Many men struggle with infertility because they have little to no motile sperm in their ejaculate, blocked tubes or are born without a vas deferens. Sperm extraction procedures allow these men to improve their fertility by retrieving the healthiest, most viable sperm from the testes. These procedures, known as MESA, TESA or PESA, are typically performed in the operating room under anesthesia using an operating microscope. Most patients who undergo MESA will cryopreserve sperm obtained during this procedure for future IVF/ICSI attempts.
MESA (microsurgical epididymal sperm aspiration) involves making an incision in the scrotal skin and opening the testis and epididymis with an operating microscope to expose the epididymal tubules for sperm aspiration. This allows for an extensive collection of sperm that can be used in the future, especially for patients with a history of vasal obstruction (e.g., s/p vasectomy or congenital bilateral absence of the vas deferens).
This procedure is often done in conjunction with an IVF or ICSI egg retrieval. However, in some cases patients choose to have MESA on its own if they are not interested in IVF.
TESA (testicular epididymal sperm aspiration) is similar to MESA, but it involves inserting a needle into the testicles rather than the epididymis. During this procedure the physician will use a fine needle to pull out a sample of sperm from the testicle. An andrologist will then separate the sperm from other tissue in a special medium.
A recent study has found that testicular sperm collected through TESA can lead to poor results for IVF-ICSI due to a significant increase in the rate of aberrant sperm, which is induced by the needle prick and subsequent inflammation. In addition, histomorphometry and TUNEL staining of the ipsilateral testis after TESA showed that there were dramatic alterations in the testis and a significant upregulation of apoptosis. mesa tesa