In approximately 7% of men undergoing microsurgical epididymal sperm aspiration (MESA), spermatozoa retrieval is not possible.

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.

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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. All of the sperm containing fluid is collected and taken to the IVF lab for processing, use and freezing. If the fluid is devoid of sperm or only dead sperm are found, then another area of the epididymis is sampled. This is done until enough sperm are obtained to use and to store for future use.

Adequate numbers of sperm are often retrieved allowing for cryopreservation and future ICSI cycles. With the advent of microsurgical epididymal sperm aspiration (MESA), sperm are retrieved in higher numbers than with PESA, allowing for cry preservation of large numbers of sperm.

MESA is the second option. Men with nonobstructive zoosperm have an impairment of normal spermatogenesis.

The technique of microsurgical epididymal sperm retrieval offers the advantages of minimizing contamination of epididymal fluid with bloodcells, repeated aspirations can be performed and aspiration of sufficient quantities of fluid for immediate use as well as for cry preservation are possible.

Mesa allows for the recovery of the best quality and highest quantity of sperm compared with the other techniques.