MESA/TESE question of quality
1 Replies
lesabrowning - May 25

We are ready to start ivf cycle 3. My hubby had a vasectomy 4 years ago so we have used apriration for the sperm. We had wanted MESA the first cycle but wound up with a PESA procedure that got 4 vials of what we were told was great sperm. We had about a 50% fertilization rate and froze the extra. For the second cycle we wanted to defrost the sperm but were told on the day of ER that the sperm was not alive on thaw and we needed an emergency TESE procedure. This also went well and we had about a 30% fertilization rate.

I have read that a vasal aspiration will get more mature sperm and my RE and the things I have read indicates this could improve fertilization rates. Unfoirtunately most docs we find just want to do TESE suggesting it is "fine"... What do you think?

Our only issue is the vasectomy. I am 36 and have had very successful pregnancies in the past and all tests are great.

Thanks so much!

 

Dr Smith - May 30

You are correct that the farther down the line you go (testiular, epididymous, vas deferens) the more mature the sperm and the better the fertilization. However, retrieving sperm from the vas deferens is pretty tricky and it is not routinely performed (as you found out when you asked your RE). Testicular sperm yields the lowest fertilization and embryonic growth rate. Epididymal sperm is better, but still not great. These procedures are pushing the envelope of the available technology.

Epididymal sperm does not freeze and thaw very well, so its no big surprise that the frozen-thawed epididymal sperm did not survive. I think they could have warned you that you may need an "emergency" testicular aspiration. Unfortunately, it added stress to an already stressful situation.

 

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