MESA and TESE: experiences of the German section of urological microsurgery.

The introduction of microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) has enlarged the therapeutic options for irreparable azoospermia. After standardization of the indications and surgical procedure, the German section for urological microsurgery combined the data of all groups performing assisted reproduction. The indication for MESA or TESE is given in cases of congenital aplasia of the vas deferens, irreparable obstruction of the reproductive tract, failure after refertilization, in combination with tubulovasostomy for subsequent cryopreservation and for conservatively untreatable ejaculatory disturbances. Until October 1995, 87 couples were treated by MESA and conventional IVF; the embryo transfer rate (ET) was 4.6%, the pregnancy rate 1.1%. One child (1.1%) was born. 179 couples were treated by MESA and ICSI, the ET was 68.2%, the pregnancy rate 18.4%, and 11 children (6.1%) were born. TESE in combination with ICSI was performed in 65 cases, the ET was 84.6%, the pregnancy rate 23.1% and 6 children (9.2%) were born. Modern technological developments in reproductive medicine and increasing experience in andrological surgery have stabilized the position of interdisciplinary therapeutic concepts for the treatment of infertile couples.