Male Infertility and Micro-TESE
No sperm in the semen is not the end of the road — but finding sperm cannot be guaranteed either. This page explains which tests are done, why, and how the decision is made.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
Private Online Consultation
A private, one-to-one video consultation by appointment, without visiting the clinic. Especially for patients who value privacy.
- Procedure time
- Micro-TESE 60–150 minutes
- Anesthesia
- General anaesthesia
- Hospital stay
- Day case
- Stay in Türkiye
- 5–7 days
- Return to work
- 3–7 days
- Flight clearance
- 3–5 days
About the condition
Male infertility means that pregnancy is not achieved because of factors on the man’s side. The assessment is always made AS A COUPLE, because the treatment decision is determined not only by the findings in the man but by the situation on the woman’s side and in particular by her age. Solving the problem in the man will not bring a pregnancy if there is an unresolved obstacle on the woman’s side.
SEMEN ANALYSIS IS THE BASIS OF ASSESSMENT, BUT ONE ANALYSIS IS NOT ENOUGH. Sperm values vary markedly from week to week in the same man; a feverish illness, heavy stress or a short abstinence period can spoil the result. At least two separate analyses are therefore requested, and both should be produced after 2–7 days of sexual abstinence.
AZOOSPERMIA DIVIDES IN TWO, AND THAT DISTINCTION DETERMINES EVERYTHING. There are two possible reasons for no sperm in the semen: either sperm is being produced but the passage is blocked (obstructive azoospermia), or production is inadequate (non-obstructive azoospermia). In the first, the chance of retrieving sperm is high; in the second the picture is more complex and micro-TESE comes into consideration.
The distinction is made by examination and blood tests. If testicular volume is normal, FSH is normal and the semen volume is low, obstruction is suspected. If the testicles are small and FSH is raised, a problem of production is to the fore. Genetic tests (karyotype and Y chromosome microdeletion) are requested in men with a production problem.
GENETIC TESTING SOMETIMES PREVENTS AN UNNECESSARY OPERATION. In men found to have a complete deletion in the AZFa or AZFb region of the Y chromosome, the chance of finding sperm at micro-TESE is very low. Knowing this before surgery spares the man and his partner an unnecessary procedure and the disappointment it would bring. With a deletion in the AZFc region, finding sperm is possible.
MICRO-TESE means examining the testicular tissue under an operating microscope and selecting the tubules in which sperm production is continuing. The purpose of using the microscope is both to improve the chance of finding sperm and to limit damage to the testicle by reducing the amount of tissue taken. Sperm that is found is either used fresh for intracytoplasmic sperm injection (ICSI) or frozen and stored.
THE MOST IMPORTANT POINT: FINDING SPERM CANNOT BE GUARANTEED. In non-obstructive azoospermia, micro-TESE may end without sperm being found. That is not a failure of the surgery but the reality of the underlying condition. Be wary of anyone who says "we will definitely find some"; the honest approach is to explain the likelihood in the light of your own findings.
Who is it suitable for?
May be suitable
- Men with no sperm in the semen (azoospermia) who wish to father a child
- Men in whom obstructive azoospermia is suspected — the chance of retrieving sperm is high
- Men with non-obstructive azoospermia found suitable after genetic assessment
- Men who have had a TESE before but without a microscope — reassessment may be worthwhile
- Men who wish to preserve fertility before cancer treatment — sperm freezing is discussed first
- Men with impaired sperm values who also have a varicocele — the varicocele is assessed first
May not be suitable
- Men expecting a decision on the basis of a single semen analysis — at least two are needed
- Men found to have a complete AZFa or AZFb deletion on the Y chromosome — the chance of finding sperm is very low and this must be discussed from the outset
- Couples with an untreated problem on the woman’s side that is preventing pregnancy
- Men who continue to take testosterone or anabolic substances — these must be stopped first and a period allowed for recovery
- Men for whom no simultaneous planning with an ICSI centre has been made — timing is essential if fresh sperm is to be used
Technology used
- Semen analysis (at least two separate samples, after 2–7 days of abstinence)
- Hormone profile — FSH, LH, total testosterone
- Scrotal ultrasound — testicular volume and assessment for varicocele
- Genetic tests — karyotype and Y chromosome microdeletion
- Micro-TESE with the operating microscope
- Sperm freezing and simultaneous working with the embryology laboratory
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Step 1
Assessing the couple together
The woman must also have been assessed. Her age directly affects both the treatment plan and how urgent it is.
- Step 2
Semen analysis and examination
At least two separate semen analyses are requested. Examination assesses testicular volume, the presence of a varicocele and whether the sperm ducts can be felt.
- Step 3
Hormone and genetic tests
FSH, LH and testosterone are checked. If a production problem is suspected, karyotype and Y chromosome microdeletion are requested. These results can change the decision to operate.
- Step 4
Treating correctable causes
If there is a correctable cause such as a varicocele, a hormonal disorder or the use of a drug or substance, that is dealt with first. If testosterone is being taken, it is stopped and recovery awaited.
- Step 5
Micro-TESE
Under general anaesthesia the testicular tissue is examined with the operating microscope and tubules showing sperm production are selected. The procedure can take 60–150 minutes; the patient is discharged the same day.
- Step 6
The result and the next step
If sperm is found it is used fresh or frozen. If none is found, options such as donor sperm or adoption are discussed openly with the couple.
Method comparison
| Criterion | Obstructive | Non-obstructive |
|---|---|---|
| Where the problem lies | Production occurs, the passage is blocked | Production is inadequate |
| Testicular volume | Usually normal | Often reduced |
| FSH level | Usually normal | Often raised |
| Genetic testing | Cystic fibrosis carrier status may be checked | Karyotype and Y microdeletion required |
| Chance of retrieving sperm | High | Variable — cannot be guaranteed |
| Method | Simpler techniques may suffice | Micro-TESE |
This distinction determines both the method and the expectation. It is made by examination, hormone profile and testicular volume together; no single test is sufficient.
Risks
- NO SPERM BEING FOUND: in non-obstructive azoospermia this is the most important and most real risk. It is not a complication but a possible outcome, and it is discussed plainly before surgery
- A fall in testosterone level because part of the testicular tissue is removed — using the microscope aims to limit this by reducing the amount of tissue taken
- Swelling, bruising and a collection of blood (haematoma) in the scrotum
- Infection
- Pain in the testicle — usually temporary
- A reduction in testicular volume
- An unnecessary procedure: in a man with an AZFa/AZFb deletion taken to surgery without genetic testing, both expectation and tissue are wasted — which is why the test is requested first
Alternatives
- Treating the correctable cause — varicocele repair, hormonal correction, stopping a drug or substance
- Retrieving sperm by simpler methods from the epididymis or testicle in obstructive azoospermia
- Lifestyle change — stopping smoking, weight control, avoiding excessive heat
- Going directly to assisted reproduction with ICSI where sperm is available
- Sperm freezing — as a safeguard before treatment
- Donor sperm or adoption — options discussed when no sperm is found
Recovery
First 48 hours
Swelling and tenderness in the scrotum are expected. Ice and supportive underwear bring relief. Painkillers are used.
Days 3–7
A return to desk work is possible. Gentle walking is allowed; heavy lifting and sport are not.
Weeks 2–4
A gradual return to normal activity is made. A return to sexual activity is planned during this period.
Months 3–6
The testosterone level is checked to assess whether removing tissue has caused a fall.
Frequently asked questions
There is no sperm at all in my semen. Is my chance of having a child over?
No, it is not — but nor can it be guaranteed. First it must be established whether the absence of sperm is due to an obstruction or to a problem of production. With an obstruction the chance of retrieving sperm is high. With a production problem, micro-TESE may find sperm, but it may not. The honest answer is to discuss the likelihood in the light of your own findings.
Is one semen analysis not enough?
No. Sperm values vary markedly from week to week in the same man; a feverish illness or a short abstinence period can spoil the result. Deciding on a single poor analysis leads to the wrong conclusion. At least two separate analyses are requested, each after 2–7 days of abstinence.
I am using testosterone injections — will they improve my sperm values?
No — they do the opposite. Testosterone taken from outside suppresses the signal the brain sends to the testicles and reduces sperm production, and can stop it altogether. This use, common in gyms, is a frequent and often overlooked cause of infertility. If you want a child you need to stop it in discussion with your doctor and allow a period for recovery.
Why is genetic testing requested?
Because the result sometimes changes the decision to operate. If a complete deletion is found in the AZFa or AZFb region of the Y chromosome, the chance of finding sperm at micro-TESE is very low. Knowing this beforehand spares you an unnecessary operation and a considerable disappointment. With an AZFc deletion, finding sperm is possible.
What is the difference between micro-TESE and ordinary TESE?
Micro-TESE uses the operating microscope. Tubules that look fuller, where sperm production is continuing, can therefore be selected and taken. This aims both to improve the chance of finding sperm and to limit damage to the testicle by reducing the tissue removed. If you have had a TESE without a microscope and no sperm was found, reassessment may be worthwhile.
What happens if sperm is found?
Sperm that is found is either used the same day for ICSI or frozen and stored. If fresh use is planned, it has to be timed with your partner’s treatment schedule, which is why the procedure is arranged together with the embryology team.
What if no sperm is found?
This possibility is discussed from the outset. If none is found, the options are donor sperm or adoption. In some men a second attempt may come into consideration after a certain interval, but that is not appropriate for everyone and is judged on the findings.
I have a varicocele — should that be operated on first?
If you have a varicocele that can be felt on examination and your sperm values are impaired, repairing the varicocele may come first; in some men this improves the sperm values. But it carries no guarantee of pregnancy either, and if the woman’s age leaves little time, going straight to assisted reproduction may be the better course.
Will the procedure lower my testosterone?
Because part of the testicular tissue is removed, the testosterone level can fall. One purpose of using the microscope is to keep the amount of tissue taken to a minimum. Testosterone is checked at 3–6 months after surgery and monitoring continues if needed.
When can I return to work and fly?
A return to desk work is usually possible within 3–7 days; flying is permitted after 3–5 days. A stay of 5–7 days is planned for patients travelling from abroad. For heavy lifting and sport, waiting 2–4 weeks is advised.
Articles on this topic
Scientific sources
This page is for general information only and is not a substitute for medical advice.
Let's talk about this treatment
Message us on WhatsApp with your questions or fill in the pre-assessment form.
Pre-assessment form
Leave your details and our team will get back to you shortly.
Other treatments
Overactive Bladder and Urgency Incontinence
A sudden, hard-to-defer need to pass urine, going frequently, and sometimes not getting there in time. Treatment is stepwise, and most women improve markedly without needing medication or surgery.
Learn moreTesticular Cancer: Why Acting Early Changes Everything
The commonest solid cancer in young men, and one that responds very well to treatment. If you have noticed a painless lump, do not wait — delay turns a readily treatable disease into a harder one.
Learn moreStress Urinary Incontinence: the Treatment Options
Leaking urine when you cough, sneeze or exercise. The type has to be established first, and treatment should begin with the least invasive step — surgery is not the first option.
Learn more