Micro-TESE

Roughly 40% to 60% across all men with non-obstructive azoospermia — but the honest answer for you depends on the pattern inside the testicle, which ranges from over 90% where all stages of development are present to around a quarter where only supporting cells appear to remain. The table above sets those out.

Your hormone profile, testicular volume, genetic results and any previous biopsy all refine that estimate, and we will go through your own figures rather than the average at the consultation.

This is the question that matters most, and it deserves a straight answer rather than a reassuring one. If the embryologist confirms that no viable sperm can be located, the operation is concluded without taking further tissue unnecessarily. There is nothing to be gained from continuing.

It is a hard day. What it also does is end the uncertainty — you have a definitive answer rather than an open question, and that allows you and your partner to move to donor sperm or adoption as a considered decision rather than a defeat. Both are routes to fatherhood, and your fertility clinic will take that conversation forward with you. I would rather give you a clear answer than leave you wondering for another five years.

Pain, bruising and swelling are expected for the first few days and are managed with rest, ice, support and paracetamol.

Bleeding into the scrotum — a haematoma — is the main complication to watch for, which is why the first 48 hours are spent horizontal with an ice pack. Infection is uncommon and minimised by strict surgical technique.

Testosterone. Because testicular tissue is removed, levels can fall — typically by up to around 16%, and sometimes taking 18 to 24 months to return to baseline. In a small number of men it does not fully recover and replacement therapy is needed. The microsurgical technique exists partly to limit this: taking a fraction of the tissue a conventional biopsy would remove is what protects the cells that make your testosterone. Levels are checked afterwards rather than assumed.

This is why we tell you which pain to ignore and which to ring about. A dull ache that eases day by day, and bruising that spreads before it fades, are the ordinary course of things. Pain that is out of proportion to how the scrotum actually looks, and that escalates rather than settles over the first day or two, is not.

The reason for drawing that line is a complication called testicular compartment syndrome, where swelling inside the fibrous capsule of the testicle raises the pressure within it until the blood supply is choked off. It is genuinely rare — around fourteen cases have been reported in the entire literature, one of them after a bilateral micro-TESE — and it is here not to frighten you but because it is the one thing on this page where the timing of the phone call changes the outcome.

The treatment is surgical decompression, and it works when it is done early. That is why pain of that kind needs to be seen the same day rather than the next morning, and why the out-of-hours instruction is to go to A&E rather than wait for the clinic to open. If you are not sure whether what you are feeling counts, ring and let us make that call.

No. Sperm taken directly from the testicle has not matured through the epididymis and cannot fertilise an egg on its own, so it must be used with ICSI — where a single sperm is injected directly into the egg. That is not a limitation of this operation; it is true of all surgically retrieved sperm.

There is one incidental advantage worth knowing: testicular sperm carries substantially less DNA damage than ejaculated sperm from the same man, because much of that damage happens after production, during storage and transit.

Medical treatment first. Where the hormone profile suggests a treatable cause, a course of medical therapy before surgery can improve the odds — and occasionally produces sperm in the ejaculate, avoiding an operation altogether. That is established at the assessment.

Conventional TESE or TESA. Older techniques that sample without a microscope. They remove more tissue and find sperm less often in non-obstructive azoospermia, which is why micro-TESE is preferred where production failure is the problem. Where the cause is obstruction rather than production, simpler retrieval — or surgical reconstruction — may be the better answer.

Donor sperm. A successful and well-established route to fatherhood, coordinated through your fertility clinic. Raising it is not giving up; having it in view from the beginning is part of making a considered decision.

The operation does not affect erections or the mechanics of ejaculation. Abstain from sexual activity for at least two weeks while the tissue heals, then resume normally. If testosterone falls significantly afterwards it can affect libido and energy, which is a further reason levels are monitored.

It changes one laboratory measurement, and that is worth explaining rather than hiding. The DNA fragmentation index — the proportion of sperm carrying broken DNA strands — does rise across a freeze and thaw. In one study it went from around 25% before freezing to around 40% after thawing. On its own, that number sounds alarming.

The measurement and the outcome are not the same thing. Where fresh testicular sperm has been compared directly with frozen and thawed testicular sperm, the comparisons have not found a difference in fertilisation, embryo quality or live birth. Testicular sperm also starts with less DNA damage than ejaculated sperm from the same man, which is part of why it is used at all.

Both of those can be true because of how ICSI works. A single sperm is selected and injected rather than a population competing, and the egg itself has some capacity to repair damaged sperm DNA. A rise in an average taken across thousands of sperm does not necessarily describe the one that is used.

The caveat is that this is a much smaller body of evidence than the retrieval-rate literature, and one of the supporting sources is a conference abstract rather than a full paper. What it does support is where to put your worry. The freeze is not the thing to be anxious about; whether sperm is found at all, and your partner's age and ovarian reserve, matter far more.

That depends on whether the plan is a synchronised retrieval or retrieval and freezing — see the section above. Where sperm is frozen, the cycle can begin once you have recovered and the laboratory has confirmed what is stored. Where it is synchronised, the two are booked together from the outset, with your fertility clinic.