In the past decade, the techniques of epididymal sperm retrieval and micromanipulation to assist fertilization have been two of the most exciting developments in the field of male infertility treatment. Men with congenital bilateral absence of the vas defences (CBAVD) or surgically unreconstructable reproductive tract obstruction are now able to achieve pregnancies with use of these advanced techniques.
We have found that microsurgical epididymal sperm aspiration (MESA) using a glass micropipet technique simultaneous to intracytoplasmic sperm injection (ICSI) appears to maximize opportunities of pregnancy for these infertile couples with unreconstructable male reproductive tract obstruction.
MESA from individual epididymal tubules with a micropuncture technique allows retrieval of high numbers of sperm with optimal quality for immediate use during ICSI as well as for cryopreservation. A unique micropuncture pipet holding apparatus, MESA- Holder has been developed and patented at Cornell. Its unique 180° angle adjustable pipet holding system simplifies the procedure of micropuncture epididymal sperm retrieval. The micropuncture technique is an atraumatic technique that limits damage to the epididymal tubules and avoids potential blood cell contamination of the epididymal fluid, while yielding high quantities of motile spermatozoa.