Retrieving Sperm From Patients With Azoospermia

There are a number of options to try and retrieve sperm from patients with azoospermia. Percutaneous epididymal sperm aspiration, or PESA, involves opening the epididymal tubules to remove immature sperm cells, typically under local anesthesia. This can be done in men who cannot undergo a vasectomy reversal, or in cases of CBAVD where the ejaculate is absent due to obstruction. Microsurgical epididymal sperm aspiration (MESA), on the other hand, involves removing the immature sperm cells from the ejaculate and/or the testicle using a microsurgical procedure.

Studies have shown that both percutaneous PESA and MESA can result in high sperm recovery rates, with similar SRRs and reported fertilization and pregnancy outcomes when used in conjunction with ICSI. However, MESA requires an operating room setting and specialized microsurgical skills, and can only be performed if the patient has no obstructed pathology proximal to the ejaculate.

Another option is a more invasive technique called tetraepidiosperm aspiration or TESA. This method is often more effective than PESA and allows for the retrieval of sperm from the testicle in patients with no ejaculate. The sperm is then injected directly into the egg for ICSI, which has been shown to produce higher fertilization and pregnancy rates than IVF alone.

A number of urology practices require their patients to sign an advanced beneficiary notice, or ABN, before they undergo PESA, MESA and TESA. This ensures that the practice will receive payment directly from the patient if the insurance carrier denies reimbursement. pesa mesa

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