Progress of MESA
The appendage is removed through a 1.5–2 cm incision on the scrotum; Under a magnification of 15–20×, the dilated tubule is located; it is opened with a microneedle, and the flowing liquid is aspirated into the medium. The embryologist immediately assesses the number and motility of sperm; If the result is good, the procedure is completed, the material is used on the day of follicle puncture or frozen. The appendage and skin are sutured with microsutures. After 1–2 hours the patient goes home; pain is minimal.
When is sperm retrieval needed?
With azoospermia - the absence of sperm in the ejaculate - conception is possible through IVF-ICSI, for which sperm are obtained surgically. In the obstructive form (patency is impaired, spermatogenesis is preserved), they are aspirated from the epididymis (MESA) with a success rate of more than 95%. In the non-obstructive form (spermatogenesis itself is impaired), foci of preserved spermatogenesis are looked for under a microscope inside the testicle (Micro-TESE) - sperm are found in 40–60% of men, including those with Klinefelter syndrome and after chemotherapy.
Results and cryopreservation
The resulting sperm are either immediately used to fertilize the partner’s eggs (the operation is synchronized with follicle puncture), or are frozen in a cryobank for future IVF cycles. The embryologist evaluates the material directly in the operating room. Complications are rare: hematoma, temporary pain; testicular function after Micro-TESE is preserved thanks to gentle microsurgical techniques.
