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MESA treatment is a surgical sperm retrieval technique. MESA is a very effective method of sperm retrieval from epididymis for ART (Assisted Reproductive Technology) methods such as IVF (In-vitro Fertilization), IUI (Intrauterine Insemination) or ICSI (Intracytoplasmic Sperm Injection).
What is MESA?
MESA (Micro-Epididymal Sperm Aspiration) is an open surgical sperm retrieval technique to treat male infertility problems such as Azoospermia (total absence of sperm in ejaculation) and reproductive tract blockage. Reproductive tract can be blocked due to various genital surgeries including vasectomy.
Under this procedure, an operating microscopy is used and sperm retrieval is done directly from the epididymis (reproductive tube connecting the testicles to the sperm carrying vessels) organ in the male genitalia.
MESA is normally used to assist pregnancy for the childless couples through Assisted Reproductive Technology (ART) such as IVF (In-Vitro Fertilization) and sometimes IUI also. It involves a surgery to cut open the scrotum and retrieve the sperm. This MESA procedure causes pain for some days.
When to expect MESA?
This technique is used when the father has issues in sperm production due to various reasons such as:
1- Azoospermia– When zero sperm is found in the ejaculated semen in a Semen Analysis Test or Sperm Culture Report then MESA may be suggested. Azoospermia is of two kinds -
- Obstructive Azoospermia(no sperm in the semen due to infection/accident/surgery in testicles, prostate or the reproductive tract)
- Non-obstructive Azoospermia(no sperm in the semen due to abnormal sperm production mostly related to hormonal problems or genetic)
However, MESA is not suggested in Non-Obstructive Azoospermia (NOA) as it is difficult to find sperm in the epididymis when sperm production is impaired due to genetic factors in NOA.
2- Oligospermia-MESA is suggested when the male has Oligospermia (low sperm concentration in the semen)
3- MESA is helpful when the male has previous genital surgeries such as Vasectomy (male sterilization surgery for permanent contraception) and Inguinal Hernia Repair (surgery to repair hernia in the groin)
4- Men diagnosed with Cystic fibrosis (a genetic disorder affecting lungs), which leads to infertility problems by affecting the development of vas deferens-tube carrying the sperms to the testicles.
5- MESA is required when the male has a problem with blockage of seminal tissues or vas deferens due to cysts.
Procedure of MESA
1- While performing the procedure, it was studied that Microsurgical Epididymal Sperm Aspiration involves careful dissection of epididymis beneath the operating microscope and the incision of a single tubule.
2- The fluid spills once incised from the epididymal tubule and collects in the epididymal bed.
3- This pooled fluid is aspirated.
4- This procedure can lead to invariable contamination of blood cells as the epididymis is vascularized and can affect the sperm fertilizing capacity.
The MESA retrieval technique provides advantages of decreasing the contamination of epididymal fluid with the blood cells. It helps in performing repeated aspirations in which sufficient quantities can be utilized immediately for cryopreservation.
a- Aspiration Device- For aspirating the fluid from epididymal tubules, a sharp and fine device is used which can easily pierce the tubule. Plus, it also avoids damage to the extensive and delicate vessels network, which covers the epididymis.
b- Detailed Operative Procedure of Extracting Sperms from Epididymis Yellow Tubules-
- A process of midline scrotal incision is performed.
- The testes are then delivered and tunica vaginal is is opened for exposing the epididymis.
- The epididymis is observed under the sterile field through operating microscope.An obstructed sample will have a different characteristic.
- The epididymis tail has dilated yellow tubules because of the macrophages predominance and degenerating sperm.
- The aspiration’s first puncture is made proximal to yellow tubules. The puncture- can be made through tunic if the tubules can be visualized clearly with epididymal tunic intact.
- If the tubules are obscured then a linear opening in tunic is made with micro knife with bipolar electrocautery after coagulating the surface. Incising tubules and collecting fluid once it flows out of tubules is another approach.
- The operating surgeon then punctures the appropriate tubule and fluid is aspirated gently once the assistant stabilizes the testicle.
- The assistant can also begin the retrieval by compressing testis and epididymis gently. If there is no flow anymore, then the retrieved fluid is flushed back via a system by using human tubal fluid and then forwarded to IVF team who are also present in the lab.
- The fluid is then examined carefully under the microscope immediately for assessing the sperm count as well as its motility. Until the optimal sperm quality is not obtained, sequential micropunctures are performed.
- Optimally, there is 100 X 106 sperm with good motility is retrieved by using the MESA method.
- As the sperm in the epididymal fluid is highly concentrated so, only microlitre quantity of fluid is required. In this way, MESA offers more than required number of sperm for quick use along with ICSI as well as for sperm cryopreservation.
c. Procedure of Extracting Sperms from Efferent Ductules During MESA
- Fluid can also be retrieved from efferent ductules with the help of micropuncture procedure if optimal sperm quality is not found in the epididymis body.
- The efferent ductules arise from the testis’s superior pole that is just above the testicular vessels.
- The operating surgeon along with the assistant adjusts the testicles properly. The surgeon performs it with the help of incising the tunic at the intersection of testis and epididymis to expose the efferent ductile.
- In this process, the caput epididymis is dissevered bluntly of the testis. Once the required fluid is collected, the punctured sites are then closed along with the tunic incisions.
- For avoiding any inflammation and adhesions, which can complicate the future explorations, the tunica vaginal is is then closed in a watertight fashion. The samples are then taken to the laboratory where they are subjected to centrifugation; swim up and for sedimentation process for removing any debris, blood products and macrophages.
How is MESA procedure performed?
MESA procedure is very minimal and less invasive. The entire procedure of sperm retrieval through MESA takes only 30-45 minutes. The detailed MESA procedure is explained below:
1- The patient is given general or local anesthesia with intravenous sedation.
2- The scrotal skin is sterilized with antiseptic and prepared for the surgery.
3- The surgeon makes an incision in the scrotal skin exposing the testicles and the epididymis.
4- An operative microscope is used to locate a single Epididymal tubule.
5- Sperm is retrieved from the Epididymis and tested in the laboratory using sperm culture or general semen analysis test.
6- Retrieved sperm can be used for IVF (in-vitro fertilization) or can be frozen (cryopreserved) for future IVF cycle/s.
If you are curious to know more about infertility, read what are infertility causes and treatments.
What are MESA Risks & Benefits?
MESA procedure entails lots of benefits as well as risks. Below we have outlined how much MESA can be beneficial for you. Also, the risk factors of MESA are discussed accordingly.
- MESA is beneficial as it allows you to retrieve a large amount of sperm, which can be cryopreserved or frozen to use in future IVF cycles as well.
- MESA benefits to those couples who do not want donor sperm and want their biological child.
- Less invasive and needs microsurgery.
- MESA is the best way to retrieve sperm if TESA (Testicular Sperm Aspiration) fails or when sperm retrieval is not possible through TESA.
- Mild pain lasting 3 to14 days is common after MESA.
- Risk of Haematoma (swelling with clotted blood in the scrotal tissue) is thereafter MESA.
- Swelling of the testicles with discoloration of the scrotal skin is also observed in some patients after MESA.
- Risk of infection in the incision site (swelling, redness, rash, itching) persists up to a week after MESA surgery.
- One should avoid the sexual activity and spicy food after MESA as these can complicate patient’s pelvic and bowel area respectively.
When is TESA preferred over MESA?
If no sperms are found during the procedure of MESA, then TESA (Testicular Sperm Aspiration) needs to be done. TESA is more advanced technique than MESA in which immature sperms can also fertilize eggs.
SOURCES AND REFERENCES:
- Treatments used for infertility issues in couples Assisted Reproductive Technology, Elawoman - 2017
- What is ivf (in- vitro fertilization)? IVF, Elawoman - 2018
- Everything you need to now about intrauterine insemination (iui) IUI, Elawoman - 2017
- Facts on semen color and semen health semen, Elawoman - 2017
- What is a normal sperm count for pregnancy? sperm, Elawoman - 2017
- What is icsi ICSI, Elawoman - 2017
- Five things you need to know about fertility treatments five things you need to know about fertility treatments, Elawoman - 2017
- Infertility symptoms, causes and treatments infertility causes and treatments, Elawoman - 2017
- About unexplained infertility and its treatment unexplained infertility and its treatment, Elawoman - 2017
- Treatment for male infertility Male Infertility Treatments, Elawoman - 2017
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