TESE Procedure Step by Step: What Happens During the Surgery

Microsurgical testicular sperm extraction, known as the micro TESE procedure, is a highly advanced surgical technique designed to retrieve sperm directly from the testicular tissue.

The goal is to find high-quality sperm, gather enough for fertilization, and protect reproductive structures from unnecessary damage. Healthcare providers typically recommend the micro TESE procedure for men diagnosed with azoospermia, where no sperm are present in the semen.

Men may require this procedure due to genetic factors, previous testicular surgery, abnormal sperm production, or medical treatments that affect fertility. For these individuals, the TESE procedure provides a crucial opportunity to retrieve sperm when natural production or release is impaired.

Read More: How is testicular biopsy carried out?

The micro TESE procedure offers a precise, targeted method of locating sperm in cases where sperm production is extremely limited. Since no test can accurately predict sperm presence in men with severe testicular issues, surgical exploration becomes essential.

Performed under general anesthesia, the TESE procedure is carried out by a urologist supported by anesthesiologists and nurses. Using a microscope, the surgeon examines the testicular tissue to locate promising tubules. This advanced method increases the likelihood of success and minimizes tissue removal.

The TESE procedure steps involve several carefully coordinated stages that ensure safety and maximize the chances of successful sperm retrieval.

Step 1: Pre-Procedure Evaluation and Diagnosis

Before surgery, the patient undergoes a comprehensive health review. Allergies, medications, supplements, and medical history must be shared openly, as some substances increase bleeding risks.

Although blood tests may offer limited prediction of sperm retrieval success, genetic testing can sometimes provide additional insight. This essential stage lays the groundwork for a safe and effective TESE procedure.

Step 2: Preparing for the TESE Surgery

Patients receive specific instructions regarding fasting before the TESE procedure. Typically, no food or drink is allowed after midnight before surgery.

If needed, medications may be taken with a small sip of water. Following these steps is crucial for safety during anesthesia.

Step 3: The Surgical Sperm Extraction

Once under anesthesia, the urologist makes a single incision along the scrotum and smaller incisions within the testicle to retrieve tissue samples. In the micro-TESE procedure, an operating microscope is used to identify the tubules most likely to contain sperm.

Because the microscope provides magnification, it helps the surgeon locate the best tissue while removing as little as possible. This stage is crucial in understanding what this procedure is and why micro-TESE is often more effective.

Step 4: Laboratory Analysis and Sperm Processing

Tissue samples are sent immediately to the embryology lab, where technicians examine them under high-powered microscopes. If sperms are found, they can be used immediately or frozen for future ICSI treatment.

Once the samples are collected, the surgeon closes the incisions with non-absorbable stitches. Results may be available within hours or within 1 day.

The TESE procedure recovery phase begins as anesthesia wears off. Most patients feel drowsy but stable, and many go home the same day.

Full TESE procedure recovery time typically ranges from one to two weeks. Pain and swelling may occur during the first 48 hours and can be managed with ice packs and over-the-counter pain relievers.

Patients should avoid strenuous exercise, heavy lifting, and sexual activity for several days. Following these instructions supports healing and reduces complications during recovery from the TESE procedure.

The following are some possible complications and side effects of the TESE procedure.

• Unsuccessful Sperm Retrieval: The most significant concern is that sperm may not be retrieved in some cases.
• Bleeding: Mild bleeding at the incision site can occur after the procedure.
• Infection: There is a small risk of infection, especially if aftercare instructions aren’t followed.
• Discomfort or Pain: Temporary soreness and discomfort in the testicular area are common.
• Swelling: Some men may experience noticeable swelling that typically improves within a few days.
• Rare Long-Term Damage: Although extremely rare, long-term testicular damage can occur.
• When to Seek Help: Contact your doctor if you notice fever, increased swelling, severe pain, pus, or any signs of infection.

The micro-TESE procedure provides a significantly higher chance of finding viable sperm, approximately 50% depending on the underlying cause of azoospermia. If all retrieved sperm are used during treatment, another TESE procedure may be required for future cycles. Most specialists recommend waiting 8-12 months before repeating the surgery.

The TESE procedure cost varies widely depending on insurance coverage, clinic pricing, and geographic location. Many insurance providers do not cover the TESE procedure, although some make exceptions for specific cases. Financial coordinators can help patients understand expenses and available options.

Understanding the difference between TESE and micro-TESE is essential for choosing the right treatment.

Facing infertility can be emotionally challenging, but it is not a personal failure and does not diminish anyone’s ability to become a loving parent. Procedures like microsurgical testicular sperm extraction (micro-TESE) offer real hope for couples wishing to have a biological child.

If you and your partner have been trying to conceive for over a year, speaking with a specialist is the next essential step. At ART Fertility Clinics, our expert teams combine advanced science with precise diagnosis to create personalized treatment plans and maximize the chances of a successful pregnancy.