Azoospermia, or the condition of no sperm in the ejaculate, happens either because there is a blockage in the reproductive tract or a deficiency in sperm production. For many men with this type of infertility, a surgical procedure is necessary to extract sperm directly from the epididymis, where mature sperm are stored, or the testicles, where they are produced.
The era of In Vitro Fertilization (IVF) with ICSI has allowed the reproductive laboratory to fertilize an egg with just a single sperm by placing the sperm directly into the egg. This has lowered the requirement for the number of sperm needed to get pregnant from millions to just a few.
Extracting sperm from their storage site in the epididymis is an excellent way of getting sperm to use for IVF in patients with a blockage in the reproductive tract.
Microsurgical Epididymal Sperm Aspiration or MESA is a relatively painless and minimally invasive procedure performed in our office under local anesthesia.
Only a very small incision need be made under local anesthesia to be able to access the epididymis. Using magnification, Dr. Werthman can see the tiny epididymal tubules and open several to get the sperm contained within. Usually enough sperm can be obtained to freeze for multiple cycles of IVF.
The sperm that are removed are always checked immediately under a microscope. If they are not very good quality, Dr. Werthman will proceed to remove sperm fluid directly from the testicle through the same small incision.