Male Surgical Procedures
Testicular Sperm Aspiration (TESA) is an ambulatory procedure performed by the Urologist in the office very rapidly and with minor discomfort. In the laboratory we can then identify the sperm cells from a small sample of testicular tissue and using ICSI (Intracytoplasmic Sperm Injection) an isolated sperm cell is injected into each egg, giving these couples the opportunity of having children.
Microscopic Epididymal Sperm Aspiration (MESA) is a technique for the retrieval of sperm from the epididymis of men in whom transport of sperm from the testicle to the ejaculate is not possible because the drainage (ductal) system is absent or is not subject to reconstruction. This problem most commonly occurs in men with vasal agenesis, a condition in which the vas deferens or drainage system of the testicle fails to develop prior to birth. The majority of these men have mutations of the Cystic Fibrosis (CF) gene; therefore, their female partners require CF testing. In some circumstances the obstruction may be acquired after a failed epididymovasal anastomosis; here again, MESA may be indicated. While the male is being evaluated as a candidate for MESA, his wife is being screened in our IVF program where ICSI is also offered. MESA and IVF-ICSI complement each other and are an essential component of our assisted reproduction laboratories. Epididymal aspiration may be performed on the day of the wife’s egg retrieval, or preferably ahead of time, and the aspirated sperm cryopreserved. The success of pregnancy from this procedure is reported to be 25%-60% depending on female factors. It is a complex process, requiring significant manipulation of the human gametes (eggs and sperm) but one that offers a previously sterile couple the chance of establishing a pregnancy using their own genetic material.