Microsurgical Epididymal Sperm Aspiration (MESA)

MESA (Micro-Epididymal Sperm Aspiration) is an open surgical sperm retrieval technique to treat male infertility problems such as Azoospermia (total absence of sperm in ejaculation) and reproductive tract blockage. Reproductive tract can be blocked due to various genital surgeries including vasectomy.

Under this procedure, operating microscopy is used and sperm retrieval is done directly from the epididymis (reproductive tube connecting the testicles to the sperm carrying vessels) organ in the male genitalia.

MESA is normally used to assist pregnancy for the childless couples through Assisted Reproductive Technology (ART) such as IVF (In-Vitro Fertilization) and sometimes IUI also. It involves s.a surgery to cut open the scrotum and retrieve the sperm. This MESA procedure causes pain for some days.

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When to expect MESA?

This technique is used when the father has issues in sperm production due to various reasons such as:

1- Azoospermia– When zero sperm is found in the ejaculated semen in a Semen Analysis Test or Sperm Culture Report then MESA may be suggested. Azoospermia is of two kinds -

  • Obstructive Azoospermia (no sperm in the semen due to infection/accident/surgery in testicles, prostate or the reproductive tract)
  • Non-obstructive Azoospermia (no sperm in the semen due to abnormal sperm production mostly related to hormonal problems or genetic)

However, MESA is not suggested in Non-Obstructive Azoospermia (NOA) as it is difficult to find sperm in the epididymis when sperm production is impaired due to genetic factors in NOA.

2- Oligospermia- MESA is suggested when the male has Oligospermia (low sperm concentration in the semen)

3- MESA is helpful when the male has previous genital surgeries such as Vasectomy (male sterilization surgery for permanent contraception) and Inguinal Hernia Repair (surgery to repair a hernia in the groin)

4- Men diagnosed with Cystic fibrosis (a genetic disorder affecting lungs), which leads to infertility problems by affecting the development of vas deferens-tube carrying the sperms to the testicles.

5- MESA is required when the male has a problem with blockage of seminal tissues or vas deferens due to cysts.

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How is MESA Procedure performed?

MESA procedure is very minimal and less invasive. The entire procedure of sperm retrieval through MESA takes only 30-45 minutes. The detailed MESA procedure is explained below:

1- The patient is given general or local anesthesia with intravenous sedation.

2- The scrotal skin is sterilized with antiseptic and prepared for the surgery.

3- The surgeon makes an incision in the scrotal skin exposing the testicles and the epididymis.

4- An operative microscope is used to locate a single Epididymal tubule.

5- Sperm is retrieved from the Epididymis and tested in the laboratory using sperm culture or general semen analysis test.

6- Retrieved sperm can be used for IVF (in-vitro fertilization) or can be frozen (cryopreserved) for future IVF cycle/s.

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What are MESA Risks & Benefits?

MESA procedure entails lots of benefits as well as risks. Below we have outlined how much MESA can be beneficial for you. Also, the risk factors of MESA are discussed accordingly.

MESA Benefits-

  • MESA is beneficial as it allows you to retrieve a large amount of sperm, which can be cryopreserved or frozen to use in future IVF cycles as well.
  • MESA benefits to those couples who do not want donor sperm and want their biological child.
  • Less invasive and needs microsurgery.
  • MESA is the best way to retrieve sperm if TESA (Testicular Sperm Aspiration) fails or when sperm retrieval is not possible through TESA.

MESA Risks-

  • Mild pain lasting 3 to14 days is common after MESA.
  • Risk of Haematoma (swelling with clotted blood in the scrotal tissue) is thereafter MESA.
  • Swelling of the testicles with discoloration of the scrotal skin is also observed in some patients after MESA.
  • Risk of infection in the incision site (swelling, redness, rash, itching) persists up to a week after MESA surgery.
  • One should avoid the sexual activity and spicy food after MESA as these can complicate a patient’s pelvic and bowel area respectively.

Source :- https://www.elawoman.com/blog/fertility-treatments/what-is-mesa-treatment

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