Azoospermia Management

Azoospermia Management

What is Azoospermia?

Azoospermia is the absence of measurable sperm in a man’s ejaculate (semen). It also means that a man has no sperm in his semen. The reproductive system is either blocked (obstructive azoospermia), or hormonal issues, ejaculatory issues, or issues with testicular structure or function are some of the possible causes of nonobstructive azoospermia. 

Fertility can sometimes be restored as it might be possible to surgically collect live sperm for use in assisted reproductive methods for various purposes. Azoospermia affects 10% to 15% of infertile males and about 1% of all men. (1)

Are there types of azoospermia?

There are two main types of azoospermia: 

  • Obstructive azoospermia: 

This type of azoospermia means there is a blockage or missing link in the epididymis, vas deferens, or elsewhere in yourthe reproductive system. There is no measurable amount of sperm in your semen although you are making sperm is produced butas theirthe output is blocked. 

  • Nonobstructive azoospermia: 

This type of azoospermia refers to sperm production that is inadequate or absent due to problems with the testicles’ structure or function. (3)

How sperm can be extracted from men with azoospermia? 

Sperm extraction may be an option for many azoospermic patients with nonobstructive azoospermia (NOA) as part of an IVF cycle. Because sperm can be found in some, but not all, testes of such men, multiple samples of testicular tissue are often taken to improve the chances of finding sperm in patients with nonobstructive azoospermia. This is known as TESE (testicular sperm extraction) which is a surgical biopsy of the testis. The biopsy itself is done by an urologist specialized in androlgy and the dissection of the biopsy is done in parallel by an embryologist. Biopsies are analyzed under a microscope in the operating room to determine in which sample sperm is present. This allows the urologist to be guided in a region of the testes where sperm can be found and used for fertilization.

TESA (testicular sperm aspiration) with negative pressure fluid and tissue aspiration by inserting a needle into the testis is done under local anesthesia for men with obstructive azoospermia. 

How is azoospermia treated?

The cause of azoospermia affects the course of treatment. Understanding and treating azoospermia frequently involve genetic testing and counseling. Various treatment modalities include: 

  • Surgery can either unblock the tubes or reconstruct and tie up any abnormal or undeveloped tubes if a blockage is the root of  azoospermia. 
  • Hormone therapy may be prescribed if low hormone production is the primary factor. Follicle-stimulating hormone, human chorionic gonadotropin, clomiphene, anastrozole, and letrozole are examples of hormones.
  • If sperm production is inadequate due to a varicocele, the problematic veins can be tied up surgically while still protecting the surrounding structures. 
  • In certain men, sperm can be extracted directly from the testicles through a thorough biopsy.

If viable sperm are present, they can be extracted from the testicles, epididymis, or vas deferens for additional pregnancy procedures including in vitro fertilization or intracytoplasmic sperm injection (injection of a sperm into an egg). 

Before considering assisted insemination procedures, your healthcare professional might advise genetic testing of your sperm if the reason for azoospermia is regarded to be something that can be passed on to children.

How can azoospermia be prevented? 

There is currently no known way to prevent the genetic problems that lead to azoospermia. If your azoospermia is not a genetic problem, avoiding radiation, learning the dangers and advantages of medications that can impair sperm production, avoiding extended exposure to high temperatures for your testicles, and avoiding activities that can hurt the reproductive organs are a few of the things you can do.

Achieving Pregnancy with Azoospermia

Facing azoospermia does not mark the end of the road for aspiring parents. Remarkably, medical advancements offer hope and viable pathways toward parenthood. Firstly, addressing obstructive azoospermia often involves surgical interventions. These procedures aim to remove blockages, thereby facilitating the natural flow of sperm into the ejaculate. Hence, natural conception becomes a tangible possibility.

Furthermore, in instances of non-obstructive azoospermia, innovative techniques come to the fore. Specifically, sperm retrieval methods such as:

  • Testicular sperm extraction (TESE)
  • Microdissection TESE (micro-TESE)

are pivotal. These approaches meticulously harvest sperm directly from the testicles. Subsequently, the extracted sperm is utilized in conjunction with In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). This combination allows the injection of a single sperm into an egg, initiating fertilization.

Moreover, alternative options remain accessible for couples. Depending on individual circumstances and underlying causes, pathways such as adoption emerge as means to build a family. Ultimately, the journey to parenthood, despite azoospermia, is illuminated by a spectrum of solutions. Each tailored to navigate the complexities of infertility with a beacon of hope.

Source:

Chiba, K., Enatsu, N., & Fujisawa, M. (2016). Management of non-obstructive azoospermiaReproductive medicine and biology15, 165-173.

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