India
    Top Indian Cities
  • Delhi
  • Kolkata
  • Mumbai
  • Bangalore
  • Hyderabad
  • Lucknow
  • Pune
  • Ahmedabad
  • Chennai
  • Patna
  • Jaipur
  • Indore
  • Gurgaon
  • Surat
  • Bhopal
  • Nagpur
  • Varanasi
  • Noida
  • Kanpur
  • Ranchi
  • Amritsar
  • Udaipur
  • Ludhiana
  • Srinagar
  • Agra
  • Chandigarh
  • Allahabad
  • Bhubaneswar
  • Vadodara
  • Guwahati
  • Rajkot
  • Ghaziabad
  • Faridabad
    Top Global Cities
  • Abu Dhabi
  • Bangkok
  • Cebu City
  • Chiang Mai
  • Chittagong
  • Colombo
  • Depok
  • Dhaka
  • Doha
  • Dubai
  • Eldoret
  • Ipoh
  • Jakarta
  • Johor Bahru
  • Kathmandu
  • Khon Kaen
  • Kiev
  • Klang
  • Kota Damansara
  • Kuala Lumpur
  • London
  • Makati
  • Malacca
  • Manila
  • Minsk
  • Monroe
  • Nairobi
  • Odessa
  • Padang
  • Penang
  • Phnom Penh
  • Phuket
  • Quezon City
  • Selangor
  • Singapore
  • Tbilisi
    pink loader
    fertility treatments

    MESA Procedure Male Infertility - Azoospermia Treatment Success Rate

    • 11917 views
    • 4.7   (5 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 22 May 2019 - Written by Dr. Sankar Das Mahapatra - MS, Fellowship, MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    Mesa Procedure Male Infertility is the recommended treatment for azoospermia, oligospermia, cystic fibrosis, past genital surgeries, and blockage of seminal tissues. Azoospermia treatment success rate is worth appreciating. MESA risks are mild pain, haematoma, possibility of risks, and difficulty in bowel and pelvic area.

    Let’s Discuss in More About MESA (Micro-Epididymal Sperm Aspiration) Treatment:

    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, 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)

    Oligospermia

    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 a 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 tests are then delivered and tunica vaginal is opened for exposing the epididymis.
    • The epididymis is observed under the sterile field through an 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 the 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 the 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 the required number of sperm for quick use along with ICSI as well as for sperm cryopreservation.

    Go through five things you need to know about fertility treatments.

    c. The 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.

    sperm can be used for ivf

    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 Benefits-

    • 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.

    MESA Risks-

    • 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 a 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 a more advanced technique than MESA in which immature sperms can also fertilize eggs.

    You can read our detailed article on unexplained infertility and its treatment. Also, please feel free to read our article on Male Infertility Treatments.

    Dr. Sankar Das Mahapatra

    Written by

    MS, Fellowship, MBBS
    Laparoscopic Surgeon, Obstetrician
    Kolkata

    Dr. Sankar Das Mahapatra is one of the leading Gynecologist, Obstetrician and Infertility Specialist based in Salt Lake, Kolkata. He has almost 2 decades of experience and has performed more than 3000 laparoscopic surgeries with a good track record. He is an expert in Laparoscopic hysterectomy, Intrauterine insemination (IUI) and Gynecology Laparoscopy.
    He provides full support to patients having High-Risk Pregnancies and Abnormal Vaginal or Menstrual Bleeding. He is very skilled in performing Laparoscopic Hysterectomy, Laparoscopic Myomectomy & Endometriosis surgery.
    Dr. Sankar Dasmahapatra earned his bachelor’s degree (M.B.B.S) from Nil Ratan Sirkar College and Hospital under Calcutta University in 1990. Three years later, he also achieved the Master’s degree (M.S) in gynecology & obstetrics from Patna University. Furthermore, he went on to complete his Fellowship in Minimal Access Surgery from, Sydney University, Australia in 2005. He is an esteemed member of Federation of Obstetric and Gynecological Societies of India (FOGSI) and Indian Association of Gynecological Endoscopist (IAGE).
    With a book “State-of-the-art of Laparoscopic Suturing” under his name, he has been in a successful career of performing nearly 2000 Laparoscopic Procedures. Dr. Sankar Das Mahapatra is well-updated with the latest advancements in fertility treatments and carries the knowledge along with good communication and excellent operative skill. He has received sophisticated training in many advanced centers in India and is accredited by the American College of Gynecologist & Obstetrician which is highly valued in the medical industry. He is a very reliable gynecologist who has successfully handled many high-risk pregnancies during the medical practice of the last 2 years. He is presently practicing as a Consultant Infertility Specialist at Millenium Clinic and The Barasat Clinic.
    Millenium Clinic is a well-known Gynecology/Obstetrics Clinic in Tegharia, Kolkata. The centre is known for providing a wide range of services related to gynecology and obstetrics such as Antenatal care, Laparoscopic surgery, Myomectomy, Community Gynaecology and treatment of Female Urinary tract disease, PCOS, Endometriosis, Abnormal Uterine Growth and many more. The hospital provides the best surrogacy and fertility service as per the requirement and budget of patients. The centre caters to the medical needs of the patient with full dedication, precision, and care.
    The Millenium Clinic serves the patient from Mon to Sat - 7:00 AM to 9:00 PM.

    SOURCES AND REFERENCES:

    • Most in demand infertility treatments for couples with high success rates  Assisted Reproductive Technology, Elawoman - 2017
    • Ivf - ivf procedure steps, costs, ivf success rates, types, and faq's  IVF, Elawoman - 2018
    • Intrauterine insemination - iui success rate, iui success tips  IUI, Elawoman - 2017
    • Facts about semen quality, and color - know with semen analysis test  semen, Elawoman - 2017

    5 Comments

    user_img

    Devinder Goyal

    Can we freeze the embryo after MESA treatment in case of family planning?

    Oct. 10, 2018, 4:37 a.m. 5.0

    user_img

    Sakshi Dev

    After the embryo insemination into my uterus, I have heavy cramps in my lower abdomen. Is this a side-effect of IVF??

    Sept. 28, 2018, 2:12 p.m. 4.5

    user_img

    Subham Verma

    If this is a much more reliable method than ICSI and IMSI, then why don't we execute it in the first place?

    Aug. 15, 2018, 5:13 p.m. 4.5

    user_img

    Amar Singh

    If I'm not wrong, MESA treatment if for the ones who have no sperms in their semen or as they put it azoospermia. Infertility treatments have touched an all-time high. Proud to see our country making such advancements in the medical field.

    June 2, 2018, 4:31 p.m. 5.0

    user_img

    Sadashiv Bhosle

    MESA procedure proved to be very useful in our case and we now have twin babies.

    April 8, 2018, 3:59 p.m. 4.5

    View all comments

    Leave a Comment

    Rating

    Disclaimer

    The information displayed on this webpage covers general information on several medical conditions, fertility treatments, IVF ICSI, surrogacy procedure, home remedies, and their respective treatments. The exclusive purpose of the displayed information is for the sake of general understanding and it has been collected from open sources which heavily rely on research and laboratory tests. However, the information shared here should not be considered as a medical advice or an alternative to consultation with a registered medical practitioner or licensed healthcare professional.

    It is not advised to self-diagnose or treat any medical condition or disease following the information given in this article. We insist you to consult a registered practitioner and never try to replace their advice or discontinue treatment in between by relying solely on the information obtained. External links to different websites as well as videos given on the website serve the purpose of sharing knowledge only. Ela being an Independent Medical Information platform is neither responsible nor guarantees the authenticity, reliability, and accuracy of these videos and websites in any way. We do not intend the information displayed here to be used for a medical emergency, if you seek medical attention for yourself (or any other person with whom you want to share the information with), we advise you to directly get in touch with the hospital or the doctor.

    More From Author

    Family Planning
    Best birth control methods for teenagers - Copper T insertion, Transdermal patch

    Best birth control methods for teenagers - Copper T insertion, Transdermal patch

    posted on 11 Jul 2018 4.7/ 5

    Best birth control methods for teenagers include Copper T insertion and Transdermal patch. Copper T insertion method of birth control is one of the in-demand birth contr…

    Read More

    Family Planning
    Female condoms - What are the Advantages, Disadvantages, Effectiveness?

    Female condoms - What are the Advantages, Disadvantages, Effectiveness?

    posted on 11 Jul 2018 4.7/ 5

    Female condoms are used by females to prevent successful contraception. Female condoms advantages are prevention of HIV, STD's, and unwanted pregnancy. Female condoms di…

    Read More

    Family Planning
    How to avoid pregnancy effectively? - Top 6 methods to do it

    How to avoid pregnancy effectively? - Top 6 methods to do it

    posted on 13 Jul 2018 4.7/ 5

    If you want to avoid pregnancy effectively, then you can choose 6 methods to avoid it without much side effects. Barrier methods like female and male condoms, birth cont…

    Read More

    Related Article view all

    Fertility Treatments
    Male infertility - Causes of Infertility, Male infertility tests

    Most of the men with male infertility issues think about how to increase sperm count. Male infertility causes include chemotherapy, genetic abnormalities, undescended testicle, and infections of testicles. Male infertility tests includes Sperm Analysis test, Testicular Biopsy, and Hormone Evaluation.

    Read More

    Fertility Treatments
    Effect of infertility drugs on Premature Menopause - When to worry, What to do

    Premature menopause concerns most of the woman who are still away from the phase of menopause. Infertility drugs especially ovulation induction drugs can impact the periods in your 40's. So, it is important to consult your infertility specialist before you reach any self conclusion.

    Read More

    Fertility Treatments
    Most In Demand Infertility Treatments for Couples with high success rates

    The most in-demand infertility treatments for couples with high success rates include Intrauterine insemination (IUI), In vitro fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI) and surrogacy. The IVF success rates depends on age, quantity, quality of sperms and a woman's health to hold a pregnancy.

    Read More

    Trending Articles

    surrogacy
    surrogacy

    5 Best Surrogacy Doctors in India

    posted on 27 Dec 2018 4.5 / 5(1 Votes)

    Find the list of best surrogacy doctors in India who offers the best treatment with the highest success rate. The list has been categorized on the basis of doctors fame, experience, reviews, ratings, and cost. Dr. Mohit Saraogi from Saraogi Hospitals and IRIS IVF Centre and Dr. Kaberi Banerjee from Advanced Fertility Centre top the list of the best surrogacy doctors in India.

    Read More

    IVF
    ivf

    Best IVF Doctors in India with Highest Success Rates

    posted on 19 Dec 2018 4.7 / 5(3 Votes)

    Find here the list of best IVF doctors in India on the basis of Ratings, Success Rate, Services offered, IVF cost packages and available Facilities. Dr. Nisha Bhatnagar, Dr. Kaberi Banerjee and Dr. Anjali A Deval top the list of such IVF doctors in India due to their unique pricing system, popularity and high success rate.

    Read More

    surrogacy
    surrogacy

    Top Surrogacy Centres in India with Highest Success Rates

    posted on 20 Dec 2018 4.8 / 5(2 Votes)

    In this article we bring you the best Surrogacy Centres and clinics in India with Review Ratings, Cost Estimates, and Surrogacy Success Rate to help you make the best choice. Aveya IVF and Surrogacy Centre and Advanced Fertility and Surrogacy Centre tops the list of such surrogacy centres in India due to their low treatment costs, popularity and high success rates.

    Read More