(353) Microsurgical Epididymal Sperm Aspiration

Introduction Microsurgical Epididymal Sperm Aspiration (MESA) is a refined microsurgical technique employed for sperm retrieval in men with obstructive azoospermia, such as in cases of congenital bilateral absence of the vas deferens (CBAVD) or post-vasectomy obstruction. Objective To describe the microsurgical technique of MESA in men with obstructive azoospermia, and to compare its outcomes with TESE in terms of sperm yield, motility, cryopreservation efficiency, surgical invasiveness, and recovery profile Methods This video illustrates the microsurgical technique of MESA. Under high magnification, dilated epididymal tubules are carefully identified, incised, and their fluid aspirated using fine microsurgical instruments. The collected epididymal fluid is then examined to assess the presence and motility of spermatozoa, which are subsequently used for intracytoplasmic sperm injection (ICSI) or cryopreserved for future assisted reproduction. Results MESA consistently demonstrated a higher sperm yield and better motility, often providing enough motile sperm for multiple ICSI cycles from a single procedure. Cryopreservation efficiency was superior with MESA, allowing long-term storage and repeated use. Tissue trauma and postoperative complications were minimal due to the targeted aspiration of epididymal tubules. Conversely, TESE produced a lower sperm yield with more variable motility, required direct testicular extraction, and caused greater tissue trauma. While recovery after TESE was generally uncomplicated, it was slower compared to MESA. Microsurgical expertise was essential for MESA and micro-TESE but less critical for basic TESE in obstructive cases. Conclusions MESA offers significant advantages in sperm yield, quality, and tissue preservation but demands advanced microsurgical skills. TESE remains a valuable alternative, particularly in non-obstructive azoospermia or when epididymal sperm are unavailable. The choice of technique should be individualized, considering etiology, surgical expertise, and patient-specific fertility goals. Disclosure No