Microsurgical epididymal sperm aspiration (MESA) describes the microsurgical retrieval of sperm from the epididymis.
The procedure is always combined with intracytoplamatic sperm injection (ICSI) and in vitro fertilization (IVF).
Indications (areas of application)
- Occlusive azoospermia (= complete absence of mature spermatozoa and cells of spermatogenesis in the ejaculate in cases of bilateral spermatic duct obstruction) Presence of obstruction (occlusion) of the spermatic ducts (between the rete testis (testicular mesh) and the colliculus seminalis/semen mound), with usually normal testicular volume and FSH serum level in the normal range.
- Congenital bilateral absence of the vas deferens (synonyms: CAVD for congenital aplasia of vas deferens) – congenital bilateral absence of the vas deferens.
- Young syndrome – chronic obstructive pulmonary disease (COPD), chronic sinusitis (sinusitis), and obstructive azoospermia. The cause is probably abnormal mucous or ciliary function.
- Failed refertilization of the vas deferens (failed surgical restoration of the vas deferens).
- Bilateral (bilateral) non-surgically treatable obstruction of the ductus ejaculatorii (occlusions of the squirt tubules).
- Not conventionally treatable ejaculatory disorder.
Before surgery
A microsurgical epididymal sperm aspiration (MESA) and intracytoplamatic sperm injection (ICSI) must be preceded by an examination of the man by physicians with the additional title “andrology“. This includes a personal, family and couple history including a sexual history, a physical examination and an ejaculate analysis (including spermiogram/sperm cell examination). If indicated, this is supplemented by scrotal sonography (ultrasound of the testicles and epididymis) and, if necessary, hormone diagnostics and cyto- or molecular genetic diagnostics. If sexually transmitted diseases (STDs) and other urogenital infections are present that could endanger the woman or child, these must be treated [Guidelines: Diagnosis and therapy before assisted reproductive medicine treatment (ART)].Anticoagulants (anticoagulants) should not be taken for up to 7 days before surgery.
The procedure
In microsurgical epididymal sperm aspiration, the epididymis is punctured with a fine cannula to obtain epididymal sperm. Subsequently, the epididymal fluid is examined for epididymal spermatozoa (= active mature sperm).
Afterwards, the sperm sample is stored by cryopreservation and prepared only shortly before the intracytoplasmic sperm injection (ICSI).
The procedure takes place under general anesthesia.
The duration of the operation is approximately 10 minutes.
After the operation
After the procedure, the patient remains in the recovery area for about 1-2 hours. He should then take it easy for five days. Showering should be done on the next day at the earliest. Bathing and saunas should be avoided for approximately 2 weeks.
Possible complications
- Hematoma (bruise)
- Scrotal edema (swelling of the scrotum).
- Epididymitis (inflammation of the epididymis)
Please note
The physical and mental health of men and women, as well as a healthy lifestyle are important prerequisites for successful fertility treatment.
Before starting therapeutic measures, you should in any case – as far as possible – reduce your individual risk factors!
Therefore, before starting any reproductive medical measure (e.g. IUI, IVF, etc.), have a health check and a nutritional analysis performed to optimize your personal fertility (fertility).
