Epididymal and testicular sperm retrieval (MESA - TESE) for ICSI in obstructive and non-obstructive azoospermia

Congenital absence of the vas deferens or other unbeatable forms of obstructive azoospermia may be successfully overcome by microsurgical epididymal sperm aspiration (MESA) as described by Silber. Thanks to the introduction of sperm microinjection techniques (ICSI), the results of MESA have been improved and pregnancies have been reported also in cases with testicular failure, employing sperm retrieved from the testicular parenchyma (TESE). The steps of MESA and TESE techniques, including the laboratory section of ICSI are shown in detail in the video. The standard approach of MESA with tubule micropuncture is illustrated. This technique, which employs a glass micropipet with a cutting tip, allows a bloodless sperm retrieval. We have also recently developed a minimally invasive approach of MESA under local anaesthesia, performed through a small "window" scrota! incision, without delivering the testis through the scrotum. Total count of sperm retrieved are comparable to the standard technique, but the patient can be immediately discharged. In selected cases the procedure may be preceded by the endoscopie exploration of the whole epididymis. TESE was performed on azoospermic patients with testicular failure (Sertoli Cells Only Syndrome, maturation arrest). In the procedure, multiple biopsies are taken from both testes and the specimen obtained are processed for sperm extraction. The interesting case of a man with azoospermia due to severe tubular fibrosis and maturation arrest is presented No mature germ cells were visible in the diagnostic testicular biopsy. However, with TESE a total of 200 sperms were retrieved and 4 good quality embryos developed after ICSI. This confirms the possibility of fertilization in cases so far considered absolutely infertile.