Sperm retrieval techniques in Obstructive azoospermia: MESA, PESA, and TESA

Abstract

Advances in assisted reproductive technologies (ART), specifically intracytoplasmic sperm injection (ICSI) and sperm retrieval (SR) techniques, allow azoospermic men to father biologic offspring. High success rates have been demonstrated in the cohort of men with obstructive azoospermia. Sperm may be retrieved from the testis or epididymis, for immediate use or cryopreservation in conjunction with ICSI. The choice of SR modality, source of sperm, and the decision to use fresh versus cryopreserved sperm depends largely upon the reproductive surgeon, the reproductive lab personnel, facility in which the sperm is retrieved and patient preferences. Currently there is no expert consensus on which SR modality or sperm source is superior, and it is recommended that decisions be made on a case-by-case basis. The following chapter will review the technical aspects of several SR modalities. In addition, a review of the pros and cons as well as the success rates of each procedure will be discussed.