If there are no living spermatozoa found (azoospermia) after a repeated sperm analysis, spermatozoa can be gathered using MESA or TESE techniques.
Description of the techniques
The MESA technique is intended for men suffering from a vas deferens obstruction (obstructive azoospermia). Vas deferens is a tube that enables transport of the sperm from the testicle to the urethra during ejaculation. Spermatozoa are usually created, but they cannot penetrate the cap in the urinary tract. This situation can occur as a result of inflammation complications, reproductive organ injuries, sterilization or it can be a congenital growth defect caused by genetic predispositions.
TESE is appropriate for the treatment of the non-obstructive form of azoospermia. Testicles usually do not produce mature and functional sperm cells (spermatozoa). In such case, it is sufficient for the seminiferous tubules of the testicles to contain enough undeveloped sperm cells.
Gathered sperm cells do not possess the required motility. Thus, it is necessary to perform the ICSI method of injecting the sperm directly into the egg. The sperm can also be cryopreserved (stored in very low temperatures) and used in other IVF cycles.
Following correctly performed smear and an acquisition of enough suitable sperm cells, the success rate is not different from standard ICSI and it is roughly 20-35%.
If the suitable sperm cells are not found by any of the above mentioned methods, sperm cells from an anonymous donor can be used.
Approach to Sperm Retrieval Using the MESA Technique
The MESA technique is performed under general anesthesia. A small incision (15mm) is made in the upper area of the scrotum. The testicle and the epididymis are pulled in the direction of the incision until the epididymis is visible. Then, the epididymis is magnified by 8-15 times and examined for expanded tubuli which can be filled with spermatic liquid. These tubuli are light yellow in color. Next, the liquid is extracted from the tubuli. The extracted liquid is immediately transported to the laboratory where it is evaluated under a microscope for the presence of sperm cells, their quality and quantity. Aspiration (extraction of the sperm liquid) is performed repeatedly from several different areas in the epididymis until sufficient quantities of sperm are reached.
Approach to Sperm Retrieval Using the TESE Technique
Performed under general anesthesia. A microsurgical incision is made on the scrotum through which the testicles are observed for milky white colored tubuli. These tubuli usually contain sperm at different stages of development. This area is removed from the testicle and examined in the laboratory for the presence of sperm cells, their quantity and quality.
How to Prepare for the Procedure
No special preparations are necessary for the MESA or TESE techniques. It is recommended to stop eating, smoking and drinking 12 hours before the start of the procedure. The procedure lasts about an hour and the patient is discharged after a 3-hour recovery period.