Surgical Options for Male Infertility: Sperm Extraction

Microsurgical epididymal sperm aspiration (MESA) is considered the best way to obtain sperm in men that have a blockage which interferes with the delivery of the sperm during ejaculation.  In these cases, the male partner produces sperm in adequate amounts, but the sperm is unable to move from the epididymis to the testicle and into the ejaculate. Vasectomies, unsuccessful vasectomy reversals, Cystic Fibrosis, infection, and trauma to the area can block sperm from being released.

During MESA, a skilled surgeon will remove the sperm directly from the epididymal tubes using a specialized microscope that allows for visualization of the individual tubes.  The surgeon will make a small incision in the scrotum, identify the epididymal tubes, and aspirate the fluid. Typically, MESA results in a high number of motile sperm that can be used immediately or frozen for future IVF cycles, eliminating the need for future sperm retrieval procedures and decreasing the damage to the epididymis.

For the MESA procedure, patients will need general or spinal anesthesia; your urologist will discuss recovery times and the restrictions involved when undergoing a MESA procedure. 

Understanding TESE

In about 7 percent of men who undergo MESA, doctors are unable to retrieve sperm.  For these cases, sperm is taken from the testicle itself in a procedure known as testicular sperm extraction (TESE).

Prior to the TESE procedure, patients should undergo a diagnostic testicular biopsy to make sure that mature sperm are being produced by the testis. If the biopsy shows mature sperm that have complete tails, then proceeding as planned with the TESE procedure is recommended. 
During the TESE procedure, the doctor inserts a small, fine needle into the testicles to obtain many samples of tissue. These specimens are then examined under a microscope to determine if sperm are present.  If no sperm are identified, a testicular biopsy can be performed and a small amount of tissue is directly examined to look for sperm.

Because sperm retrieved using TESE are immature, the physician will perform ICSI for fertilization to occur.  ICSI is also suggested due to the low sperm numbers that are typically found during the TESE procedure.  Any sperm and testicular tissue retrieved during the TESE procedure can be frozen for use in future IVF cycles, which avoids the need for a repeat sperm retrieval procedure. 
Your urologist will discuss the procedure (specific to your case), recovery time and restrictions involved when undergoing a TESE procedure.