Micro-TESE и MESA

Micro-TESE and MESA are microsurgical procedures used to retrieve sperm when no sperm are found in the ejaculate. The retrieved material may be used for fertilisation through ICSI as part of IVF treatment.

The two procedures have different indications. Micro-TESE is used mainly when sperm production in the testes is severely impaired. MESA is used when sperm production is preserved, but the sperm cannot reach the ejaculate because of an obstruction or the absence of part of the seminal ducts.

At Adella Clinic, we begin by identifying the cause of azoospermia. Only then can we determine whether surgical sperm retrieval is appropriate and which procedure is medically indicated.

Duration

Depends on the type of procedure, the anaesthesia, and the course of the surgical sperm retrieval.

Stay at the Clinic

After the procedure, you will remain under observation depending on the type of anaesthesia and how you feel.

Feeling

Under anaesthesia. After the procedure, pain, tenderness, swelling, and bruising in the scrotal area may occur.

Identifying the Cause of the Absence of Sperm

What Is Azoospermia?

What Does It Mean?

Azoospermia means that no sperm are found in the semen sample, including after laboratory processing.
A single result is not sufficient to automatically plan surgery. The test is usually repeated.
The specialist then reviews the medical history, physical examination, hormone levels and, when necessary, recommends additional tests.

What Is Important to Know?

The aim is to determine whether the azoospermia is obstructive or non-obstructive.
In obstructive azoospermia, the testes may produce sperm, but there is a blockage preventing them from reaching the ejaculate. In these cases, MESA may be considered.
In non-obstructive azoospermia, sperm production is severely impaired or absent. Micro-TESE searches for small areas of preserved spermatogenesis using an operating microscope.

What Is the Difference?

Micro-TESE and MESA — What Is the Difference?

Micro-TESE is the microsurgical retrieval of sperm from testicular tissue. It is used mainly in cases of non-obstructive azoospermia, where sperm production is severely impaired.
Using an operating microscope, the specialist searches for small areas where sperm are more likely to be present. The collected samples are immediately passed to the laboratory team.

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Micro-TESE

Micro-TESE is the microsurgical retrieval of sperm from testicular tissue. It is used mainly in cases of non-obstructive azoospermia, where sperm production is severely impaired.
Using an operating microscope, the specialist searches for small areas where sperm are more likely to be present. The collected samples are immediately passed to the laboratory team.
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MESA

MESA is the microsurgical retrieval of sperm from the epididymis. It is used in cases of obstructive azoospermia, when sperm are being produced but do not reach the ejaculate.
The procedure may be considered in cases of congenital absence or obstruction of the vas deferens, previous vasectomy, surgery, inflammation, or another obstructive cause.
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How Is the Appropriate Method Selected?

The choice between Micro-TESE and MESA depends on the cause of azoospermia and whether sperm production in the testes is preserved.
The assessment includes medical history, physical examination, at least two semen analyses, hormone levels and, when necessary, ultrasound or genetic testing.
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Freezing Retrieved Sperm

When the retrieved material is suitable, some of the sperm may be frozen for future procedures.
This option is determined after laboratory assessment and may reduce the need for another surgical procedure.

Genetic Testing May Change the Medical Plan

In non-obstructive azoospermia, certain genetic results provide important information about the likelihood of finding sperm.
In some complete Y-chromosome microdeletions, surgical sperm retrieval is not recommended because sperm are not expected to be found. Other genetic changes may be passed on to a future child and require counselling in advance.
In cases of congenital absence of the vas deferens, CFTR gene testing may be recommended. Depending on the result, testing of the female partner may also be necessary.

How Are the Procedures Related to IVF and ICSI?

Surgically retrieved sperm are usually limited in number and may not have the same motility as sperm found in the ejaculate. For this reason, they are most commonly used for ICSI.
With ICSI, the embryologist selects an individual sperm cell and injects it directly into a mature egg. The use of this method does not guarantee fertilisation, embryo development, or pregnancy.

Planning Treatment for Both Partners

Micro-TESE and MESA are not planned separately from the overall fertility treatment. The female partner’s age, ovarian reserve, and medical plan are important when determining the timing of the surgical procedure.

In some cases, sperm are retrieved and frozen first, followed by ovarian stimulation of the female partner. In other situations, surgical sperm retrieval is coordinated with egg retrieval.

In non-obstructive azoospermia, the number of sperm retrieved may be very limited, and some may not survive freezing and thawing. For this reason, the decision to use fresh or frozen material is made individually by the surgical, reproductive medicine, and laboratory teams.

How Should You Prepare for the Procedure?

Before Micro-TESE or MESA, you will be assessed by a specialist in male reproductive health. You will receive an individual plan for the necessary laboratory, imaging, and genetic tests.

Inform the team about any medical conditions, previous surgery, allergies, medications, and dietary supplements you are taking. Do not stop anticoagulants or any other prescribed treatment on your own.

Instructions regarding food and fluids depend on the type of anaesthesia used. Follow the preoperative instructions carefully. If you have not followed them, inform the medical team before the procedure.

Arrange for someone to accompany you and allow sufficient time for recovery. After anaesthesia, you should not drive for the period specified by the medical team.

Coordination Between the Surgical and Laboratory Teams

How Are Micro-TESE and MESA Performed at Adella Clinic?

What Happens During the Procedure?

Before the procedure begins, we confirm the medical plan, the type of procedure, the anaesthesia, and how the retrieved material will be processed.
The surgical and laboratory teams work in close coordination, and the samples are assessed while the procedure is still in progress.
During Micro-TESE, the specialist examines the testicular tissue under an operating microscope and collects small samples from selected areas.
During MESA, material is retrieved from the epididymis through a small microsurgical approach and is immediately examined in the laboratory.

What Happens After the Procedure?

If suitable sperm are found, part of the material may be prepared for ICSI and another part may be frozen.
After surgery, you will remain under observation depending on the type of anaesthesia, the course of the procedure, and how you feel.
Before discharge, you will receive instructions on caring for the surgical area, pain relief, physical activity, and follow-up.
During the first few days, pain, tenderness, swelling, and bruising may occur. Follow a gentle recovery routine and do not change your treatment without consulting your doctor.

Recovery, Risks and Expectations

What Should You Know After Micro-TESE or MESA?

Micro-TESE and MESA are surgical procedures, and recovery depends on the type of surgery, the anaesthesia used, and the individual patient’s condition. Possible effects include pain, swelling, haematoma, infection, bleeding, or an adverse reaction to anaesthesia.

Sperm retrieval cannot be guaranteed, particularly with Micro-TESE in cases of non-obstructive azoospermia. For this reason, at Adella we first identify the underlying cause, discuss realistic expectations, and plan the next steps without pressure to make an immediate decision.

When Should You Contact the Clinic?

Seek medical advice if you experience severe or increasing pain, significant swelling, heavy bleeding, or fever.
Contact the team if you notice redness, discharge from the surgical wound, difficulty urinating, or a sudden deterioration in your condition.
Before discharge, you will receive information about whom to contact if you have any concerns.

What Are Realistic Expectations?

The likelihood of finding sperm depends on the cause of azoospermia, genetic results, hormone levels, and testicular function.
With MESA, expectations are generally different because sperm production is often preserved, but there is an obstruction preventing sperm from reaching the ejaculate.
Even when sperm are retrieved, the outcome also depends on the eggs, fertilisation, embryo development, and the overall IVF treatment plan.

Frequently Asked Questions

Micro-TESE is used mainly for non-obstructive azoospermia, when sperm production in the testes is severely impaired. Tissue is collected from carefully selected areas of the testis.
MESA is used for obstructive azoospermia, when sperm are produced but do not reach the ejaculate. They are retrieved from the epididymis.
At least two semen analyses are usually required, particularly when the first result is abnormal. The sample should also be assessed after appropriate laboratory processing.
A specialist evaluation is then performed to determine the underlying cause.
In non-obstructive azoospermia, karyotyping and testing for Y-chromosome microdeletions may be recommended. In cases of congenital absence of the vas deferens, CFTR gene testing may be recommended.
The need for genetic testing is determined individually.
The type of anaesthesia depends on the procedure, the patient’s general health, and the surgical protocol. Before surgery, you will receive specific information and preparation instructions.
Appropriate anaesthesia is used during the procedure. Afterwards, pain, tenderness, swelling, and bruising in the scrotal area may occur.
You will receive instructions on pain relief and care of the surgical area.
No. The procedure increases the opportunity for targeted examination of testicular tissue, but it cannot create sperm where sperm production is absent.
The individual likelihood is discussed according to the underlying cause, genetic testing, and medical findings.
Yes, when the number and condition of the retrieved sperm allow it. With Micro-TESE, the amount of material may sometimes be very limited, and not all cells survive freezing and thawing.
The decision to use fresh or frozen material is made jointly by the medical and laboratory teams.
The team will discuss the result with you, including possible explanations and the clinical options for the next steps.
You will not be pressured to choose a new approach immediately after the procedure.