Testes biopsy and epididymal aspiration are two techniques available for acquiring sperm in men with vas deferens obstruction. These techniques developed and became useful in men whose wives need to achieve fertility through in vitro fertilization. The two techniques of sperm retrieval yield different quality of sperm and should be chosen carefully based on the requirements of the IVF lab. The ultimate success of a sperm retrieval depends on the quality of sperm production at the time of retrieval.

PROCEDURE	REQUIRE IVF?	SUCCESS RATES*
		SPERM	PREGNANCY
BIOPSY FOR SPERM RETRIEVAL...PESA To be done with IVF cycle with 24 hours of retrieval Done under local anesthethic Fresh sperm results in 100,000 to 500,000 sperm The sperm may have poor or no motility (swimming ability). Procedure fee: $2,200	YES	~99%**	25-35% (national avg is 25-35% with IVF)
MESA PROCEDURE Epydidimal aspiration Incision made in scrotum and aspirated from epydidimis Gives a good quality sample to freeze Requires more lab processing, which results in better quality Sperm can be frozen and used at anytime For more than one IVF cycle More convenient Results in 10 to 15 million sperm General anesthesia Procedure fee: $4,400 (includes 1 year freezing in storage)	YES	~99%**	35-45% (national avg is 37% with IVF)
VASECTOMY REVERSAL Results in 60 to 80 million sperm General anesthesia Procedure fee: $7,070 (includes anesthesia and facility fee)	NO	95-100%	~60-70% (fertile female) within 12 months

* in terms of sperm available for fertilization
** with normal sperm production

Dr. Russel Williams will evaluate sperm production and review the process of sperm retrieval at the initial evaluation.