MESA, TESE, MicroTESE
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This document discusses and compares different sperm retrieval techniques for assisted reproduction, including MESA (microscopic epididymal sperm aspiration), TESE (testicular sperm extraction), and Micro-TESE. It provides details on the techniques, including their effectiveness, efficiency, costs, complexity, and complication rates. For non-obstructive azoospermia, Micro-TESE has higher sperm retrieval rates of 40-67% compared to 20-60% for conventional TESE. Micro-TESE also retrieves less tissue on average but has higher fertilization and live birth rates. The document emphasizes Micro-TESE as the preferred technique for non-obstructive azoospermia cases.
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MESA, TESE, MicroTESE
- 1. MESA, TESE, MicroTESE Sandro C. Esteves Diretor Médico e Científico, ANDROFERT Campinas, São Paulo XXXV Congresso Brasileiro de Urologia Rio de Janeiro, Novembro 2015 – C37
- 2. Técnicas de Captação de Espermatozoides para Reprodução Assistida (ICSI) Esteves et al. Sperm Retrieval Techniques. Int Braz J Urol 2011; 37: 570-83 Acrônimo Técnica MESA Microsurgical Epididymal Sperm Aspiration TESE Testicular Sperm Extraction Micro-TESE Microdissection Testicular Sperm Extraction ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 2 2015 ANDROFERT
- 3. Azoospermia Obstrutiva Technique Acronym Percutaneous Epididymal Sperm Aspiration PESA Microsurgical Epididymal Sperm Aspiration MESA Testicular Sperm Aspiration TESA Esteves & Agarwal. Sperm Retrieval Techniques. Cambridge University Press, 2011 ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 3 2015 ANDROFERT
- 5. Microsurgical Epididymal Sperm Aspiration (MESA) ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2015 ANDROFERT Cortesia Dr. Marcello Cocuzza
- 6. Esteves SC, Int Braz J Urol 2015; 41:817-8. Available at: www.brazjurol.com.br/videos/july_august_2015/Esteves_817_818video.htm
- 7. MESA vs PESA MESA PESA Efetividade (Sptz +) ~100% ~100% Eficiência (No. Sptz) +++ ++ Criopreservação ~100% casos 1/3 casos Custo-efetividade NA NA Complexidade +++ + Complicações ++ + (8/146=5.5%)* Repetição Sim Sim Efetividade ICSI ~40% NV/TEMiyaoka & Esteves. Clinics 2013; 68 Suppl 1: 111-9. *Esteves et al. J Urol. 2013; 189(1): 232-7
- 8. 100% 96.6% 96.3% CBAVD Vasectomy Post-infection OBSTRUCTIVEAZOOSPERMIA Successful Retrievals PESA + rescue TESA PESA alone Esteves et al. J Urol. 2013; 189(1): 232-7 146 patients Sperm retrieval in CBAVD ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 8 2015 ANDROFERT 78.1% ~100%
- 10. Azoospermia Não-obstrutiva Técnica Acrônimo Tx sucesso Testicular Sperm Aspiration TESA 15-50% Testicular Sperm Extraction TESE 20-60% Microsurgical Testicular Sperm Extraction Micro-TESE 40-67% Esteves & Agarwal. Sperm Retrieval Techniques. Cambridge University Press, 2011 ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 10 2015 ANDROFERT
- 13. Micro-TESE vs TESE: Efetividade 45% 93% 64% 20% 25% 64% 9% 6% Overall Hypospermatogenesis Maturation Arrest Sertoli-cell Only Sperm Retrieval Success Rates Micro-TESE single-biopsy TESE Controlled series (N=60) Histology categories pairwise comparisons: p<0.0001 Method P=0.0005 Verza Jr & Esteves. Fertil Steril 2011; 96 (Suppl.): S53 ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 13 2015 ANDROFERT
- 14. Tissue removed (mg) Conventional TESE Micro-TESE P-value 65 ± 25 8.9 ± 2.5 <0.01 Conventional TESE Micro-TESE Esteves & Varghese J Reprod Sci 2012; 5: 233-43. ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 14 2015 ANDROFERT Micro-TESE vs TESE: Eficiência
- 15. 41.4 47 43.3 20 100 64 61 34.2 Sperm retrieval (%) 2PN Fertilization (%) Top Quality Embryos (%) Live Birth (%) Non-obstructive (N=365) Obstructive (N=146) P<0.01 ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 15 2015 ANDROFERT
- 17. http://androfert.com.br/videos Esteves SC, Int Braz J Urol 2013 ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 17 2015 ANDROFERT
Editor's Notes
- Certain cases of OA are potentially reversible by using microsurgical or endoscopic methods. Another option for this group of patients is ART. Sperm can be easily obtained from the epididymis or testicles by percutaneous or microsurgical methods.
- Sperm can be easily obtained from the epididymis or testicles by percutaneous or microsurgical methods.
- 14
- The chances of finding sperm, and the chances of achieving a live birth by ICSI is completely different depending on the type of azoospermia. Successful sperm retrieval are 43 times higher in man with OA compared to NOA. Although men with NOA should not be considered sterile, their chances of having their own offspring is significantly lower compared to the counterpart with NOA