The Difficult MESA: Findings From Tubuli Recti Sperm Aspiration

Ulrike Zenke, Liza Jalalian, Shehua Shen, Paul J Turek
Departments of Urology and Obstetrics, Gynecology and Reproductive Sciences
University of California San Francisco School of Medicine
San Francisco, California 94143


During difficult MESA sperm retrieval procedures, sperm from the tubuli recti may provide an excellent alternative to testis sperm extraction.

…tubuli recti sperm may provide an excellent alternative to testis sperm extraction in selected cases. ”
– Dr. Paul Turek


To investigate sperm quality aspirated from the tubuli recti compared to that obtained from microsurgical epididymal sperm aspiration (MESA).


Sixteen patients with congenital bilateral absence of the vas deferens (CBAVD) underwent MESA. Six MESA procedures were difficult, and therefore sperm were retrieved from the tubuli recti ductules. Intraoperative sperm parameters, recovery after freeze-thaw, and ICSI outcomes were analyzed and compared between tubuli recti and MESA sperm.


Mean initial sperm concentration was similar in both groups (18 million sperm/mL vs. 16 million sperm/mL). Initial sperm motility was significantly higher in the tubuli recti group (35%) than in the MESA group (25%). However, post-thaw motility was higher with MESA compared to tubuli recti sperm (8.7% vs. 1.5%). ICSI fertilization rates after sperm freeze-thaw were 66% for tubuli recti sperm and 71% for MESA sperm.


Tubuli recti sperm may provide an attractive alternative to testis sperm extraction. Poor sperm recovery after freeze-thaw should be expected.

Tubuli Recti Sperm Aspiration (pdf)