Microsurgical Vasectomy Reversal (or microsurgical reconstruction of a blockage in the sperm transport system from a different cause) should always be performed when natural pregnancy achievement is possible.
The microsurgical skill set of the surgeon is as important as anything else in getting the best result for you. As microsurgery is a big part of my practice, I am happy to lend my expertise and experience in this area to help you optimize your chances to realize your dream of a beautiful baby.
Microsurgical Epididymal Sperm Aspiration
Microsurgical Epididymal Sperm Aspiration (MESA) is performed when there is a blockage to sperm flow that cannot be corrected.
Having one of the world’s largest experiences in this procedure, I extract sperm from outside the testis, freeze it at one of the many IVF groups I work with, and they use it later as a source of sperm for a cycle of ICSI. The pregnancy rate is excellent. I authored the first papers on intentionally freezing the sperm, now a commonly used approach in the top IVF centers.
Microsurgical Testis Sperm Extraction
Testis Sperm Extraction (TESE) is carried out in those unfortunate men who have a problem with sperm production to such a degree that there are no sperm seen in the semen. By microsurgically searching through the testis, I look for areas that may have tiny amounts of sperm within them. Those areas are harvested and either used right away in an ICSI cycle or frozen for later use.
As for MESA, we first described the intentional frozen-thawed approach, now used world-wide. A karyotype and Y chromosomal microdeletion assay almost always need to be obtained prior to TESE.