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You are here : Home / Fertility / MESA
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MESA
MESAMicroepididymal sperm aspiration (MESA) has perhaps been the procedure most commonly performed in men with vasal obstruction. A scrotal skin incision is made, and the testis and epididymis are exposed. Using an operating microscope, a single epididymal tubule is opened and sperm aspirated. This procedure may be performed with a general anesthetic, or a local anesthetic with intravenous sedation. An operating microscope is used to examine the very small tubules of the epididymis that contain the sperm. A dilated tubule is opened and the fluid is collected and examined for the presence and quality of sperm.

MESAAll of the sperm containing fluid is collected and taken to the IVF lab for processing, use and freezing. If the fluid is devoid of sperm or only dead sperm are found, then another area of the epididymis is sampled. This is done until enough sperm are obtained to use and to store for future use. Adequate numbers of sperm are often retrieved allowing for cryopreservation and future ICSI cycles. With the advent of microsurgical epididymal sperm aspiration (MESA), sperm are retrieved in higher numbers than with PESA, allowing for cryopreservation of large numbers of sperm.

Which Option is Best for Us? ??

Having so many options is great because "one size does not fit all." A comprehensive male fertility evaluation and a careful discussion with you and your partner will determine which option is the safest and the most efficient way to locate and retrieve sperm for you. Each option has its advantages and disadvantages:

Option

Advantages

Disadvantages

MESA *

? Blood contamination

Lots of sperm back/? Retrieval rates

? Risk of hematoma

Best pregnancy rates

Requires microsurgery expertise

? Cost

General anesthesia

Requires scrotal exploration

? Post-operative discomfort

PESA


No microsurgery expertise required

Local or general anesthesia

Few instruments required

Fast/Repeatable

Minimal post-operative discomfort

? Cost

Feasiblility depends on anatomy

Less sperm back

Blood contamination

? Risk of hematoma

Damage to adjacent tissues

TESA

No microsurgery expertise required

Local or general anesthesia

Few instruments required

Fast/Repeatable

Minimal post-operative discomfort

? Cost

Less sperm back

Blood contamination

? Risk of hematoma

Risk of testicular damage/atrophy

TESE

No microsurgery expertise required

Local or general anesthesia

Few instruments required

Fast/Repeatable

If non-obstructive azoospermia,

Then less sperm back.

Risk of testicular damage/atrophy

Scrotal exploration required

Micro-TESE*

Few instruments required

Best for Non-Obstructive Azoospermia

Microsurgical expertise required.

General anesthesia

Not fast/Time consuming

Scrotal exploration required

??? Cost

?? Risk of testicular damage

?? Post-operative discomfort

Minimally repeatable

* Requires microsurgical expertise with fellowship-training preferable.




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