Male fertility surgery · Mr Musaab Yassin
Microdissection TESE
microTESE is the gold-standard surgical technique for men diagnosed with azoospermia — the absence of sperm in the ejaculate. Using a high-powered operating microscope, the surgeon can pinpoint and extract viable sperm directly from the testicle while preserving healthy tissue. For many men with non-obstructive azoospermia it offers the best available chance of finding sperm, where no other route is open.
- Anaesthetic
- General
- Setting
- Day case
- Retrieval rate
- 40–60%
- No driving
- 24 hours
- Scrotal support
- 2 weeks
The procedure
Why the microscope changes the odds.
In non-obstructive azoospermia, sperm production is not absent everywhere in the testicle — it is patchy. Small pockets of tissue may still be producing sperm while the tissue around them is not. The difficulty has never been whether those pockets exist; it is finding them.
A conventional biopsy takes tissue more or less blind. Microdissection TESE does the opposite. Under high magnification, the seminiferous tubules can be examined directly, and the fuller, more opaque tubules — the ones most likely to contain sperm — can be identified and sampled selectively. Less tissue is removed, the blood supply is better preserved, and the chance of finding sperm rises.
The procedure is carried out under a general anaesthetic. Any sperm retrieved is passed to the embryology laboratory for use with ICSI, either fresh or frozen for a later cycle, and this is coordinated with your fertility clinic in advance.
Questions
What patients ask before deciding.
What is the success rate?
Globally, microTESE offers a sperm retrieval rate of roughly 40% to 60% in men with non-obstructive azoospermia. Your own likelihood depends on the underlying cause, your hormone profile and previous surgical history, and Mr Yassin will give you a figure specific to your case rather than the population average.
What are the alternatives?
Depending on your diagnosis, a course of medical fertility treatment may be recommended before surgery to optimise your chances. In some men this alone changes the picture enough to be worth doing first. Where the azoospermia is obstructive rather than non-obstructive, other retrieval techniques — or reconstructive surgery — may be more appropriate.
What if no sperm is found?
This is difficult news, and it is better to have thought about it beforehand than to meet it cold. If no sperm is retrieved, your clinical team will support you in exploring alternative family-building options with your fertility clinic. Nothing about that conversation has to happen on the day of surgery.
Before your surgery
Preparing for a general anaesthetic.
Two rules matter more than the rest, because getting either wrong means the operation cannot go ahead safely on the day.
Solid food
6 hours before
Nothing to eat
Stop all solid food six hours before your admission time. A cancelled operation is almost always a fasting error.
Clear fluids
2 hours before
Water, black tea or coffee
Clear fluids are allowed up to two hours before admission. After that, nothing at all.
The night before
Clip the hair Clip the scrotal hair short with electric clippers rather than shaving with a razor — razor shaving causes small nicks that raise the risk of infection. Take your time with it. Pack supportive underwear — a jockstrap or snug briefs — and loose trousers for the journey home.
On the morning
Shower thoroughly Shower before you set off. Do not apply lotions, creams or talcum powder to the genital area.
Before you leave
Confirm your driver You must not drive for 24 hours after a general anaesthetic, and you should not travel home alone. Arrange for a responsible adult to collect you and to be with you that evening.
Afterwards
The first fortnight, in order.
Recovering safely at home protects the delicate tissue and helps the wound heal cleanly. Most men find the discomfort manageable; the swelling is what needs managing.
First 48 hours
Strict bed rest Stay off your feet. Apply an ice pack for 15 to 20 minutes every few hours — wrapped, never directly against the skin — and keep the incision completely dry. Use paracetamol for the ache, and avoid ibuprofen and other anti-inflammatories in the first week unless your surgeon has told you otherwise, since they increase the risk of bleeding into the scrotum.
After 48 hours
Warm, gentle showers You can begin showering. Let warm water run over the area rather than scrubbing it, and pat dry.
After one week
Light desk work Most men are ready to return to desk-based work. Heavy lifting and strenuous exercise should still wait.
First two weeks
Support, continuously Wear supportive underwear day and night for the full fortnight. This is the single most effective thing you can do to limit swelling.
When to contact us
Signs that need a call, not a wait.
Some discomfort and bruising are expected and settle steadily. The following are not part of a normal recovery, and we would far rather hear from you early than late.
- Excessive swelling — rapid enlargement of the scrotum, rather than the gradual puffiness that settles.
- Signs of infection — fever, chills, or spreading redness and heat around the incision.
- Severe testicular pain that does not settle with regular paracetamol.
In clinic hours
01865 307733Outside clinic hours, contact the hospital where your surgery took place. If you cannot reach anyone and you are worried — or if the pain or swelling is severe — go to your nearest emergency department. Do not wait for the clinic to reopen.
Talk it through before you commit.
microTESE is a considered decision, not an urgent one. A consultation will tell you what your own likelihood of retrieval looks like and how it fits with your fertility clinic’s plan.