What is a microscopic testicular sperm extraction?

Microscopic testicular sperm extraction (microTESE) is a procedure that takes sperm directly from the testicular tissue of a man’s reproductive system. If a man cannot release or make healthy sperm naturally, this medical procedure may be recommended for fertility reasons (to enable the man to father a child). The testicular tissue is found in the two testes, where the sperm is made. The testes are found inside the scrotum, the small sac behind and under the penis.

Male reproductive system | Cleveland Clinic

The goals of the microTESE procedure are to:

  • Obtain the best quality sperm.
  • Get enough sperm to fertilize an egg from a woman.
  • Minimize damage to the reproductive organs.

What is male infertility?

Infertility is a disease of the reproductive system that makes it difficult for the body to perform the basics of reproduction. It affects both men and women. Most infertility cases are treated with medication or surgery.

Male infertility may be caused by a condition known as nonobstructive azoospermia (the man does not produce sperm), or by obstructive azoospermia (sperm is produced, but blocked, and cannot be released from the body).

Many times, the causes of infertility are unexplained. Sometimes, the difficulties may be from a genetic disease such as cystic fibrosis, a birth defect, a medical problem, or the result of an earlier treatment that may cause infertility (such as certain cancer treatments). In other cases, we do not know what the cause of the infertility is, but we still have treatments that may help.

How is infertility diagnosed?

If a couple wants to conceive a child, but are unable to after a year of trying without birth control, they should see a doctor. The doctor will perform a physical exam of both partners to check for any physical issues that may be causing infertility. The doctor will also ask many questions and discuss each patient’s medical history.

The following tests may also be recommended or ordered to evaluate male fertility:

  • Semen analysis: Determines the number and quality of sperm. Semen is a bodily fluid that is secreted by the male reproductive organs. It carries sperm and other nutrients that help the sperm survive to enable successful fertilization.
  • Blood test: Checks for genetic or hormone problems. (Hormone levels are important in both male and female fertility.)
  • Culture exam: Examines the fluid discharged from the penis to check for infections.
  • Ultrasound of the scrotum: Looks for abnormalities in the veins that carry blood from the testicles and back to the rest of the body.

In-home testing kits may be available for semen analysis. Ask the doctor for more information.

What will the infertility tests determine?

Semen analysis will give the doctor necessary information to help assess fertility and create a treatment plan. The tests should show some of the following:

  • Amount of semen: At least 1.5 milliliters is considered normal. A lower number may mean that there is an internal issue with a part of the reproductive system, such as the seminal vesicles or a prostate gland, blocking the release of semen.
  • Sperm count: 15 million to 300 million per milliliter is considered a normal range. Below 15 million is abnormal.
  • Morphology: The size and shape of the sperm: 4% of normal-shaped sperm (using the “strict” criteria) is enough to reach and fertilize an egg. Some doctors consider even a lower percentage as normal.
  • Motility: The movement of the sperm. Approximately 40% of sperm should be moving. The quality of movement is graded from 0-4, with a score over 3 considered good.

Microscopic testicular sperm extraction is usually performed on a man who may be infertile, or a man who wants to have children but is having difficulty conceiving with his female partner. Often, these men have no sperm in their ejaculation (azoospermia).
