What is A MESA surgery and who is it for? What are the benefits and disadvantages?
What is a MESA surgery?
A MESA surgery is a microsurgical aspiration of sperm from the epididymis = Microsurgical Epididymal Sperm Aspiration.
During surgery, an opening is made in the epididymis under a designated surgical microscope. The surgeon examines the tissue in high resolution, selects better areas that have potential for producing a large amount of quality sperm cells, avoiding injuries to the blood vessels which nourish the epididymis tissue.
Who is it for?
The surgery is for patients who are diagnosed with OA – Obstructive Azoospermia. In this condition, although a normal production of sperm exists in the testicle, in the sperm test no sperm cells were observed due to various obstructions in the sperm ducts which prevent the passage of semen into the urethra. These obstructions are caused by acquired reasons (such as infection in the sperm ducts, hernia surgery), or congenital (such as being a carrier of CF, in this case it is possible there is a congenital lack of sperm ducts).
In this situation, sperm must be extracted from the testicle surgically, and to then inject the cells into the eggs (IVF-ICSI), in order to achieve pregnancy.
What are the benefits?
There are 2 significant benefits to the extraction of sperm from the epididymis:
The testicle has a double function: to manufacture sperm and to produce testosterone – a most important hormone for a man.
The sperm cells start to form in the testicle, in a process which takes about 6o days, after which they advance to the epididymis, where they mature completely, are provided with mobility, and they are collected in it. In fact the epididymis acts as a kind of “warehouse” for the sperm. When extracting sperm from the epididymis, it is expected to obtain a very large number of sperm cells, in a way that eliminates the need for further surgery in the future.
Also, during a MESA surgery, the surgeon receives feedback from the lab adjacent to the operating room, regarding the quality of the sperm received from each area samples, and focuses on the areas that have the best potential both in terms of quality and quantity.
[The extraction of sperm from the epididymis in a non-surgical manner – PESA, is carried out “blindly” without observing it in the microscope, and has the risk of epididymis degeneration, as well as the fact that during this procedure the surgeon does not have the opportunity to select the better tissue, and the sperm extraction potential quantity is significantly lower].
What are the disadvantages?
The MESA surgery is performed only by a male fertility specialist (Andrologist) who underwent micro-surgery training, and also, the surgery takes longer compared to other options of sperm extraction in obstruction cases – TESE/TESA (about two hours or more as opposed to half an hour to an hour). For this reason, its availability in the Israeli health system is relatively low.
Dr. Shlomi Barak performed all types of sperm extraction surgeries. Each treatment starts with a consultation session during which Dr. Barak reads the file thoroughly, physically examines the patient and independently performs a testicular US, thus adapting the best possible treatment for him.