Obstructive Azoospermia is the complete absence of sperm in the ejaculate due to obstruction in the male reproductive tract. Though this number is close to 40%, the number of people having unreconstructable Azoospermia is also quite significant. This is helped by the ICSI procedure with advanced techniques like Microsurgical Epidydymal Sperm Aspiration. Sperm obtained from men with chronic obstruction may have poorer motility and fertilizing capacity as compared with fresh ejaculated sperm. Hence the need for ICSI to obtain optimal results.
What is the Epidydymis?
The Epidydymis is an organ closely attached to the posterior part of the testis and contains a single twisted tubule through which sperm from the testis must pass. Spermatozoa attain maturation within the epidydymis in that they become fully motile and get the ability to fertilize an egg. The epidydymis takes care of sperm maturation, transport and storage.
Types of Epidydymal Sperm Aspiration
Epidydymal sperm aspiration can be done either by Percutaneous or Microsurgical techniques. The success of Percutaneous Epidydymal Sperm Aspiration (PESA) is about 80%. It does not yield sufficient numbers and hence must be done simultaneously along with egg pick up.
Microsurgical Epidydymal Sperm Aspiration (MESA)
This requires the use of an operating microscope. As this is a guided procedure with magnification, the tubule is identified and incised precisely. The sperm yield is higher in the head portion than in the tail in people with chronic obstruction. The sperms can be aspirated directly onto a micro pipette, used concurrently for ICSI or can be cryopreserved for later use. The sperm quality is also better as the best tubule can be selected under the microscope and incised with sperm retrieval.