Concierge fertility surgery · London
Testicular mapping (micro-TESE), micro-dissection testicular sperm extraction for non-obstructive azoospermia.
Testicular mapping (micro-TESE) is a micro-dissection operation to find and retrieve sperm from testicular tissue. It is the definitive treatment option for non-obstructive azoospermia. It is done under general anaesthetic at a dedicated fertility surgical unit.
Why patients choose us
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The right hands
We route you to a consultant andrologist or fertility urologist experienced in micro-TESE — the surgeon who operates decides the retrieval odds.
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Combined with ICSI
Retrieved sperm is used for ICSI on the same day, coordinated with your fertility clinic and embryology lab.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
What testicular mapping is, in six lines.
A quick orientation to micro-TESE — the procedure, the setting, and what it delivers.
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Definition
Micro-dissection sperm retrieval (micro-TESE). Sperm are recovered directly from testicular tissue.
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General anaesthetic day-case
Performed as a day-case procedure under general anaesthetic in a dedicated fertility surgical unit.
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Micro-dissection with operating microscope
The surgeon uses an operating microscope to identify the most productive seminiferous tubules — sparing testicular tissue.
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Higher sperm retrieval than TESE
Micro-dissection consistently outperforms conventional TESE for sperm retrieval in non-obstructive azoospermia.
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Combined with ICSI on the day
Retrieved sperm is used the same day for intracytoplasmic sperm injection with your partner’s oocytes.
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Complements fertility hormone profile
Interpreted alongside FSH, LH, testosterone, inhibin B and genetic testing.
The problem
Micro-TESE is only as good as the surgeon and the microscope.
The dissection is the answer. The surgeon deciding which tubules to sample — and the embryology lab receiving the tissue — determines whether sperm is found and whether ICSI proceeds.
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Non-obstructive azoospermia?
We route you to a consultant fertility urologist with dedicated micro-TESE experience.
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Klinefelter or Y-microdeletion?
We coordinate genetic counselling and set realistic expectations before consent.
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Post-chemotherapy azoospermia?
We build a plan around micro-TESE with your oncology team already in the loop.
The pathway
From consultation to structured plan — what happens, in order.
A coordinated pathway across urology, endocrinology, genetics and embryology.
Phase 1 · Before surgery
Work-up and consent
Phase 2 · On the day
Micro-TESE and ICSI
Phase 3 · After
Structured plan
- 01
Before
Fertility / urology consultation
A confidential consultation with a fertility urologist to review your history, prior semen analyses and any previous fertility treatment.
- 02
Before
Hormone profile
FSH, LH, testosterone and inhibin B — the endocrine picture that predicts the underlying pattern.
- 03
Before
Karyotype + Y-microdeletion
Genetic testing for Klinefelter syndrome (47 XXY) and Y-chromosome AZFa/b/c microdeletions.
- 04
Before
Consent + anaesthetic assessment
Consent for micro-TESE, pre-operative bloods and a general-anaesthetic pre-assessment.
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On the day
Micro-TESE surgery
Day-case procedure under general anaesthetic — the testis is opened and dissected under an operating microscope to identify dilated seminiferous tubules.
- 06
On the day
Sperm retrieval + ICSI cycle
Retrieved sperm is passed to embryology for immediate ICSI with your partner’s oocytes; any surplus is cryopreserved.
- 07
After
Structured plan
A written operative note, embryology report and a structured follow-up plan with the fertility team.
Typical end-to-end: weeks from first consultation to surgery, coordinated with your partner’s IVF cycle.
What it shows
When micro-TESE is the right procedure.
Micro-TESE answers a specific question — can sperm be identified in the testicular tissue of a man with non-obstructive azoospermia. These are the presentations we see most.
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Sperm retrieval yield
The primary outcome — whether motile sperm can be identified for ICSI.
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Testicular volume
Correlates with the volume of seminiferous epithelium available for dissection.
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Klinefelter syndrome (47 XXY)
Micro-TESE retrieves sperm in a meaningful proportion of Klinefelter men.
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Y-chromosome microdeletion
AZFc microdeletions have a reasonable retrieval rate; AZFa/b do not.
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Sertoli-cell only pattern
Focal spermatogenesis may still be found under the microscope, even when the general pattern is Sertoli-cell only.
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Maturation arrest
Areas of complete spermatogenesis can sometimes be identified within an otherwise arrested testis.
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Post-chemotherapy azoospermia
Micro-TESE offers a retrieval option after cancer treatment when no cryopreserved sperm exists.
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Red flag: complete AZFa/b microdeletion — no sperm retrieval expected
These deletions predict zero sperm retrieval; the discussion turns to donor sperm or adoption.
Treatment options
What follows micro-TESE — every route on the table.
Each option is discussed openly before consent — the fertility pathway is built around your situation, not the other way round.
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ICSI with retrieved sperm
Intracytoplasmic sperm injection using freshly retrieved testicular sperm — the primary reason to do micro-TESE.
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Sperm cryopreservation
Surplus retrieved sperm is frozen for future ICSI cycles.
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Repeat micro-TESE (attempt 2)
A second procedure can be considered after an interval, with counselling on reduced yield.
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Donor sperm
Donor sperm remains an option if retrieval fails or is not attempted.
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Adoption pathway
For couples who wish to explore family-building outside biological parenthood.
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Testosterone replacement (Klinefelter’s)
After fertility decisions are made — testosterone replacement is separated from the fertility pathway.
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Structured fertility follow-up
Coordinated follow-up with andrology, embryology and the partner’s fertility clinician.
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MDT review
Complex cases are reviewed in a fertility MDT before proceeding.
Our vetted London network
A small panel of fertility surgical units, we picked them.
HFEA-licensed partners with dedicated micro-TESE experience and on-site embryology. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Consultant fertility urologists or andrologists with dedicated micro-TESE experience
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On-site embryology able to process testicular tissue and perform same-day ICSI
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HFEA-licensed clinic for the ICSI and cryopreservation component
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Structured MDT with fertility, andrology and clinical genetics input
Safety, eligibility and red flags
A day-case procedure with a serious pre-op conversation.
Micro-TESE is well-tolerated as a day-case. The important conversation is about who is likely to benefit — and who is not.
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General anaesthetic
Day-case general anaesthetic with a standard pre-operative assessment.
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Testicular tissue is spared
The operating microscope allows the surgeon to target only the most productive tubules.
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Scrotal support after surgery
Supportive underwear for a week or two — most men return to office work within a few days.
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Coordinate with your partner’s cycle
Timing is coordinated with the partner’s oocyte retrieval so that ICSI happens on the same day.
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Testosterone can drop transiently
A short-term reduction in testosterone is expected — monitored on follow-up.
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Sertoli-cell only is not zero
A general Sertoli-cell only pattern does not automatically rule retrieval out — focal spermatogenesis can exist.
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Complete AZFa/b microdeletion
These deletions predict zero retrieval — micro-TESE is not offered.
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A negative retrieval is possible
Even in the best hands, retrieval fails in a proportion of cases — discussed in detail before consent.
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Bring prior imaging and hormone results
Previous scrotal ultrasound, hormone profile and any genetic testing materially sharpens the plan.
Red flags — surface these before consent
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Complete AZFa/b microdeletion
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Sertoli-cell only syndrome
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Prior failed TESE
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Post-chemotherapy azoospermia
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Post-radiotherapy azoospermia
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Cryptorchidism history
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Klinefelter with cardiovascular disease
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Post-mumps orchitis
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Testicular cancer history
Reading your report
A micro-TESE report can look intimidating. It isn’t.
Whatever the finding, the operative note and embryology report keep to the same four parts.
A quiet reminder
The report is written for your fertility team, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and history
Your fertility history, prior semen analyses, hormone profile and any genetic testing.
- 02 Technique
Micro-dissection under the operating microscope
Which testis was opened, the microscopic technique used, and the tubules targeted.
- 03 Findings
Sperm retrieval yield and tissue morphology
Whether motile sperm were identified, the volume of tissue processed, and the histological pattern.
- 04 Impression
The conclusion: read this first
Retrieval outcome, ICSI plan, cryopreservation, and the concrete next step.
Sources
The guidance we work from.
- European Society of Human Reproduction and Embryology (ESHRE). Guidelines on male infertility.
- British Fertility Society. Clinical practice guidance.
- American Society for Reproductive Medicine (ASRM). Practice committee opinions.
- European Association of Urology (EAU). Guidelines on sexual and reproductive health.
Published 2026-07-30. Next review 2027-07-30. Reviewed by Pulse Atlas Editorial Board ().
Recognised by major UK insurers
Cover for fertility surgery varies significantly by policy; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about testicular mapping.
Quick answers on how micro-TESE differs from TESE, retrieval odds, anaesthetic, ICSI timing, and what happens if no sperm is found.
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What is micro-TESE?
Micro-dissection testicular sperm extraction — a surgical procedure performed under general anaesthetic that uses an operating microscope to identify and extract sperm directly from testicular tissue. It is the definitive treatment option for non-obstructive azoospermia.
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How is micro-TESE different from TESE?
Conventional TESE takes random biopsies of testicular tissue. Micro-TESE uses an operating microscope to identify the most productive seminiferous tubules — it consistently retrieves sperm at higher rates and spares more testicular tissue.
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What are the chances of finding sperm?
It depends on the underlying cause. Klinefelter syndrome and AZFc microdeletion have meaningful retrieval rates; complete AZFa or AZFb microdeletion predicts zero retrieval. Your fertility urologist will give you a personalised estimate based on hormone profile and genetics.
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Is micro-TESE done under general anaesthetic?
Yes — micro-TESE is a day-case procedure performed under general anaesthetic in a dedicated fertility surgical unit.
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When is ICSI performed?
The same day as the micro-TESE. Retrieved sperm is passed to embryology for immediate intracytoplasmic sperm injection with your partner’s oocytes; any surplus is cryopreserved.
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What if no sperm is retrieved?
A negative retrieval is possible even in the best hands. The conversation turns to donor sperm, an adoption pathway, or — in selected cases — a second attempt at micro-TESE after an interval.
Related tests
Looking for a different test?
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Semen analysis
The first-line fertility test — sperm count, motility and morphology.
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Testicular ultrasound
Scrotal ultrasound for testicular volume, varicocele and structural causes.
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Male hormone testing
FSH, LH, testosterone and inhibin B — the endocrine work-up for azoospermia.
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In practice, in London
The honest picture around testicular mapping in London
With testicular mapping, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The wait for testicular mapping on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.
Once you’re in the private system for testicular mapping, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For testicular mapping specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
There are a lot of consultants in London who can technically handle testicular mapping. Fewer who do it week in, week out for the exact question you’re bringing. We spend most of our time working out which is which — and being straight when a different test or a different specialist would serve you better. Everything runs to CQC, GMC and Royal College standards; the choice is about fit, not floor.