What to do with the diagnosis of Azoospermia?

Herry Brook December 23, 2024

4 min read

Azoospermia (absence of sperm in the ejaculated semen) is one of the causes of conjugal infertility, affecting 15-20% of men with infertility. About 1-2% of men in the general population have Azoospermia.

Before any azoospermia treatment, the most important test is a sperm analysis with sperm count performed in our specialized laboratory. There are often cases previously diagnosed as Azoospermia in which we find some sperm in the entire sample, sufficient to be frozen and used in an in vitro fertilization procedure without the need for surgical procedures.

Suppose you have Azoospermia. In that case, a specific sperm count confirms Azoospermia. It is necessary to determine its cause and perform a surgical procedure to search for sperm directly from the testicle and/or epididymis. Azoospermia can be divided into "secretory" and "obstructive"."

What to do with the diagnosis of Azoospermia?

Secretory or non-obstructive Azoospermia is the most severe and frequent, accounting for 70% of azoospermia cases. It can be congenital (from birth) or acquired (after diseases or treatments), and its most common causes are:

Anomalies in the descent of the testicles.

Exposure to toxic substances: medications, radiotherapy and chemotherapy.

Genetic alterations.

Problems with the testicles (trauma, inflammation, severe varicocele, among others).

Hormonal changes.

Although it is effective in some cases, obtaining sperm via microsurgery in cases of secretory Azoospermia is problematic since, in most cases, the alteration is in the sperm production itself.

Obstructive Azoospermia

Obstructive Azoospermia is characterized by a problem of obstruction in the channels that transport sperm from the testicles to the urethra. The most common causes are:

Absence of vas deferens (from birth or due to surgical intervention).

Inflammation or trauma to the testicles, epididymis, vas deferens or prostate.

It is easier to obtain sperm in this type of Azoospermia by performing microsurgery since sperm production is not affected; there is only an obstruction in its passage to the ejaculate. CEFERP provides all the techniques necessary for microsurgical sperm removal, performed by a specialist urologist in our surgical centre. They are:

TABLE: Microsurgical aspiration of sperm from the epididymis

PESA: Percutaneous epididymal sperm aspiration

THESIS: Testicular biopsy

TESA: Testicular sperm aspiration

Each technique has its indications and variations in the quality of the sperm recovered. After the puncture/biopsy, the material is taken to the laboratory for a thorough search for sperm. If any are found, they are frozen for later use in IVF treatment Pakistan (ICSI or SUPER ICSI). If no sperm is found in the sample, sperm from national or international sperm banks may be used. With the use of donor semen, the treatment can be artificial insemination or in vitro fertilization (ICSI / SUPER ICSI), depending on the assessment of female fertility.