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If there is normal or near-normal sperm production in the testis, but the ducts are clogged and there is no ѕperm in the semen (obstructive azoosрmi), it is the procedure to obtain sреrm from the ducts (epididymis) of men by microsurgery method (MESA) under local or general anesthesia.
The epididymis is examined at 15-25 times magnification. There are enlarged intratesticular ducts (tubules). The wide channels found are entered with an ophthalmic micro scalpel. At this point, sperm analysis is performed and it is determined whether the procedure will continue or not. Epididymal function (sperm collection) is continued until sufficient fluid is identified microscopically. If sufficient epididymal fluid is identified, it is atraumatically collected with glass micropipettes.
Mesa surgery is performed by making an incision into the canal in the epididymis under the microscope. The purpose of MESA is to identify and open a single epididymal tubule to aspirate a sperm-rich, red blood cell-free fluid that has been frozen for either fresh sperm injection or one or more microinjection attempts. A large amount of uncontaminated, quality sperm can be found for microinjection with the MESA technique. MESA is required for obstructive azoospermia cases and Micro-TESE is applied for the most severe nonobstructive azoospermia cases. The post-mesa recovery period is longer than the TESA procedure.