Surgical sperm retrieval is an important procedure in the treatment of azoospermia due to vasal or epididymal obstruction. The most commonly used procedures include TESA (Testicular Epididymal Sperm Aspiration) and TESE (Testicular Epididymal Sperm Extract). During a TESA procedure, the physician inserts a needle into the testis and aspirates the sperm from the surrounding tissue. Afterwards, the andrologist separates the sperm from the other cells in a medium. These sperm can then be used for IVF/ICSI. These sperm can be either fresh or cryopreserved for future use.

Both TESA and TESE procedures result in a high amount of sperm retrieved; however, the number of viable sperm varies and is rarely enough to utilize for standard In-Vitro Fertilization with Intracytoplasmic Sperm Injection (ICSI). The sperm from these procedures will need to be obtained using more advanced methods.

A more invasive method is the MESA (Microsurgical Epididymal Sperm Aspiration) procedure, in which the doctor removes the spermatic cord with a local skin block and then cuts open the scrotum to access the epididymes. This is the most effective way to obtain a large quantity of mature sperm; however, it can lead to postoperative scrotal edema and necrosis of the tunica albuginea or the testicular canal.

During the MESA procedure, there is also a significant increase in serum antisperm antibodies and a reduction in the spermatogenic potential of the testis. Additionally, histomorphometric analysis revealed alterations in the testis and epididymis following MESA; however, these findings may not be clinically relevant. mesa tesa