PESA/MESA/TESE – Surgical sperms retrieval
In the event of absence of vital sperms in the ejaculate, the possibility of getting sperms by surgical means from epididymis (PESA or MESA) or from testicle (TESE) should be considered.
PESA (Percutaneous Epididymal Sperm Aspiration)
MESA (Micro Epididymal Sperm Aspiration)
In both methods sperms are obtained from epididymis upon the impaired transport of sperms between epididymis and urethra. In the event of the PESA method the sperms are aspirated together with the fluid from epididymal ducts with a fine needle directly through the skin of scrotum; in the event of the MESA method a small microsurgical skin incision is performed, a puncture needle is inserted via this incision and the fluid is aspirated. The fluid is immediately analyzed in an embryology laboratory.
TESE (Testicular Sperm Extraction)
If no sperms have been obtained with the MESA method, we proceed to the TESE. This method is based on an attempt to get sperms directly from the testicular germinal epithelium. Tissue samples are taken from small incisions in the outer testicular layer and are referred to the embryology laboratory.
The procedures are performed on the outpatient basis in a short general anesthesia. The advantage of our clinic is the planning of the procedure for the same day as the oocyte puncture in the female partner. The obtained fresh sperms are immediately used for oocyte fertilization with the ICSI method. The spare tissue is cryopreserved to avoid the need to repeat the procedure.
Therefore, the team consisting of a gynecologist and a urologist at the same clinic is a prerequisite of excellent cooperation and of high success of treatment. Additional PGD examination would be useful in indicated cases.
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