Testicular Sperm Extraction — Procedure Guide, Recovery & Risks | MyMedicPlus

Testicular sperm extraction (TESE) surgically biopsies the testis to retrieve spermatozoa for use in intracytoplasmic sperm injection (ICSI). Conventional TESE takes multiple random biopsies. Microsurgical TESE (micro-TESE) uses a 16-25x operating microscope to identify dilated seminiferous tubules most likely to contain mature sperm, maximizing retrieval while minimizing tissue damage.

TESE is indicated for non-obstructive azoospermia (NOA) where sperm production is severely impaired (Sertoli-cell-only syndrome, maturation arrest, hypospermatogenesis), and for obstructive azoospermia (OA) when epididymal sperm retrieval (PESA) has failed or is not feasible. Genetic evaluation (karyotype, Y-chromosome microdeletion) precedes the procedure.

Under general anaesthesia or local block; scrotal incision exposes the testis. Conventional TESE: multiple small excision biopsies from various testicular poles sent to the embryologist immediately. Micro-TESE: operating microscope identifies dilated opaque tubules (enriched with sperm); targeted biopsies taken; albuginea closed with fine absorbable sutures; scrotal closure.

Day procedure; patients go home with a scrotal support and ice pack applied for 48 hours. Analgesics (NSAIDs, paracetamol) are used for 3-5 days. Strenuous activity and sexual intercourse are avoided for 7-10 days. Retrieved sperm is cryopreserved for a future IVF-ICSI cycle. Follow-up testosterone level checked at 3 months to detect hypogonadism.

Haematoma occurs in 5-10% of conventional TESE versus 1-2% with micro-TESE. Infection is rare (under 1%). Testicular atrophy (volume loss from vascular damage) is a serious concern with repeated conventional TESE; micro-TESE minimizes vascular disruption. Transient testosterone reduction is common; permanent hypogonadism occurs in 1-5% of micro-TESE cases.

Micro-TESE achieves sperm retrieval in 50-60% of non-obstructive azoospermia patients, superior to conventional TESE (30-40%). For obstructive azoospermia, retrieval rates approach 100% regardless of technique. When sperm are retrieved and IVF-ICSI performed, clinical pregnancy rates are 30-50% per embryo transfer cycle depending on female partner age and embryo quality.