Microsurgical Epididymal Sperm Aspiration

M. Kabha, Y. Dekel

Obstructive azoospermia, Congenital bilateral absence of vas deferens, Microsurgical Epididymal Sperm Aspiration

Description

This work presents congenital anomalies associated with absence of the vas deferens and outlines the principles and technique of Microsurgical Epididymal Sperm Aspiration (MESA). It also compares MESA with Testicular Sperm Extraction (TESE), focusing on sperm yield, quality, cryopreservation outcomes, invasiveness, recovery, and required expertise.

Background

MESA is a microsurgical sperm retrieval technique used in obstructive azoospermia, including congenital bilateral absence of the vas deferens (CBAVD) and post-vasectomy obstruction.

Methods

Under high magnification, dilated epididymal tubules are identified, incised, and aspirated. Retrieved fluid is assessed for sperm presence and motility, then used for intracytoplasmic sperm injection (ICSI) or cryopreserved.

Results

MESA demonstrated higher sperm yield and motility, often enabling multiple ICSI cycles from a single procedure, with superior cryopreservation outcomes and minimal tissue trauma. In contrast, TESE showed lower and more variable yield, greater invasiveness, and slower recovery. MESA and micro-TESE require advanced microsurgical expertise, unlike conventional TESE.

Conclusions

MESA provides superior sperm outcomes with minimal tissue damage but requires specialized expertise. TESE remains an important alternative, particularly in non-obstructive azoospermia. Technique selection should be individualized based on etiology, surgical skill, and patient goals.

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1.Bernie AM et al. Asian Journal of Andrology, 2013.

2.Schroeder-Printzen I et al. Human Reproduction, 2000.

3.Nudell DM et al. Human Reproduction, 1998.

4.Tournaye H. Human Reproduction, 1999.