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(MESA) Microsurgical Epididymal Sperm Aspiration

Some men have either no sperm or a markedly diminished concentration of sperm in the ejaculate . This condition frequently results from a blockage in the pathway through which sperm have to travel to get from the testicles to the outside. The MESA procedure was developed for men with obstructed or absent ejaculatory ducts (this also includes patients with an unsuccessful vasectomy reversal or even congenital absence of the vas deferens). Sperm are aspirated directly from the epididymis (the tiny collecting tubules next to the testes) by a urologist using a local anesthetic. The few drops of fluid obtained are taken into the IVF laboratory, where they are evaluated by the embryologists for the presence of viable sperm. Some MESA samples may yield enough sperm such that some can be frozen for subsequent ICSI procedures.

(TESA/TESE) Testicular/Epididymal Sperm Aspiration/Extraction

In even more severe cases of male factor infertility – where it is not likely that a urologist can obtain sperm from the epididymis, other microsurgical procedures may be of benefit. Conditions such as testicular failure, congenital absence of all or part of the ejaculatory pathway, or scarring from previous surgery or infection may prevent sperm from being able to be ejaculated. In such cases, a surgical procedure can be performed by a urologist in which a small amount of tissue from the testicle is removed (TESE – testicular/epididymal sperm extraction) or aspirated (TESA-testicular/epididymal sperm aspiration) using a needle under local anesthesia. These sperm are then isolated by the embryologist and used to fertilize the oocyte via the ICSI procedure. Recent reports suggest that TESE may also be beneficial for males who have early testicular failure and do not produce mature sperm in their ejaculate.