P-003 Obstructive azoospermia; MESA should be employed as the method for sperm retrieval, not TESE

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Abstract Study question TESE is widely used for obstructive azoospermia (OA) as a surgical method for sperm retrieval, but is it benefiting the patient? Summary answer Since MESA-ICSI has a very good fertilization rate, clinical pregnancy rate and delivery rate, MESA should be employed for the OA subjects, not TESE. What is known already TESE and micro-TESE are technically simple, and widely used as a sperm retrieval surgery because they do not require microsurgical skills. Some review articles have shown no significant differences in the rates of cleavage, good-quality embryos, implantation, clinical pregnancy between ICSI with epididymal sperm or testicular sperm. Clinical usefulness of MESA is still controversial according to previous reports. Study design, size, duration We studied 110 patients diagnosed with OA and treated with MESA at the Asada Ladies Clinic between April 2004 and December 2021. Participants/materials, setting, methods The MESA was performed using a micropipette with a micropuncture technique under operative microscope. When no sperm were present or motility was not observed, additional punctures to the epididymal tubule were performed. Aspirated samples were transferred into modified human tubal fluid and sent to the in vitro fertilization (IVF) laboratory for cryopreservation. Main results and the role of chance Motile sperm were recovered in all cases (110 cases). Of these, ICSI using frozen thawed sperm was performed in 101 cases. The rate of normal fertilization rate was 76%. Of the 399 embryo transfer (ET) cycles, 168 had a clinical pregnancy (41% per ET). Of the 101 patients who underwent ART, 94 (93% per case) had clinical pregnancies resulting in 90 (89.1%) deliveries. It should be emphasized that since MESA does not involve incision of the testes, there are fewer postoperative peritoneal irritation symptoms and no concerns about postoperative testicular atrophy or low testosterone levels. Some review articles showed no significant differences in the rates of cleavage, good-quality embryo, implantation, clinical pregnancy between ICSI with epididymal sperm or testicular sperm. Although clinical usefulness of MESA is still controversial, if the ART results of MESA-ICSI and TESE-ICSI are the same, MESA should be performed as it is less invasive on the patient and reduces the burden on the embryologist who have to process the TESE tissue. Limitations, reasons for caution Some authors have reported that since MESA specimens contain DNA fragmentated sperm when compared with specimen of TESE, subsequent ICSI results in poorer fertilization and pregnancy rates. We did not evaluate sperm DNA fragmentation. Wider implications of the findings A large quantity of uncontaminated sperm can be retrieved using MESA which is less invasive for the patient, and there is no need for special processing before cryopreservation. Additionally, it can reduce the laboratory workload. Trial registration number not applicable