Microtese: Procedure, Benefits, Risks, Recovery and Alternatives

Microtese: The Procedure

When facing a diagnosis of non-obstructive azoospermia (NOA)—a condition where a man's semen contains no sperm due to impaired sperm production—hope often hinges on advanced surgical options. Microdissection testicular sperm extraction, commonly known as Microtese, has emerged as the gold standard for retrieving sperm directly from the testicles in these challenging cases. But what exactly is Microtese, and how does it work?

Step	Approach	Purpose	Source
Microsurgical	Use of microscope	Identifies sperm-rich areas	1 5
Targeted	Selective tissue removal	Minimizes tissue damage	1 5
Outpatient	Same-day procedure	Reduced hospital stay	1 5
Gold Standard	For NOA cases	Higher success vs. conventional	1 5

Table 1: Microtese Procedure Overview

What Is Microtese?

Microtese is a minimally invasive microsurgical technique designed to extract sperm from the testicular tissue of men with NOA. Unlike conventional testicular sperm extraction (TESE), which removes larger, random portions of testicular tissue, Microtese uses an operating microscope to precisely pinpoint and extract the tiny tubules most likely to contain sperm. This approach maximizes the chances of retrieving sperm while minimizing damage to the testicular tissue 1 5.

How Is Microtese Performed?

• Preparation: The patient is typically under general or regional anesthesia.
• Microsurgical Exploration: The surgeon makes a small incision in the scrotum and then opens the testicle to examine the seminiferous tubules under high magnification.
• Selective Extraction: Using fine instruments, the surgeon carefully removes only those areas of tissue that appear more likely to contain sperm.
• Immediate Assessment: The extracted tissue is examined in the lab for the presence of viable sperm, which can then be used for assisted reproductive techniques like IVF/ICSI 1 5.

Who Needs Microtese?

Microtese is primarily indicated for men with non-obstructive azoospermia, in whom sperm are not present in the ejaculate due to impaired sperm production but may still be found in isolated pockets within the testes 5 7. It is especially considered after less invasive sperm retrieval methods (like TESA) have failed or are unlikely to succeed 9.

Comparison With Conventional TESE

Microtese differs from conventional TESE in several key ways:

• Microsurgical Precision: Uses a microscope to limit tissue removal and improve sperm retrieval rates.
• Reduced Complications: Less testicular tissue is removed, lowering the risks of damage or testicular atrophy 1.
• Higher Success Rates: Particularly in patchy testicular conditions such as Sertoli cell-only syndrome, Microtese offers better outcomes 1 2 6.

Benefits and Effectiveness of Microtese

Microtese is celebrated for significantly improving the odds of sperm retrieval in men with NOA, but its advantages extend beyond just numbers. Let's explore what makes this technique a pivotal tool in male infertility treatment.

Benefit	Effectiveness (SRR)	Best for	Source
High Retrieval	40–63% (varies by group)	NOA, Sertoli cell only, hypospermatogenesis	1 2 3 6
Less Damage	Targeted extraction	Reduces complications	1 5
IVF-ICSI Success	Similar with fresh/frozen sperm	Couples seeking ART	3 7
Prognostic Factors	Histology most important	Patchy spermatogenesis	1 4 6

Table 2: Microtese Benefits and Effectiveness

Sperm Retrieval Rates (SRR)

Microtese achieves higher sperm retrieval rates compared to conventional TESE, especially in men with certain histological patterns:

• Overall SRR: Microtese yields retrieval rates between 40% and 63%, markedly better than the 16.7–45% for conventional TESE 1.
• Histological Influence: In men with Sertoli cell-only syndrome or hypospermatogenesis, the likelihood of finding sperm is notably higher with Microtese 1 2 4.
• Etiology Matters: Men with a history of cryptorchidism or mumps orchitis have the highest SRRs (over 80%), whereas idiopathic NOA cases have lower rates (~32%) 3.

Reduced Tissue Damage and Complications

Because Microtese removes only targeted tissue, it minimizes the risk of testicular damage and post-operative complications, such as reduced testosterone production or scarring. Ultrasound studies show fewer complications after Microtese compared to more invasive approaches 1 5.

Assisted Reproductive Technology (ART) Outcomes

• IVF/ICSI Success: Sperm retrieved through Microtese can be used fresh or frozen for IVF/ICSI, with similar fertilization, embryo quality, and pregnancy rates in both cases 3 7.
• Pregnancy Rates: Clinical pregnancy rates per Microtese-ICSI cycle can reach 40%, with fertilization rates of around 58% 7.

Prognostic Factors for Success

• Testicular Histology: The most reliable predictor of success—patchy patterns like Sertoli cell-only or hypospermatogenesis fare best 1 4 6.
• Hormonal Levels: High FSH or low testosterone alone are not clear predictors. Recent research suggests that anti-Müllerian hormone (AMH) and the AMH/testosterone ratio may help identify candidates most likely to benefit from Microtese 8.
• Testicular Volume: Some studies note that larger testicular volume may be associated with higher retrieval rates, but findings are mixed 7.

Risks and Side Effects of Microtese

While Microtese is less invasive than many alternatives, it remains a surgical procedure with inherent risks. Understanding these helps patients and clinicians make informed, balanced decisions.

Risk	Frequency	Severity	Source
Bleeding	Low	Mild/Moderate	1 5
Infection	Rare	Mild/Serious	1 5
Testicular Damage	Lower than TESE	Potential loss of function	1
Hormonal Impact	Low risk	Rarely affects testosterone	1 5

Table 3: Microtese Risks and Side Effects

Surgical Risks

• Bleeding and Hematoma: Minor bleeding or bruising may occur, but significant hematoma is unusual due to the precise, minimal-tissue approach 1 5.
• Infection: As with all surgery, infection is a risk, but proper sterile technique reduces this to a minimum 1 5.

Testicular Damage and Function

• Tissue Loss: Microtese removes less tissue than conventional TESE, but any surgical extraction carries a risk of causing testicular scarring or, rarely, atrophy 1.
• Hormonal Changes: The risk of long-term testosterone deficiency is low but possible. Most men maintain normal hormone levels post-procedure 1 5.

Other Possible Complications

• Pain and Discomfort: Mild post-operative pain or discomfort is common and usually resolves within days.
• Swelling: Temporary swelling of the scrotum is possible.

Mitigating Risks

The use of an operating microscope and meticulous surgical technique are key to minimizing complications. Experienced centers report very low rates of serious side effects, making Microtese a safe choice for most candidates 1 5.

Recovery and Aftercare of Microtese

Undergoing Microtese can be daunting, but most men recover quickly and experience minimal disruption to their daily lives. Proper aftercare ensures a smooth recovery and reduces the likelihood of complications.

Aspect	Recommendation	Time Frame	Source
Rest	Limit activity	1–2 days	5
Return to Work	After 2–7 days	1 week	5
Pain Control	Oral analgesics	As needed	5
Complication Monitoring	Watch for swelling/infection	1–2 weeks	1 5

Table 4: Recovery and Aftercare Guidelines

Immediate Post-Operative Period

• Rest: Patients are advised to rest and avoid strenuous activities for 24–48 hours post-surgery.
• Pain Management: Mild discomfort is typical and managed with over-the-counter pain relievers 5.

Returning to Normal Activities

• Work and Physical Activity: Most men return to office work within a few days. Heavy lifting and vigorous exercise should be avoided for at least a week 5.
• Sexual Activity: Resumption is usually possible within 1–2 weeks, depending on comfort and healing.

Monitoring for Complications

• Signs to Watch: Swelling, redness, fever, or persistent pain may indicate infection or hematoma and should prompt medical attention 1 5.
• Follow-up Visits: A post-operative check-up is generally scheduled within one to two weeks.

Long-Term Outlook

• Testicular Function: Routine follow-up is not always required, but those with pre-existing low testosterone or underlying testicular problems may require periodic assessment.
• Fertility Planning: If sperm are retrieved, patients coordinate with fertility clinics for IVF/ICSI or cryopreservation.

Alternatives of Microtese

Although Microtese is the preferred method for severe male infertility due to NOA, alternative sperm retrieval techniques exist—each with its own indications, benefits, and limitations.

Alternative	Description	Best For	Source
TESA	Needle aspiration	Larger testes, lower FSH, selected NOA cases	9
Conventional TESE	Open biopsy	When Microtese is unavailable	1 6
Sperm Donation	Donor sperm	Failed retrieval, severe testicular failure	5
Adoption	Family building	Non-biological parenthood option	5

Table 5: Alternatives to Microtese

Testicular Sperm Aspiration (TESA)

• Technique: Involves needle aspiration of sperm directly from the testicle.
• Best Candidates: Men with larger testes and low FSH levels, as they have a higher chance of success. TESA is less invasive, less traumatic, and less costly, but SRRs are much lower (~24%) than Microtese 9.
• Limitations: May miss areas of focal sperm production and often fails in men with severe NOA.

Conventional TESE

• Technique: Surgical removal of small portions of testicular tissue without microsurgical guidance.
• When Used: Considered if Microtese is unavailable or in centers without microsurgical expertise. Lower SRRs and higher risk of complications compared to Microtese 1 6.

Sperm Donation and Adoption

• Donor Sperm: When sperm cannot be retrieved, donor sperm offers a path to conception via IVF or intrauterine insemination 5.
• Adoption: An alternative route to parenthood for couples where all medical options have been exhausted or are not desired 5.

Choosing the Right Approach

The choice of technique depends on:

• Underlying Testicular Histology
• Hormonal Profile (FSH, testosterone)
• Testicular Volume
• Previous retrieval attempts
• Patient and partner preference

Conclusion

Microtese represents a major advance in the treatment of severe male infertility, offering new hope to men with non-obstructive azoospermia. Here’s what you need to remember:

• Microtese is a precise, microsurgical method for sperm retrieval in NOA, offering better chances than conventional techniques 1 5.
• Success rates are highest in men with patchy testicular histology, such as Sertoli cell-only or hypospermatogenesis patterns 1 2 3 4.
• Risks are low, especially when performed by experienced surgeons using microsurgical techniques 1 5.
• Recovery is rapid, with most patients resuming normal activities within a week 5.
• Alternatives like TESA and conventional TESE exist, but are less effective for severe NOA; sperm donation and adoption are also options 1 5 9.

Ultimately, Microtese stands at the forefront of surgical sperm retrieval, combining scientific precision with patient-centered care—offering renewed possibilities on the journey to parenthood.