MESA (Micro-epididymal Sperm Aspiration) Treatment in India

MESA is a procedure to retrieve sperm from the epididymis in men who have a diagnosed  blocked vas deferens It is normally carried out under general anaesthetic. The sperm that is taken from the epididymis usually has poor motility so doctors usually proceed to ICSI on the same day.

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Microepididymal sperm aspiration (MESA) has perhaps been the procedure most commonly performed in men with vasal obstruction. A scrotal skin incision is made, and the testis and epididymis are exposed. Using an operating microscope, a single epididymal tubule is opened and sperm aspirated.

This procedure may be performed with a general anesthetic, or a local anesthetic with intravenous sedation. An operating microscope is used to examine the very small tubules of the epididymis that contain the sperm. A dilated tubule is opened and the fluid is collected and examined for the presence and quality of sperm.

Epididymal sperm aspiration and in-vitro fertilization (IVF) with intracytoplasmic sperm injection is an established treatment for obstructive azoospermia. Sperm aspiration is performed with either an incision or percutaneously. To control costs, minimize morbidity and retain the advantages of both approaches, we developed a mini-incision technique for epididymal aspiration and here report sperm retrieval and procedure-related outcomes. Twenty-six consecutive patients with obstructive azoospermia underwent epididymal sperm retrieval through a 1 cm incision with local anaesthesia to provide spermatozoa for concurrent IVF cycles.

The quality of retrieved spermatozoa, the quantity of spermatozoa cryopreserved as well as anaesthetic requirement, recovery time and patient satisfaction were evaluated. Fresh epididymal spermatozoa were retrieved in 25 of 26 (96%) patients. In one patient, testicular sperm extraction was necessary. Excess motile spermatozoa were cryopreserved in 24 of 26 (92%) patients; a mean total motile count of 4.8×10(6) motile spermatozoa were banked.

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Who is MESA suitable for?

MESA is commonly used for men with obstructive azoospermia. These men have no sperm in their ejaculate because the tube through which the sperm pass during ejaculation, the vas deferens, is absent or blocked.

What does MESA involve?

Under the care of a consultant urologist, MESA is a minor theatre procedure carried out on an outpatient basis under local anesthesia.

Sperm are retrieved from the epididymis. This is the area adjacent to the testes where sperm are stored between production and ejaculation. Sperm extracted in this way can be used to achieve fertilisation of eggs in the laboratory. However, because the numbers of motile sperm that are retrieved are low, it is usually necessary to combine MESA with ICSI.

When is MESA carried out?

In consultation with the urologist, the doctor may advise that MESA is carried out in advance of any fertility treatment to confirm that sperm can be identified. If suitable numbers of sperm are identified on this occasion, it may be possible to freeze the sperm and to thaw and use this sample for subsequent treatment. Otherwise, MESA can be carried out on the day of the egg retrieval and the fresh sample used for ICSI. Again, providing that there are suitable numbers of sperm present, the sample can often be frozen for use in future treatment cycles.

MESA Sperm retrieval Treatment in india

Occasionally there will be no sperm present in the seminal fluid at the time of ejaculation. This could be due to a blockage in the tubules of the testes or an absence of the tube, which transports the sperm to the outside. Alternatively it may mean that the process which manufactures sperm in the testes has ceased to function.

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Sperm can be removed directly from the testes by a procedure called Micro-Epididymal Sperm Aspiration (MESA). This is carried out under a general anaesthetic usually by a urologist. An incision is made in the scrotum and a fine needle is inserted into the epididymis (sperm producing tubules). The urologist extracts any sperm from the epididymis using a small syringe. An embryologist checks to see if sperm are present. The sperm are taken back to the IVF laboratory and can be frozen and used at a later date or used immediately during an ICSI cycle.

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