Micro-TESE (microsurgical testicular sperm extraction)

What micro-TESE involves

The UK fertility regulator, the HFEA, lists “Microscope-assisted testicular sperm extraction (MicroTESE).” among five ways of collecting sperm surgically, and describes it: “MicroTESE involves examining the testicle with an operating microscope to find areas (tubules) where sperm are being made. The promising areas are taken out and sperm extracted if possible.”

It is a larger procedure than TESA or PESA: the HFEA says “MESA and MicroTESE are both performed under general anaesthetic.” Afterwards, “You'll probably be given painkillers and asked to rest for a couple of days after the procedure.”

Its simpler relative, TESE, the HFEA describes as “making an incision into the testicle to take a small sample (biopsy) away from which sperm can hopefully be recovered.”

When it is used

Micro-TESE is for a production problem rather than a blockage. The HFEA says “You may have MicroTESE if you have no sperm in your semen due to a sperm production problem (non-obstructive azoospermia). This could be because:”

• “you've had chemotherapy or radiotherapy and your fertility hasn't returned to normal”
• “you have a genetic condition that affects your fertility”
• “you've had a testicle removed (perhaps as part of cancer treatment)”
• “you've had surgery to bring down undescended testes.”

It adds: “Your chances of extracting sperm will depend on the reason for the lack of sperm in your semen.” Whether it is appropriate in a particular case is a clinical decision for the treating doctor. This directory does not make that judgement.

What the regulator says about risks

On side effects, the HFEA states: “Side effects tend to be rare, but bleeding and infection can occur.” It adds: “A small number of men experience a drop in their testosterone following surgical sperm retrieval, which may cause problems with sexual function, sleep, muscle weakness and anxiety.”

It is also clear that retrieval is not the end point: “Successfully extracting sperm doesn't guarantee you'll have a baby.” and “You'll need to have a fertility treatment like ICSI to use your sperm.” See ICSI.

India’s ART (Regulation) Rules, 2022 set out two levels of clinic:

• A Level 1 clinic is one where “only IUI is carried out as part of treatment”.
• A Level 2 clinic is one where “all/advanced investigations, diagnostic and therapeutic procedures in ART are carried out”.

Because a Level 1 clinic may carry out only IUI, Micro-TESE is Level 2 work.

That is why each clinic below shows the level the national registry records for it. Of the listings below, 22 are registered as Level 2, 0 as Level 1, and 13 have no level in the registry extract. A clinic may send patients to a partner Level 2 laboratory, or its website may describe services it does not provide on site. Ask the clinic where the Micro-TESE itself is done, and check its registration on the National ART & Surrogacy Registry.