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Andrology · UK

Micro-TESE sperm retrieval, by an andrology microsurgeon.

For men with non-obstructive azoospermia. A microsurgical operation in an IVF-linked theatre, honest retrieval-rate counselling for your specific aetiology, and a plan that dovetails with your partner’s ICSI cycle.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private micro-TESE costs in the UK.

Indicative ranges across our partner andrology and IVF centres.

In short

£4,000–£8,000, day-case, home the same day.

Procedure Indicative range
Micro-TESE (surgeon + theatre + embryology, sperm search) £4,000–£8,000
Micro-TESE with sperm cryopreservation and 1yr storage £4,800–£9,000
ICSI cycle (partner) - indicative add-on £5,000–£8,000
Pre-op andrology consultation + hormone workup £300–£600
Karyotype + Y-microdeletion panel £350–£700
Scrotal ultrasound £280–£450

Prices vary by centre, by which andrology microsurgeon takes the case, by whether embryology and cryopreservation are bundled, and by the partner ICSI cycle.

The problem

The right surgeon, the right operation, the right embryology lab.

Non-obstructive azoospermia is one of the most miscounselled diagnoses in men’s fertility - quoted as untreatable, offered a blind biopsy, or referred to a general urologist. Micro-TESE, done properly, changes what is possible.

  • Told there is nothing to be done?

    A simple TESE that failed is not the end. Micro-TESE finds sperm the blind biopsy missed in a meaningful minority.

  • Confused by TESE, TESA, PESA, MESA?

    They are not interchangeable. Which one you need depends on whether the azoospermia is obstructive or not - we make sure the right one is on the table.

  • Worried about the retrieval rate?

    The number depends on your aetiology, not on averages. Klinefelter, Y-microdeletion, post-chemo and idiopathic all have their own numbers - you deserve yours.

When it helps

When micro-TESE is the right step.

The clinical situations we see most, plus the one red flag that means a different operation, not this one.

  • Non-obstructive azoospermia (NOA)

    No sperm on two ejaculate samples with raised FSH and reduced testicular volume - spermatogenic failure, not a blockage.

  • Klinefelter syndrome (47XXY)

    The single largest genetic cause of NOA - sperm retrieval rates of roughly 30–50% with micro-TESE, best in younger men.

  • Post-chemotherapy or radiotherapy NOA

    Azoospermia after cancer treatment with no pre-treatment sperm bank - micro-TESE can find focal islands of spermatogenesis.

  • Cryptorchidism (history of undescended)

    Retrieval rates of 30–70% depending on when the testis was brought down and the current testicular volume.

  • Post-mumps orchitis or idiopathic NOA

    Roughly 40–60% retrieval in idiopathic NOA - the commonest and most encouraging group.

  • Failed simple TESE, TESA or PESA

    A negative simple biopsy does not mean no sperm exist. Micro-TESE examines the whole testis and often finds tubules the sampling technique missed.

  • Y-microdeletion (AZFc favourable)

    AZFc microdeletions can have retrievable sperm; AZFa and complete AZFb almost never do - the karyotype and panel guide the counselling.

  • Red flag: obstructive azoospermia

    Normal FSH, normal testicular volume and a suggestive history point to obstruction - MESA or PESA, not micro-TESE, is the right operation.

Procedure options

Micro-TESE is not the only surgical sperm retrieval.

What each option on the table actually involves - and which fits which diagnosis.

  • Micro-TESE (mTESE)

    Microdissection testicular sperm extraction. Operating microscope, whole-testis exploration, targeted tubule sampling. The gold standard for NOA.

  • Simple TESE

    One to three blind biopsies without a microscope. Faster and cheaper, but lower retrieval rates and more tissue removed for the sperm found.

  • TESA (aspiration)

    A needle aspiration of testicular tissue under LA. Suitable for some obstructive cases; rarely enough for NOA.

  • PESA (percutaneous epididymal)

    Needle aspiration from the epididymis. An option in obstructive azoospermia only - there is no sperm to reach in the epididymis in NOA.

  • MESA (microsurgical epididymal)

    Open microsurgical retrieval from the epididymis. The procedure of choice for obstructive azoospermia such as post-vasectomy or CBAVD - not for NOA.

  • Pre-op hormonal optimisation

    Clomifene, hCG or letrozole to raise intratesticular testosterone before micro-TESE. Evidence is variable; exogenous testosterone is usually avoided or stopped well in advance.

  • Cryopreservation of retrieved sperm

    Freezing any sperm found, so a second theatre trip is not needed if the first ICSI cycle does not work.

  • Fresh synchronised cycle

    Theatre timed to your partner’s egg collection so retrieved sperm go straight to ICSI the same day.

Safety and recovery

What to expect afterwards - honestly.

Micro-TESE is a longer operation than simple TESE and removes more tissue. Done microsurgically it is safe and day-case, but the recovery, the hormonal follow-up and the honest retrieval-rate conversation all matter.

  • General anaesthetic is standard

    The operation takes two to four hours and needs a still field under the microscope. A day-case, but with someone to collect you.

  • Bruising, swelling and a scrotal support

    Some bruising and swelling for one to two weeks is normal. A supportive garment for two to four weeks helps recovery.

  • No sex or heavy exercise for four weeks

    The wound needs to heal properly. Cycling, running, gym and sex all wait a full month.

  • Testosterone can dip after surgery

    More tissue is removed than in simple TESE, so testosterone may fall. We recheck at three months and treat if needed - but delay TRT if a second micro-TESE is planned.

  • Testicular atrophy is uncommon but real

    Especially with already-small testes. The microsurgical technique preserves blood supply better than blind biopsies, but the risk is not zero.

  • Bleeding, haematoma and infection are rare

    Careful haemostasis under magnification makes significant bleeding uncommon. Antibiotic cover is not routine but is given if indicated.

  • Persistent scrotal pain is rare

    Post-vasectomy-style chronic pain (PVPS) has been described but is unusual after micro-TESE.

  • No sperm found - the honest number

    Roughly 40–60% overall retrieval in NOA, less in AZFa/b Y-microdeletion, better in idiopathic. If none are found, donor sperm and adoption are discussed before you leave.

  • Red flags

    Fever, spreading redness, a rapidly enlarging scrotum or heavy bleeding are not normal - call the clinic or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever aetiology brought you here, the note the andrology microsurgeon sends you keeps to the same shape.

A UK andrology microsurgeon reviewing a patient’s operation notes

A quiet reminder

Surgical and embryology language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Diagnosis, aetiology and prior workup

    Why the procedure was done - the NOA diagnosis, the underlying cause where known, hormones and karyotype/Y-microdeletion results.

  2. 02 Technique

    Microsurgical technique and tubules sampled

    The incision, magnification used, which regions of each testis were sampled, and how much tissue was taken.

  3. 03 Findings

    Embryology result - sperm found or not

    What the embryologist saw on the day: motile sperm, non-motile sperm, spermatids only, or no sperm - and whether anything was cryopreserved.

  4. 04 Impression

    Recovery, hormone monitoring, next steps

    Read this first: recovery timeline, when to recheck testosterone, whether to proceed to ICSI or consider a repeat, and the counselling offered.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Fertility surgery cover varies significantly by policy - most UK private medical policies exclude assisted conception, though the diagnostic workup is often included.

Frequently asked

Everything we get asked about micro-TESE.

Quick answers on retrieval rates, cost, fresh vs frozen, hormones, and what happens if no sperm are found.

  • What is micro-TESE and how is it different from simple TESE?

    Micro-TESE is microdissection testicular sperm extraction. Under an operating microscope the whole testis is opened and every seminiferous tubule examined - only the whiter, fuller tubules more likely to contain sperm are removed. Simple TESE takes one to three blind biopsies without a microscope. For non-obstructive azoospermia, micro-TESE finds sperm more often and removes less tissue for each sperm found.

  • Who is micro-TESE for?

    Men with non-obstructive azoospermia (NOA) - no sperm in the ejaculate on two samples, with signs of spermatogenic failure such as raised FSH and reduced testicular volume. Common causes include Klinefelter syndrome, Y-chromosome microdeletions, post-chemotherapy or radiotherapy, a history of cryptorchidism, mumps orchitis or idiopathic NOA. Obstructive azoospermia is treated with MESA or PESA instead.

  • What are the sperm-retrieval rates?

    Roughly 40–60% overall in NOA, but it depends heavily on the cause. Klinefelter is around 30–50%, best in men under 35. Cryptorchidism 30–70%. Idiopathic NOA 40–60%. AZFc Y-microdeletion is often favourable; AZFa and complete AZFb are almost always unsuccessful and genetic counselling is essential first.

  • How much does micro-TESE cost privately in the UK?

    Roughly £4,000–£8,000 for micro-TESE alone, and £4,800–£9,000 with cryopreservation and a year of storage. A partner ICSI cycle is a further £5,000–£8,000. NHS access exists via specialist andrology centres but is typically limited to one funded attempt per couple.

  • Do we do it fresh or frozen?

    Both work. Fresh means the theatre date is synchronised with your partner’s egg collection so sperm go straight to ICSI the same day - logistically demanding but no thawing losses. Frozen means micro-TESE is done first and sperm cryopreserved for a later ICSI cycle - less pressured, and lets a second attempt use the same tissue.

  • Should I take testosterone or clomifene before micro-TESE?

    Exogenous testosterone shuts down spermatogenesis and is usually avoided or stopped well in advance. Some centres use clomifene, hCG or letrozole to raise intratesticular testosterone before the operation - the evidence is mixed and the decision belongs to the andrology microsurgeon, not to us.

  • How long is the recovery?

    Home the same day. Bruising and swelling for one to two weeks, office work in three to seven days, no gym or heavy lifting for four weeks, and no sex for four weeks. A scrotal support helps for the first two to four weeks.

  • What if no sperm are found?

    Around 40–60% of NOA cases yield sperm - which means a substantial minority do not. If none are found, donor sperm insemination or ICSI, embryo donation, and adoption are all discussed sensitively before you leave the clinic. A repeat micro-TESE is occasionally offered but the odds are lower.

  • When should I see a GP or A&E urgently after the operation?

    A rapidly enlarging or increasingly painful scrotum, heavy bleeding through the dressing, spreading redness or a fever above 38°C all need same-day medical review - call the clinic first, and A&E if you cannot reach them.

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