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Antwerp Hospital Network - ZNA

Epididymal sperm aspiration and testicular biopsy (MESA/TESE)

In a number of cases, in-vitro-fertilisation can also be brought in when the sterility problem is caused by a so-called obstructive azoospermia, i.e. when injuries cause blockage of the male transport system of the sperm. Especially in cases of failed repair after sterilisation of the man, it is often still possible to take sperm-cells from the dilated epididymis and then use them for the micro-injection (ICSI). This technique of aspiration of the epididymis is known as MESA (microscopic epididymal sperm aspiration). In these cases, the woman is stimulated (as for a IVF), but before the ovum is picked up, the man's scrotum is opened under general anaesthesia. The tubes of the epididymis are punctured until a satisfying number of sperm-cells is collected. These are being frozen so that ICSI is performed with thawed sperm-cells (so that the operation on the man is kept limited to a once-only procedure). Also the testicle itself is being punctured and in a lot of cases, testicular sperm-cells are obtained (TESE). But if, with this aspiration procedure of the epididymis and testicle, no sperm-cells are obtained at all, an aspiration of the ovum is pointless.

MESA/TESE + ICSI leads to normal pregnancies and can be applied on the same couple more than once. It all depends on the microscopic situation of the epididymis, and this as well for the right as for the left one. Generally, we try to maximise the chances by puncturing both epididymes and/or testicles in one operation, if necessary. As a rule, the operation on the man will always be carried out as a separate and preliminary stage to the ICSI treatment. We thus are certain to have available sperm-cells. Obviously, the treatment cannot be conducted without normal living sperm-cells.
In a number of cases of azoospermia caused by problems in the testicles, sometimes there is also a limited formation of sperm-cells, which can be obtained from the testicle itself and then be injected with the ICSI-technique (TESE (=testicular sperm aspiration) + ICSI).
In some cases, it is an hereditary cause that brings on very serious sperm anomalies. If present, the cause can be passed on to the child thus inheriting a decreased fertility.
We can state that, when a man has sperm-cells somewhere (ejaculate, epididymis, testicle), a pregnancy is always possible. For organisational reasons, the surgical acquisition of the man's sperm-cells is performed in a separate time, so we can see at the most whether and how sperm-cells, locked up in the biopt, can be "prepared and set free" and if so by which means.

 

with the support of the VBO-FEB & Agfa Healthcare
Realised with the help of Brussels Invest & Export