Microsurgical Epididymal Sperm Aspiration

Microsurgical Epididymal Sperm Aspiration

Around 1 to 2 percent of men suffer from azoospermia, which means that they do not produce sperm on ejaculation. Among these men, about 50% suffer from obstructive azoospermia, a condition where the sperm is produced in the testicles but could not enter the ejaculate due to a blockage. Men with this kind of infertility problem must undergo a surgical procedure for the sperm to be extracted from the epididymis which is the storage of mature sperm, or the testicles where sperm are produced.

Sperm aspiration refers to the different types of surgical procedures that are performed to obtain live sperm from the male reproductive tract. The obtained sperm cells are specifically intended for use in ICSI or Intracytoplasmic Sperm Injection, an assisted reproduction procedure that is done by injecting a single sperm cell directly into an egg. Microsurgical Epididymal Sperm Aspiration or MESA is a type of sperm aspiration for men who do not have sperm due to a blockage in or the absence of the vas deferens.

What is Microsurgical Epididymal Aspiration

Microsurgical Epididymal Sperm Aspiration or MESA is a less invasive and painless procedure that is done under general or local anesthesia. It is an open surgical sperm aspiration procedure that utilizes an operating microscope to accurately locate the tubules of the epididymis in order to extract a large amount of sperm.

What is MESA For?

Your doctor will offer you the Microsurgical Epididymal Sperm Aspiration procedure if he or she thinks that you are capable of producing sperm but it is not released with your ejaculate. By performing this sperm aspiration procedure, the blockage can be bypassed, thus obtaining viable sperm cells. The sperm can only be used for In Vitro Fertilization (IVF) so before you consider undergoing the Microsurgical Epididymal Sperm Aspiration, you and your partner should be sure that you really wish to have a baby through In Vitro Fertilization.

A lot of men who go through sperm extraction may also be candidates for a reconstructive epididymovasostomy or the connection of the epididymis and the vas deferens to bypass a blockage. The combination of the sperm extraction and surgery also increases the likelihood of sperm being released in the ejaculate.

Success Rates of Microsurgical Epididymal Sperm Aspiration

The chance of obtaining sperm through the MESA procedure is as high as 70%. If enough sperm cells are taken, these can be preserved, stored, and utilized in ICSI in a future IVF cycle. Several small studies have been done to compare the success rates of the different kinds of surgical sperm retrieval; these have concluded that Microsurgical Epididymal Sperm Aspiration takes the highest number of sperm, obtaining a hundred times more sperm than the Testicular Sperm Aspiration or TESA and the Perc Biopsy. Microsurgical Epididymal Sperm Aspiration was also seen to bring sperm with better motility, making this procedure more useful for infertility treatments such as IVF and ICSI.


The Microsurgical Epididymal Sperm Aspiration is generally performed in men with epididymal or vasal obstructions. During the operation, an incision is made in the scrotum, exposing the testis and epididymis. With the use of an operating microscope, a single epididymal tubule will be opened in order to extract the sperm. MESA allows surgeons to obtain large amounts of sperm that may be preserved by freezing, so it can be used in future fertility cycles; this cancels the need for future procedures while minimizing epididymal damage.

For the first few hours after the procedure, you will be asked to stay in bed. Before you go home, your doctor will tell you what was seen during his or her observation. In a few days, you will be called to thoroughly discuss the results of the examination.

After you go home, you will have to keep the wound clean and showering or bathing daily will be required. You must wear firm, supporting underpants during daytime and nighttime for a whole week after the procedure; you can remove these underpants when bathing. During the healing period, which is about ten to fourteen days, most men are allowed to resume daily physical activities; however, strenuous activities such as cycling, swimming, and running should be avoided. When it comes to sexual activities, it should as well be prohibited. The stitches may take around six to eight weeks before dissolving completely; if you feel any discomfort, your physician or practice nurse can remove these in seven days.

Side Effects of MESA

Complications such as infection and bleeding are rare in Microsurgical Epididymal Sperm Aspiration; this happens in only around one out of one hundred patients. You may experience a slight bruising or tenderness which may last for one to two days.

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