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Published on: May 27, 2022
Microsurgical epididymal sperm aspiration: indications, techniques and outcomes
Aaron M Bernie1, Ranjith Ramasamy, Doron S Stember
1Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10021, USA.
Abstract:
Microsurgical epididymal sperm aspiration (MESA) refers to retrieval of sperm-containing fluid from optimal areas of the epididymis that are selected and sampled using high-power optical magnification provided by an operating microscope. Retrieved sperm are subsequently used for intracytoplasmic sperm injection (ICSI) to induce fertilization and pregnancy. MESA is considered by many experts to be the gold standard technique for sperm retrieval in men with obstructive azoospermia given its high yield of quality sperm, excellent reported fertilization and pregnancy rates, and low risk of complications. However, MESA must be performed in an operating room, requires microsurgical skills and is only useful for reproduction using ICSI. Herein we present an overview of the evaluation of candidate patients for MESA, the technical performance of the procedure and the outcomes that have been reported.
Insights
Microsurgical epididymal sperm aspiration (MESA) offers a high yield of quality sperm for treating obstructive azoospermia. This gold standard technique, though requiring microsurgery, provides excellent fertilization and pregnancy outcomes.
Area of Science:
- Reproductive Medicine
- Andrology
- Microsurgery
Background:
- Obstructive azoospermia presents a significant challenge in male infertility.
- Sperm retrieval techniques are crucial for assisted reproductive technologies.
- Microsurgical epididymal sperm aspiration (MESA) is a specialized procedure for obtaining sperm.
Purpose of the Study:
- To provide an overview of Microsurgical Epididymal Sperm Aspiration (MESA).
- To detail patient evaluation, technical performance, and reported outcomes of MESA.
- To highlight MESA's role as a gold standard in sperm retrieval for obstructive azoospermia.
Main Methods:
- Sperm retrieval from optimal epididymal areas using high-power optical magnification.
- Selection and sampling of sperm-containing fluid under an operating microscope.
- Utilizing retrieved sperm for Intracytoplasmic Sperm Injection (ICSI).
Main Results:
- MESA yields a high quantity of quality sperm suitable for ICSI.
- The procedure is associated with excellent reported fertilization and pregnancy rates.
- MESA demonstrates a low risk of complications when performed by skilled microsurgeons.
Conclusions:
- MESA is considered the gold standard for sperm retrieval in obstructive azoospermia.
- The technique requires an operating room setting and microsurgical expertise.
- MESA is exclusively applicable for reproduction via ICSI.
