Option |
Advantages |
Disadvantages |
MESA * |
? Blood contamination Lots of sperm back/? Retrieval rates ? Risk of hematoma Best pregnancy rates |
Requires microsurgery expertise ? Cost General anesthesia Requires scrotal exploration ? Post-operative discomfort |
PESA
|
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable Minimal post-operative discomfort ? Cost |
Feasiblility depends on anatomy Less sperm back Blood contamination ? Risk of hematoma Damage to adjacent tissues |
TESA |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable Minimal post-operative discomfort ? Cost |
Less sperm back Blood contamination ? Risk of hematoma Risk of testicular damage/atrophy |
TESE |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable |
If non-obstructive azoospermia, Then less sperm back. Risk of testicular damage/atrophy Scrotal exploration required |
Micro-TESE* |
Few instruments required Best for Non-Obstructive Azoospermia |
Microsurgical expertise required. General anesthesia Not fast/Time consuming Scrotal exploration required ??? Cost ?? Risk of testicular damage ?? Post-operative discomfort Minimally repeatable |
* Requires microsurgical expertise with fellowship-training preferable. |
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