Microsurgical epididymal sperm aspiration (MESA) refers to the retrieval of sperm-containing fluid from optimal areas of the epididymis that are chosen and tested utilizing high-power optical magnification provided by an operating magnifying lens. Recovered sperm is subsequently used for intracytoplasmic sperm injection (ICSI) to induce fertilization and pregnancy.
MESA is considered by numerous experts to be the best quality technique for sperm retrieval in men with obstructive azoospermia given its high yield of quality sperm, excellent reported fertilization and pregnancy rates, and low risk of complications. In any case, MESA must be performed in an operating room, requires microsurgical skills and is only helpful for reproduction using ICSI.
What is MESA?
Azoospermia or the condition of no sperm ejaculation or can be called as male infertility, happens either because there is the blockage in the reproductive tract or a deficiency in sperm production gland. For many men with this type of infertility problems, a surgical procedure is necessary to extract sperm directly from the epididymis, where mature sperm are stored, or the testicles, where they are produced.
Microsurgical Epididymal Sperm Aspiration or MESA is a relatively painless and minimally invasive procedure performed under local anesthesia.
Only a very small incision need be made under local anesthesia to be able to access the epididymis. Using magnification, the tiny epididymal tubules can be seen and open several to get the sperm contained inside. Usually, enough sperm can be obtained to freeze for various cycles of IVF. The sperm that is expelled is always checked immediately under a microscope.
When to go to MESA?
This technique works well in conditions where sperm is being produced in adequate number but is blocked from traveling from the testicle to the ejaculate in below cases:
1- A prior vasectomy
2- Prior hernia repair with mesh
3- Blockage of the seminal vesicles
4- Cystic fibrosis
5- Immotile cilia syndrome
MESA is also the procedure of choice because of the ability to retrieve a large number of sperms that may be cryopreserved (frozen) and used in future cycles. Many men may be candidates for a reconstructive vasoepid dymostomy and at the same time of sperm harvest, thus increasing the chances of having sperm appear in the ejaculation. Recovery time from the operative procedure is only a few days and complications are rare and listed below:
2- Severe pain in the abdomen
3- Damage to the testicle
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