Written By: Longjam Dineshwori | Updated : February 15, 2023 2:30 PM IST
Another common genetic cause is Congenital Bilateral Absence of Vas Deferens (CBAVD) due to mutations in the CFTR gene, which leads to obstructive azoospermia, which means that there are average sperm. NOA has been identified to be associated with nearly 700 genes, but their significance has yet to be determined.
Some men may have zero sperm in their semen. The condition is called Azoospermia. The absence of sperm in a man's ejaculate can be caused by an obstruction in the reproductive system, hormonal disorders, ejaculation issues, or problems with testicular anatomy or function. Many of these reasons are curable, and fertility can be restored.
Dr Karishma Dafle, Fertility Consultant, Nova IVF Fertility, Pune, tells us more about azoospermia and the various sperm retrieval techniques used extracting sperm for IVF/ICSI in men with azoospermia.
Azoospermia is identified when your sperm sample shows no sperm when inspected under a high-powered microscope after a centrifuge spin on two or more different occasions.
Once the diagnosis is made, we take a detailed history of the patient to find out the cause of Azoospermia. A physical examination of the male partner is done. A few hormone tests, an ultrasound of the scrotum and genetic information-related tests are also suggested.
Azoospermia is classified into two types: obstructive and non-obstructive.
Obstructive azoospermia: A blockage or missing link in the epididymis, vas deferens, or elsewhere along your reproductive canal causes azoospermia. You are creating sperm, but it is being kept from leaving your body, thus there is no detectable amount of sperm in your sperm.
Nonobstructive azoospermia: You have low or no sperm production due to problems in the structure or function of the testicles or other factors.
Sperms are produced in the testes but are not released due to tube obstruction in obstructive azoospermia. In non-obstructive azoospermia, sperms are not produced in the testes. FSH levels and testicular volume can help determine which type of azoospermia a patient has.
There are various sperm retrieval techniques that are used for extracting sperm for IVF/ICSI in men with azoospermia. These include:
Aspiration of testicular sperm (TESA)
TESA is a process for men who are having their sperm extracted for IVF/ICSI. For males with obstructive azoospermia (s/p vasectomy), TESA is done. When TESA does not give enough tissue/sperm, an open testis biopsy is required.
Aspiration of Percutaneous Epididymal Sperm (PESA)
PESA is a treatment used to collect sperm for IVF/ICSI in men who have obstructive azoospermia from a previous vasectomy or infection. It is performed under local anesthetic in the operating room or office and is timed to coincide with the egg retrieval of the female spouse.
Extraction of testicular sperm (TESE)
TESE is often performed under sedation in the operating theatre, however, it can also be performed in the office under local anesthetic alone. During this technique, patients often cryopreserve sperm for future IVF/ICSI. MicroTESE has surpassed this as the best method of retrieval for men who have no sperm in their ejaculate (azoospermia) due to a production issue.
Aspiration of Microepididymal Sperm (MESA)
MESA is a surgery for males who have vasal or epididymal blockage (s/p vasectomy, congenital bilateral vas deferens absence). MESA provides for a greater collection of mature sperm than aspiration procedures, and it is the ideal method of retrieval for males with congenital bilateral absence of the vas deferens as it does not interfere with testicular steroid synthesis.
The etiology of azoospermia determines the treatment. Genetic testing and counseling are frequently used to better understand and treat azoospermia. Treatment options include:
Each etiology of azoospermia has a unique prognosis. Many causes of azoospermia are treatable. Your healthcare team and you will collaborate to establish the cause of your azoospermia and treatment choices. Hormonal issues and obstructive causes of azoospermia are frequently curable, and fertility can be restored in some cases. If testicular problems are the reason, live sperm can still be extracted for use in assisted reproductive procedures.
