hormonal treatment has had time to work. The chance on a repeat attempt is lower, around 20 to 30 percent, but much higher if sperm was found the first time.

Should the sperm be used fresh or frozen for ICSI?

Both work. Systematic reviews of men with non-obstructive azoospermia show fertilisation and pregnancy rates with frozen testicular sperm equal to fresh sperm. Freezing first avoids putting the partner through egg stimulation before it is known whether sperm exists, and lets IVF be done later at a clinic of your choice.

Is Micro-TESE worth it for Klinefelter syndrome?

Yes. Sperm is found in about half of men with Klinefelter syndrome, and results are best in younger men, so surgery should not be delayed for years. Testosterone treatment should be stopped several months beforehand, because it switches off sperm production. Children born after ICSI are usually chromosomally normal.

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When No Sperm Shows Up in the Semen, Micro-TESE Surgery in Turkey Can Still Find Sperm Inside the Testicle

Around 1 percent of all men, and 10 to 15 percent of infertile men, have no sperm at all in their semen. In many of them the testis still makes sperm in small, scattered pockets. Micro-TESE uses an operating microscope to find those pockets, and retrieves sperm in about half of men with non-obstructive azoospermia, enough for IVF with ICSI and a biological child. In Turkey, Micro-TESE is performed as a day case, with sperm frozen on site.

Medical content:This article was reviewed and approved by Assoc. Prof. Dr. Tuncay Taş.

Micro-TESE at a Glance

Used for	Non-obstructive azoospermia, Klinefelter syndrome
Anaesthesia	General or spinal
Operation time	About 2 to 3 hours
Hospital stay	Day case, occasionally one night
Sperm found	About 40 to 60 percent overall
Back to desk work	3 to 5 days
Sex and exercise	After about 2 weeks
Sperm use	ICSI, fresh or frozen

What Is Micro-TESE?

Micro-TESE stands for microdissection testicular sperm extraction. It was introduced by Peter Schlegel in 1999 for men whose testes make very little sperm. Instead of taking random biopsies, the surgeon opens the testis and examines the seminiferous tubules, the fine coiled tubes where sperm is made, at 15 to 25 times magnification.

Tubules that still make sperm tend to be wider, whiter and more opaque than empty ones. Only these are removed, often pieces smaller than a grain of rice. Blood vessels on the surface of the testis are seen and spared, which protects the testosterone-producing tissue and lowers the risk of bleeding and scarring.

Seminiferous tubules under the operating microscope during Micro-TESE, dilated sperm-producing tubules beside thin empty ones — Under the operating microscope, the few tubules that still produce sperm (right) look wider and whiter than the thin, empty tubules around them. Only these are removed.

Obstructive and Non-Obstructive Azoospermia

Obstructive azoospermia: sperm production is normal but the ducts are blocked, for example after vasectomy or infection. Sperm is easily retrieved with a needle (TESA or PESA), and Micro-TESE is rarely needed
Non-obstructive azoospermia: the testis itself makes very little sperm. This is where Micro-TESE gives the best chance

Who Needs Micro-TESE?

Men with non-obstructive azoospermia confirmed on at least two semen analyses, including a centrifuged sample
Men with Klinefelter syndrome (47,XXY)
Men with an AZFc deletion on the Y chromosome
Men with a history of undescended testicles, mumps orchitis, chemotherapy or radiotherapy
Men in whom TESA or conventional TESE found no sperm
Men with cryptozoospermia, where only a few sperm appear occasionally in the semen, if ejaculated sperm cannot be used

Small testes and a high FSH level do not rule surgery out. Neither predicts reliably whether sperm will be found, so they should not be used as a reason to go straight to donor sperm.

Tests Before Surgery

Test	Why it matters
Two semen analyses	Confirms azoospermia, including a spun-down sample
FSH, LH, testosterone, oestradiol, prolactin	Separates obstruction from low production; guides hormone treatment
Karyotype	Detects Klinefelter syndrome and other chromosome changes
Y chromosome microdeletion (AZF)	Complete AZFa or AZFb deletions mean sperm will not be found
Scrotal ultrasound	Testicular volume, varicocele and hidden masses
Previous biopsy reports	The strongest single predictor of success

Men with a complete AZFa or AZFb deletion should not have Micro-TESE. Testicular sperm has not been found in these deletions, so the operation would bring risk without any chance of success.

Hormonal Preparation

When testosterone is low, some men are given clomiphene, an aromatase inhibitor or hCG for three to six months before surgery to raise the testosterone level inside the testis. The evidence for this is mixed and it is decided case by case. Testosterone gel or injections must be stopped, as they shut down sperm production.

Micro-TESE, Conventional TESE and TESA

	TESA	Conventional TESE	Micro-TESE
Technique	Needle, blind	Open, random biopsies	Open, under microscope
Best suited to	Obstructive azoospermia	Obstruction, mild production problems	Non-obstructive azoospermia
Sperm found in NOA	Lowest	About 35 percent	About 52 percent
Tissue removed	Small	Larger	Smallest for the area searched
Complications	Rare	About 3 percent	About 1 to 3 percent

The comparison figures come from the Bernie 2015 meta-analysis of 15 studies. American (AUA/ASRM) guidelines recommend Micro-TESE for non-obstructive azoospermia; European (EAU) guidelines accept either technique, with Micro-TESE preferred where the expertise is available.

How the Operation Is Done

Your partner's IVF clinic is informed in advance, and sperm freezing is arranged with the laboratory.
Under general or spinal anaesthesia, a small midline cut is made in the scrotum.
The testis is opened along its equator, avoiding the surface blood vessels.
The surgeon searches the tubules under the microscope and removes only the dilated, opaque ones.
An embryologist in theatre breaks up each sample and looks for sperm. The search continues across the testis until sperm is found or all areas have been examined.
If none is found on one side, the other testis is searched during the same anaesthetic.
The testis and scrotum are closed with dissolving stitches. Any sperm found is frozen in several straws.

Micro-TESE surgery performed under an operating microscope in Istanbul — Micro-TESE is performed under an operating microscope, with an embryologist examining the tissue during surgery.

Micro-TESE Success Rates

Sperm retrieval rates are usually quoted as 40 to 60 percent, but the figure for an individual man depends mostly on what the testis tissue looks like under the microscope.

By Testicular Biopsy Pattern

Biopsy pattern	What it means	Sperm found with Micro-TESE
Hypospermatogenesis	All stages present, but in small numbers	About 90 to 98 percent
Maturation arrest	Production stops before mature sperm	About 35 to 60 percent
Sertoli cell only	Most tubules contain no sperm-making cells	About 25 to 40 percent
Tubular sclerosis	Tubules largely scarred	About 25 percent

In Sertoli cell only, the most common pattern, Micro-TESE finds sperm two to four times more often than conventional TESE, because small islands of production are easily missed by random biopsies.

Klinefelter Syndrome

Sperm is found in about half of men with Klinefelter syndrome, with better results in men under 30. Testosterone treatment should be stopped beforehand, and many men are prepared with medication that raises their own testosterone.

After Previous Surgery

After a failed conventional TESE: sperm is still found in about 45 percent
Each previous biopsy lowers the chance: from about 56 percent with none to about 23 percent after three or four
Repeat Micro-TESE after a failed first attempt: about 20 to 30 percent; after a successful first attempt, much higher

What Else Affects the Chance

Genetics: AZFc deletions about 50 to 70 percent
Cause: men treated for undescended testicles do relatively well
Hormones: very low testosterone may be corrected first
Surgeon and laboratory experience, which has a larger effect than testicular size or FSH level

From Sperm to Pregnancy: ICSI Outcomes

Sperm from the testis cannot swim well enough for ordinary IVF, so each egg is injected with a single sperm (ICSI). In large series of men with non-obstructive azoospermia:

Fertilisation: about 55 percent of injected eggs
Clinical pregnancy: about 39 percent per embryo transfer
Live birth: about 24 percent per embryo transfer
Cumulative delivery: about 44 percent per egg collection, counting frozen embryos

Fresh or Frozen Sperm

Systematic reviews find no difference in fertilisation or pregnancy rates between fresh and frozen testicular sperm in non-obstructive azoospermia. This allows a freeze-first plan: Micro-TESE is done first, and your partner starts IVF only once sperm is known to be available, avoiding egg stimulation that might be wasted.

Recovery Timeline

When	What to expect
Day of surgery	Home after a few hours; ice packs and a supportive brief
Days 1 to 3	Ache and mild swelling, eased with ordinary painkillers
Day 2	Shower allowed
Days 3 to 5	Back to desk work; fit to fly home
About 2 weeks	Sex, cycling, gym and lifting
3 to 6 months	Testosterone check
12 to 18 months	Testosterone usually back to its previous level

Risks and Effect on Testosterone

Micro-TESE is a safe operation. In published series about 1 to 3 percent of men have a complication, fewer than with conventional TESE.

Bruising and swelling of the scrotum
Haematoma, a collection of blood that rarely needs draining
Wound infection
Scarring or loss of testicular volume, less common than after random biopsies
A temporary fall in testosterone, deepest at three to six months

Most men's testosterone recovers within 12 to 18 months; in Klinefelter syndrome it can take longer. Men who already had low levels may need testosterone treatment afterwards, which is started only once fertility treatment is complete.

If No Sperm Is Found

The full histology report shows which pattern was present and whether a second attempt is reasonable
A repeat Micro-TESE is usually planned after six to twelve months, sometimes after hormonal treatment
In selected men, supportive regenerative treatments such as exosome therapy are being studied before a repeat operation
Donor sperm or adoption remain options for the couple

Micro-TESE Cost in Turkey

The same microsurgery costs several times more for couples paying privately in the United States, the United Kingdom, Europe, the UAE or Saudi Arabia.

Treatment	Turkey	United States	United Kingdom	Europe	UAE
Micro-TESE, one testis	$2,500 to $3,500	$10,000 to $15,000	£4,500 to £7,000	€4,500 to €7,000	$6,000 to $9,000
Micro-TESE, both testes	$3,000 to $5,000	$12,000 to $20,000	£6,000 to £9,000	€5,500 to €9,000	$7,000 to $12,000
Repeat Micro-TESE	$3,000 to $5,000	$12,000 to $20,000	£6,000 to £9,000	€5,500 to €9,000	$7,000 to $12,000

Every figure in the Turkey column is a typical package price including surgery, anaesthesia, hospital care and sperm freezing. Prices for other countries are typical private, self pay ranges. Your exact price depends on whether one or both testes are explored. The partner's IVF/ICSI cycle, genetic tests and travel are not included. Results can be sent through the contact page for a personal quote.

Planning Micro-TESE From Abroad

Many couples travel to Istanbul, Turkey, for Micro-TESE, because the success of the operation depends heavily on the surgeon's microsurgical experience. A typical plan is:

Send semen analyses, hormone results, genetic tests and any biopsy reports for review before travelling
Arrive the day before surgery for examination and blood tests
Micro-TESE as a day case, with sperm frozen on site
Check-up on day 2 or 3, then fly home
Frozen sperm is used for ICSI in Turkey, or shipped to your own IVF clinic