What is azoospermia?

Azoospermia is a condition in which a male patient does not have any sperms in his ejaculate.

Sperms are produced inside the testes and they mature and become motile, as they travel through the epididymis. During the process of ejaculation, mature sperms are carried from the epididymis to penis along the vas deferens and the released sperms fertilise the eggs during process of intercourse. Azoospermic patients are unable to release sperms and, hence, cant cause pregnancy.

Azoospermis can be obstructive (40% cases) or non-obstructive (60% cases).

Treatment options for azoospermia

A large no of cases of obstructive azoospermia, wherein the cause for absence of sperms in the ejaculate is generally physical and mostly does not involve any disturbance in the process of sperm production, can be successfully treated by retrieving the sperms using surgical techniques. These surgically retrieved sperms are then used for fertilizing the eggs using ICSI. Some of the surgical retrieval techniques can be helpful in some cases of non-obstructive azoospermia also, where there may still be some areas of sperm production in otherwise non-functional testes.

The fertilization rates and pregnancy rates using surgically retrieved sperms are similar to those obtained using ICSI on ejaculated sperm.

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Surgical sperm collection techniques

Percutaneous epididymal sperm aspiration (PESA) is a simple technique to obtain sperms for ICSI in men with obstructive azoospermia. Seminal fluid is aspirated from the vas deferens under local anaesthesia. The embryologist examines the seminal fluid sample to locate motile sperms. The procedure may need to be attempted again until motile sperm have been found. At times the procedure may be required to be attempted on both the testes simultaneously.

Testicular sperm extraction (TESE)/ Trans epididymal sperm aspiration (TESA) is used for sperm extraction in patients with severe obstructive oligospermia and non-obstructive azoospermia. It involves giving a small incision over the testes and taking out a small piece of seminiferous tubule tissue to isolate sperms from the tissue sample. The number of viable and mature sperms isolated is generally smaller than with PESA and the sperms are generally not fit for freezing. The procedure is performed just prior to egg retrieval so that ICSI can be performed simultaneously.

Microdissection TESE is one of the most advanced techniques of sperm extraction in men with non-obstructive azoospermia. It is performed in the operating room under general anaesthesia using an operating microscope. It is based on the principle that in azoospermic men there may be some islands of spermatogenic activity in testes, which are not identifiable with naked eyes but can be identified using a microscope. The surgeon picks only the healthy looking seminiferous tubules under magnification, thus optimising the chances of retrieving healthy sperms.