What is it?
Under direct observation, a special needle is used to aspirate viable sperms from the epididymis instead of the testis. Like TESE this is a useful adjunct to IVF and in particular to ICSE. Alternatively it can be done to extract sperms which can be kept refrigerated and used later. Cryopreservation offers the benefit of repeat procedure, should the IVF fail.
Who requires it?
Men with obstruction of the male reproductive tube – congenital or acquired. congenital absence of the Vaz deferens on both sides is a good indication. Acquired causes may be due to infection, injury, previous failed spermatic duct recanalization or failed duct – epididymis recanalization (called vasoepididymostory). Iatrogenic causes may be traceable bladder neck, pelvic, abdominal or inguino-scrotal surgery.
What is the rationale of using TESE?
It was a general conclusion that in a normal male the sperms undergo a certain amount of maturity, mobility and fertilizing capacity before proceeding to the Vaz deferens. However, recent research has shown that in reproductive tract obstruction, good quality sperms are available in the upper part of the epididymis. Microscopically and functionally y they are as good as the sperms of the testis and can be aspirated and used for IVF. However the same cannot be said for the distal epididymis. Here the sperms undergo destruction and plenty of macrophages can be found in histology. These observations become important while selecting the site of sperms aspiration during MESE.
Why it is preferred to donated sperm? Compared to a donor sperm, it is always preferable to have the husband’s sperm if the morphology is ok.
Are there any problems with this procedure?
This is a minimally invasive procedure done using an operating microscope. Only a tiny segment of the epididymis is sliced (called micropuncture) to extract sperms. In comparison a bit of testis tissue is removed in TESE. In MESE, amount of blood contamination of the epididymal fluid is minimised due to the micropuncture. This improves the fertilizing quality of the sperms.
MESE procedure: A tiny surgical incision is made in the scrotum and the testis is first identified. The epididymis is then identified – this is located above and behind the testis. Using an operating microscope , a micropuncture is made on the tubule in the upper part of the epididymis. Epididymal fluid is gently aspirated. The aspirate is immediately handed over to the embryologist who immediately examines the same under the microscope and confirms adequacy and good quality of sperms (sperm count and motility). It optimal amounts of sperms of the right quality is not found, the efferent ductules can similarly be approached through micropuncture. This is one advantage on the procedure. Similarly only a few microliters of fluid is required to harvest the sperms. Hence the procedure can be considered minimally invasive.
Under direct observation, a special needle is used to aspirate viable sperms from the epididymis instead of the testis. Like TESE this is a useful adjunct to IVF and in particular to ICSE. Alternatively it can be done to extract sperms which can be kept refrigerated and used later. Cryopreservation offers the benefit of repeat procedure, should the IVF fail.
Who requires it?
Men with obstruction of the male reproductive tube – congenital or acquired. congenital absence of the Vaz deferens on both sides is a good indication. Acquired causes may be due to infection, injury, previous failed spermatic duct recanalization or failed duct – epididymis recanalization (called vasoepididymostory). Iatrogenic causes may be traceable bladder neck, pelvic, abdominal or inguino-scrotal surgery.
What is the rationale of using TESE?
It was a general conclusion that in a normal male the sperms undergo a certain amount of maturity, mobility and fertilizing capacity before proceeding to the Vaz deferens. However, recent research has shown that in reproductive tract obstruction, good quality sperms are available in the upper part of the epididymis. Microscopically and functionally y they are as good as the sperms of the testis and can be aspirated and used for IVF. However the same cannot be said for the distal epididymis. Here the sperms undergo destruction and plenty of macrophages can be found in histology. These observations become important while selecting the site of sperms aspiration during MESE.
Why it is preferred to donated sperm? Compared to a donor sperm, it is always preferable to have the husband’s sperm if the morphology is ok.
Are there any problems with this procedure?
This is a minimally invasive procedure done using an operating microscope. Only a tiny segment of the epididymis is sliced (called micropuncture) to extract sperms. In comparison a bit of testis tissue is removed in TESE. In MESE, amount of blood contamination of the epididymal fluid is minimised due to the micropuncture. This improves the fertilizing quality of the sperms.
MESE procedure: A tiny surgical incision is made in the scrotum and the testis is first identified. The epididymis is then identified – this is located above and behind the testis. Using an operating microscope , a micropuncture is made on the tubule in the upper part of the epididymis. Epididymal fluid is gently aspirated. The aspirate is immediately handed over to the embryologist who immediately examines the same under the microscope and confirms adequacy and good quality of sperms (sperm count and motility). It optimal amounts of sperms of the right quality is not found, the efferent ductules can similarly be approached through micropuncture. This is one advantage on the procedure. Similarly only a few microliters of fluid is required to harvest the sperms. Hence the procedure can be considered minimally invasive.
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