Microsurgical Epididymal Sperm Aspiration (MESA)
Obstructive azoospermia can be cured with MESA, the kind of unsurgical treatment conducted with an operating microscope that helps to get sperm from the epididymis.
MESA is not applied in such cases:
1) It is not suitable for the non-obstructed system when there are no problems with ejaculation,
2) it is recommended for the severely oligospermic patients who have primary testicular dysfunction,
3) it is not suitable for the vasectomy patients who have obstructive disorders that are not cured with a surgeon.
These disorders are no the vas deferens, bilateral ejaculatory duct obstruction that can not be treated with transurethral surgery, obstructive azoospermia and the absence of the vasal ampullae and seminal vesicles taken away surgically while having cystoprostatectomy or radical prostatectomy, mistaken vasoepididymostomy. For such patients the man-made reservoirs (artificial spermatoceles) is recommended for the sperm collection for artificial insemination. 5% of the resultant pregnancy rates were observed. It was connected with problems connected with the maintenance of epididymal patency and to very bad productiveness of the collected sperm. MESA is conducted together with IVF or GIFT and/or assisted fertilization with gamete micromanipulation. Fertilization pregnancy rates can be influenced with the sperm’s level, the amount of sperm and the condition of women’s health. Pregnancy rates can change. They are high due to improved techniques of sperm and egg manipulation.
Ablation of Pituitary Adenomas
The dopamine agonist bromocriptine (Parlodel) or sometimes transphenoidal surgical ablation of pituitary micro or macroadenoma are recommended for patients with impotence and a spermatogenic defect that is closely connected with high Prolactin levels. It serum Prolactin levels become a little bit high without any concomitant suppression of gonadotropins, thay do not demand a surgeon or medical treatment.
Prophylactic Surgical Measures
Some undescended testes become lower nine months of age afterwards. Spermatogonia per tubule becomes lower before the second year of life. That’s why orchidopexy should be held before this period.
When undescended testes, treatment held with HCG injections or intranasal GnRH are unsuccessful, orchidopexy is advised. It is recommended to detorse a testicular torsion quickly. A deleterious effect of an infarcted testis on the contralateral healthy testicle was observed during experiments. It is effective because the intact blood-testis barrier destroys. The non-viable testicle is to be removed during diagnosis of torsion.
Electroelaculation and Vibratory Stimulation
Ejaculatory dysfunction is a usual health problem. Ejaculatory dysfunction in fertility though should be conducted with a sequelae of spinal cord injury to men. Ejaculatory dysfunction is possibly caused with a spinal cord injury, retroperitoneal lymph node dissection and other kinds of retroperitoneal or pelvic surgery, diabetes mellitus, transverse myelitis, multiple sclerosis or psychogenic disorders.
Electroejaculation was conducted among male animals and now it is used in treatment with ejaculatory dysfunction. The post ganglionic sympathetic nerve endings are stimulated with a rectal probe, an electrical current that have an ability to innervate the structures that are responsible for seminal emission and ejaculation. The semen has different parameters. The specimens are kept for intrauterine insemination or different reproductive techniques. The treatment is successful if it is conducted both for the husband and the wife. Pregnancy rates are 30-35%.
It is advised at first to write a patient in an electroejaculation protocol before vibratory stimulation. This technique is conducted with a high frequency vibrator that is located near the glans penis during some time with a duration from some minutes to 20 minutes before an ejaculate is conducted. In the cases of spinal cord injury and electroejaculation they are recommended to be monitored for autonomic dysreflexia. Before the treatment a calcium channel blocker (Procardia) should be applied. Vibratory stimulation is used to count sperm and its ability to productiveness; it can be conducted at home under the observation of a doctor.
| 
