Several men experience the fertility issue wherein the sperm is missing or the quantity is very low in their semen due to blockage, vasectomy or other unexplained reasons. In such cases, the expert embryologist may suggest to perform a procedure to extract sperm from the male partner’s epididymis or testes.
MESA or Microsurgical Epididymal Sperm Aspiration is a procedure wherein the sperms are taken out from the epididymis, a coiled duct behind the testes that passes the sperm to the vas deferens, using a fine needle under a local anesthesia. This minimally-invasive procedure helps in extracting greater value of sperm that can also be stored for future procedures as well.
On the other hand, TESA or Testicular Sperm Aspiration is a procedure wherein the sperms are extracted directly from the testes, the organ responsible for the production of sperms, through a similar approach used for MESA.
To treat men with azoospermia–no sperm–
Obstructive problems due to vasectomy, congenital absence of the vas deferens, or scarring of the vas deferens can be treated by microepididymal sperm aspiration (MESA), a technique in which an urologist obtains sperm from part of the male reproductive tract, such as the epididymis, the vas deferens, or the testicle. The collected sperm are then frozen until the eggs are ready to be fertilized
Retrieval of epididymal or testicular sperm for ICSI is indicated in the following cases:
- Obstructive azoospermia – when reconstruction has failed, or is not possible (e.g. vas aplasia or multiple blocks following tuberculosis), or if the couple chooses ICSI over surgery.
- Non-obstructive azoospermia - in those men who have areas of focal spermatogenesis.
- Failure to ejaculate during an ICSI procedure (if vibrator stimulation fails and electro-ejaculation is not available).
- Total astheno-/necrozoospermia - when all sperm are immotile they may be viable but immotile, or non-viable and hence immotile.
Who should undergo a MESA treatment?
This treatment procedure is best suited for couples with:
- No sperm in semen analysis without any known blockages
- Inability to ejaculate (such as injury)
- Failed vasectomy reversal or vasectomy performed several years ago