In Vitro Fertilization and MESA

IVF is a treatment for women and men who can’t get pregnant the natural way. It involves mixing sperm with eggs in a lab to help them fertilize and implant in the uterus.

MESA is a surgical sperm retrieval technique used in men with azoospermia due to vasal obstruction (s/p vasectomy or congenital bilateral absence of the vas deferens). It is often performed along with microTESE and patients usually cryopreserve sperm during this procedure for future IVF/ICSI.
Microsurgical Epididymal Sperm Aspiration (MESA)

MESA is a surgical procedure performed to retrieve sperm from the epididymis tubules in men with obstructive azoospermia. It allows for the acquisition of millions of motile sperms, which can then be electively cryopreserved for future IVF ICSI attempts.

In our study, we found that MESA-ICSI cycles yielded significantly higher live birth rates than ICSI using testicular sperm in men with obstructive AZO caused by congenital bilateral absence of the vas deferens (CBAVD) or vasectomy. The results support the hypothesis that epididymal sperm can be used effectively in ICSI and intracytoplasmic sperm injection (ICSI).

Under local anesthesia, a needle is inserted into the scrotum to access the epididymis. Under an operating microscope, the epididymis is dissected revealing 7-11 efferent ducts. Under careful microsurgical technique the caput of the epididymis is reflected and one efferent duct is punctured through an opening in the tunic. Fluid is aspirated from this duct through capillary action. Repeat aspirations can be performed if necessary to obtain sufficient quantities of sperm.
Sperm Retrieval

In cases where a man has a blockage of the vas deferens or epididymal tubes (s/p vasectomy or congenital bilateral absence of the vas deferens) or impaired testis sperm production, he may need to have a surgical procedure called microsurgical epididymal sperm aspiration (MESA). This procedure can be done with local anesthesia and is performed by a urologist under operating microscope.

During MESA, the urologist uses a needle to aspirate sperm-containing fluid from the epididymal tubes. This typically yields a high number of motile sperm that can be used immediately or frozen for future IVF cycles.

Another sperm retrieval option is percutaneous epididymal sperm aspiration(PESA). PESA is similar to MESA but it does not require anesthesia or a microsurgeon and can be performed by urologists who do not have special training. It is especially useful in men with obstructive azoospermia because it allows sperm to be retrieved from the epididymis where they often cannot travel from the testicle to the ejaculate.
Sperm Extraction

When a man is unable to produce healthy sperm or can’t ejaculate, the only way to get sperm is through a fertility procedure called intracytoplasmic sperm injection (ICSI). In this procedure, a single sperm is directly injected into an egg in a laboratory setting. The resulting embryo is then placed in the woman’s uterus for implantation. This technique is most effective when used in conjunction with sperm retrieval.

During MESA, your urologist inserts a needle into the scrotum to find the tubes that contain sperm in the epididymis, a small organ that transports sperm from the testicles. The sperm can be immediately used or frozen for future use. If the sperm retrieved is not healthy, a follow-up treatment known as TESE or testicular sperm extraction can be used to look inside the testicle for sperm.

PESA is similar to MESA, but doesn’t require a surgical cut and requires only general or spinal anesthesia. It is especially useful in conditions like a prior vasectomy or hernia repair with mesh, as well as a blocked seminal vesicles.
Sperm Cryopreservation

Once enough sperm is found, it can be frozen (cryopreserved) for future use. The sperm is stored at a very low temperature in a tank of liquid nitrogen, which has a freezing point of -196 degrees Celsius. The sperm is also tested for viability and motility.

Cryopreserved sperm can be used at any time in the future. The thawed semen is combined with eggs, either from the woman or from a donor, to create embryos that can be implanted in the uterus and result in pregnancy.

Studies have shown that thawed cryopreserved sperm is as effective in fertilizing eggs as fresh sperm. The thawing process does not seem to damage the sperm or its acrosomal membranes, which are essential for sperm-egg vitro fertilization mesa

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