Microsurgical epididymal sperm aspiration: Review of techniques, preoperative considerations, and results

Abstract

The location of optimal sperm quality in obstructed men is in the proximal portions of the epididymis, vasa efferentia, and rete testis, whereas the distal obstructed reproductive tract is the site of sperm degeneration. Spermatozoa retrieved from the testis have been successful in achieving fertilizations and pregnancies for couples in whom epididymal aspiration failed; however, reported fertilization and pregnancy rates have been lower than those achieved with epididymal spermatozoa. Of the sperm retrieval and assisted reproductive techniques, the most successful combination reported to date is microsurgical epididymal sperm aspiration (MESA) with intracytoplasmic sperm injection (ICSI), with fertilization rates and pregnancy rates as high as 45% and 56%, respectively.