Microsurgical
Epididymal Sperm Aspiration (MESA): Microsurgical
epididymal sperm aspiration is performed as open
operation under the operating microscope. This
approach has the advantages of reliable retrieval of
large numbers of epididymal spermatozoa that can be
readily frozen and thawed for subsequent attempts at
fertility.
Since MESA
involves direct retrieval of spermatozoa from
epididymal tubule, it minimizes contamination of the
epididymal fluid by blood cells, which may affect
spermatozoa fertilizing capacity during the IVF.
MESA is performed with a micropuncture siliconized
glass pipette connected to sterile medical grade
silicone tubing that is attached to an aspiration
device consisting of a 1-ml plastic tuberculin
syringe and a 10-ml glass syringe.
The tip
size of micropuncture pipette is about 250 to 350 µm
sharpened on a fine grinding wheel to facilitate
puncture of the epididymal tubule. Puncture sites
are then closed with interrupted 9-0 Nylon suture,
or cauterized and the epididymal tunic closed with
6-0 polypropylene sutures. Epididymal sperm can also
be retrieved by an opening individual epididymal
tubule with a micro-knife and collecting the sperm
though a simple micropipette/capillary action
technique during some epididymal reconstructive
microsurgeries.
It is a
simple, inexpensive and safe sperm recovery
technique for the microsurgery vasoepididymostomy.
Retrieval sperm from epididymis of men with
obstructive azoospermia is possible in over 99% of
patients by experienced microsurgeons.
