Microsurgical Epididymal Sperm Aspiration (MESA)

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.

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