MESA stands for Microsurgical Epididymal Sperm Aspiration. It is a procedure that requires an operative setting with a microscope. This is the dissection of the epididymis, and then opening and aspiration of a tubule.



PESA stands for Percutaneous Epididymal Sperm Aspiration. It is the use of a fine needle to retrieve sperm from the epididymis (the tiny tube that transports sperm from the testicle to the vas deferens). Oftentimes, we are able to collect sperm without making an incision. This is why patients prefer this procedure. They can be back at work the same day. The pain is less, and we often not only get sperm for the IVF cycle that you are going through, but also to have some sperm to freeze for future use. Unlike the MESA procedure, which involves the use of a large operating microscope, it does not require any special equipment. In the event that the PESA is not successful, either an open aspiration of the visualized epididymis or a TESE can be done.



TESE stands for Testicular Sperm Extraction. It involves making an incision in the scrotum, the skin that surrounds the testicle. This is an attempt to obtain sperm directly from the testicle. It involves opening the covering of the testicle called the tunica albuguinea. The tubules of the testicle are excised, and the tissue is minced in order to check for sperm. This is typically done in the presence of an embryologist who will confirm if sperm is present or not. Obviously, one of the possible outcomes for the TESE is the failure to find sperm. The more advanced form of the TESE is the microTESE (Microsurgical Testicular Sperm Extraction), which involves the use of an operating microscope to look for the most dilated tubules, in hopes that those tubules will contain sperm. The microTESE is a more involved procedure because it involves the delivery of the testicle from the scrotum in order to open it and view the entirety of the tubules. This involves sedative anesthesia in my practice.

There are risks to any procedure, and the TESE is no exception. The risks include infection, pain, bleeding, failure to find sperm, and injury to the testicle. Depending on the patient's pain tolerance, the patients will be uncomfortable or even in pain for several days. The return to work and physical activity will depend on the patient and how extensive the procedure is. Typically, the patient can return to work (depending on what they do in a day or so) and be back to full physical activity in one to two weeks.

Postoperatively, patients are encouraged to take at least the next day off from work, and to ice the scrotum as much as possible for 24 hours. A small amount of external oozing of blood is not uncommon. Patients return at approximately one week for follow-up.