Azoospermia, a condition characterized by the absence of spermatozoids in the ejaculate, is found in 5% of couples wishing to become pregnant. Azoospermia can be secretory, that is characterized by the complete absence of spermatozoids caused by a primary pituitary or testicular insufficiency, or obstructive, due to the obstruction of the excretory ducts. Although azoospermia is associated with male infertility, it does not necessarily result in infertility because sperm production can be maintained at various levels within the testis. Therefore, several methods have been developed to recover spermatozoids from the epididymis or testis of infertile men, which can then be used to achieve pregnancy through medically assisted fertilization techniques.
Microsurgical epididymal sperm aspiration (MESA) is typically performed in men with vasal or epididymal obstructions. During the procedure an incision is made in the scrotal skin and the testis and epididymis are exposed. Using an operating microscope, the epididymal tubules will be opened and sperm will be extracted.
MESA can be performed under general or local anesthesia. After having identified and dissected the tunica vaginalis, by means of a 10x-40x magnification under the microscope, a micro-incision is made at the level of the epididymal serosa, initially highlighting the tubules at the level of the body and then, more and more proximally, up to the head. A sufficiently dilated tubule is selected and opened. The spermatozoids present inside are sucked by a special glass capillary with blunt tip. The collected material is immediately examined to assess the presence of spermatozoids, their motility and quality of progression. Usually, it is necessary to take only a few ml, because the spermatozoids are highly concentrated in the epididymis.
If the sperm motility is not excellent, a new aspiration is performed by changing its position in a caudo-cranial sense: in fact, at the level of the head of the epididymis the spermatozoids with greater motility are usually found. The complete absence of spermatozoids, after repeated attempts, is an indication to perform the testicle sampling (TESE). The tubule is then sutured. The technique offers the advantage of being able to perform intratubular sampling under direct visual control, implement proper hemostasis and collect spermatozoids from multiple sites.
Patients that have had a vasectomy and are not good candidates for a vasectomy reversal or have failed a vasectomy reversal. Some patients may be good candidates for a vasectomy reversal but choose to do a sperm harvesting surgery in order to do in vitro fertilization (IVF) procedures in order to increase the possibility of pregnancy if the spouse is older than 35.
Some patients need a Sperm Harvesting Surgery due to congenital absence of the sperm tubes that carry sperm from the testicle or from obstruction of these tubes as a complication of prostate or inguinal hernia surgeries.
Some patients have a neurological condition that blocks the nerve signals responsible for ejaculation and sometimes patients have had trauma that led to paraplegia and associated ejaculation problems.
Iranian surgery is an online medical tourism platform where you can find the best doctors and surgeons in Iran. The price of MESA procedure in Iran can vary according to each individual’s case and will be determined by an in-person assessment with the doctor.
For more information about the cost of Microepididymal Sperm Aspiration procedure in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.