AZOOSPERMIA (NILL SPERM COUNT / ZERO SPERM COUNT)
What is azoospermia?
Azoospermia, also known as a zero or no sperm count, is a male fertility issue that occurs when there is sperm in a man’s ejaculate. Azoospermia is present in 1-2% of the general male population, and as such, is a frequent factor involved with the inability to conceive
What Does A Zero Sperm Count Mean?
Azoospermia means that a man does not have a measurable number of sperm in his ejaculate. Repeat semen analysis is done to confirm the diagnosis. A semen analysis will be performed and if virtually no sperm is found, then a high speed centrifugation is used to see if any sperm can often be found in a semen pallet that may have been missed previously. This can find sperm in approximately 15% of specimens initially thought to have zero sperm.
What Causes Azoospermia?
There are two broad categories of azoospermia:
Obstructive azoospermia: Obstructive azoospermia simply indicates a blockage somewhere in the reproductive tract. Sperm production is normal but the problem lies in the transport of sperm into the ejaculatory duct. Often, men with obstructive azoospermia will have reduced volumes of semen when the ejaculate. If the blockage is closer to the testicle such as after a vasectomy, ejaculatory volume will be normal.
Common causes of obstructive azoospermia are listed below.
Nonobstructive azoospermia (NOA):
Some common causes of NOA are listed below.
Does Azoospermia Have Any Symptoms?
There are no symptoms that are recognized in relation to having zero sperm count except when there is no ejaculation or very less ejaculation volume semen in complete reproductive system obstruction.
Can I Still Get My Partner Pregnant If I Have a Zero Sperm Count?
Whether or not you can impregnate your partner is dependent on the diagnosis made by the fertility specialists. Even when no sperm is found in the ejaculate, about 50% of the time there is sperm in the testicles that can be retrieved using sperm retrieval techniques. ICSI treatment is done with extracted sperm with a pregnancy rate of 50%.
Male Fertility history and Physical Exam:
The first step in evaluating male factor infertility involves a consultation with a doctor. During this visit, your doctor will take your general medical history, evaluates your lifestyle choices, such as diet and exercise routines, and perform a physical examination
Semen Analysis (Sperm Test):
A semen analysis is typically the first test prescribed to evaluate male factor infertility. Semen analysis can reveal potential causes of male infertility such as low sperm count and production, sperm motility and morphology for sperm quality, a lack of sperm in the ejaculate, and much more.
Testicular Biopsy:If your semen analysis shows no sperm, a testicular biopsy can be done to evaluate whether there is sperm in the testicles. A testicular biopsy involves taking a small sample from the testicles under local anaesthesia. This helps diagnose whether the lack of sperm is caused by a blockage or low sperm production.
Genetic Tests:Genetic factors can play a role in fertility by affecting sperm quality and quantity. Karyotypetest for Klinefelter Syndrome, which is caused by an extra X chromosome orCFTR Gene Mutation test, a mutation in the gene that causes Cystic Fibrosis. These men lack the tube that carries sperm from testicles to penis.Y chromosome micro deletiontest in case of severe oligospermia and azoospermia.
Sperm DNA Fragmentation test: This test is done in case of long standing unexplained subfertility, recurrent miscarriages or recurrent ivf failures.
Scrotal Ultrasound: This Scan helps us to confirm our findings such as varicocele and rule out any abnormalities
What are the treatments available? Is There A Cure for Azoospermia?
Treatment options for azoospermia are entirely dependent on the type and cause of the condition.
Medical Treatment:If the issue is more hormonal in nature due to hypo gonadotrophic hypogonadism cases, then doctor may prescribe you medications and injections to correct hormonal imbalances and promote sperm production. It may take 6 to 18 months after hormonal treatment to see sperm in semen analysis.
Sperm Retrieval: Techniques and Success Rates:
Sperm can be successfully retrieved from men in using today's minimally invasive techniques. Sperm retrieval (also known as sperm extraction or sperm aspiration) helps men with a vasectomy, a failed vasectomy reversal, an absence of the vas deferens, or blockages anywhere along the seminal tract (obstructive azoospermia) obtain sperm. Even when the sperm count or quantity is so low it does not make it to the outside world (non-obstructive Azoospermia or NOA), sperm aspiration can help.
What is Sperm Retrieval?
Sperm retrieval is a surgical technique for sperm collection from the male reproductive tract. With the help of sperm extraction techniques, viable sperm can be obtained from the testis or epididymis, and when used together with intracytoplasmic sperm injection (ICSI), it can help infertile men have children.
Sperm Retrieval Techniques:There are a few different types of sperm retrieval procedures that can be used depending on your individual situation. Each of these extraction techniques have certain benefits and drawbacks and used in conjunction with ICSI.
PESA: Percutaneous Epididymal Sperm Aspiration is typically the first choice for obstructive azoospermia. PESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI who have obstructive azoospermia from either a prior vasectomy, absence of tube connecting the testes and penis (vas deferens) or blockage from infection.
It is done with local anaesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval. It is done by inserting a needle through the scrotum into the epididymis to collect a small amount of seminal fluid.
MESA: Microscopic Epididymal Sperm Aspiration (MESA) is slightly more invasive technique than PESA and uses microsurgical techniques to collect sperm from the epididymis. It is a procedure performed for men who have vasal or epididymal obstruction. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval.
MESA is performed in the operating room with general anaesthesia utilizing the operating microscope. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MESA allows for an extensive collection of mature sperm as compared to aspiration techniques..
TESA: Testicular Sperm Aspiration: TESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI. It is done with local anaesthesia in the operating room and is coordinated with their female partner’s egg retrieval. A needle is inserted in the testicle and tissue/sperm are aspirated. Occasionally, TESA doesnot provide enough tissue/sperm and an open testis biopsy is needed.
TESE:TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. TESE is usually performed in the operating room with sedation, but can be performed in the office with local anaesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.
MicroTESE: Microsurgical Testicular Sperm Extraction: is a procedure performed for men who have a sperm production problem and are azoospermic. MicroTESE is performed in the operating room with general anaesthesia under the operating microscope. MicroTESE is carefully coordinated with the female partner’s egg retrieval, and is performed the day before egg retrieval. Patients frequently have donor sperm backup in case sperm are not found in the male partner.
Here the testis is open completely and tiny seminiferous tubules are spread and dissected. Thick and dilated seminiferous tubules should be differentiated from thin tubules. Dilated and thick tubules are identified and removed with forceps and seen under microscope to identify sperm.
MicroTESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed and higher success rate os sperm retrieval. Patients cryopreserve sperm during this procedure for future IVF/ICSI. With Micro TESE, in 1/3rd of men sperm could be obtained where it was not obtained initially by TESA / TESE procedure. It is expensive, time consuming and needs expertise in performing the procedure.
Sperm Retrieval Surgery & Recovery: Sperm retrieval surgery typically takes about an hour and is done under local or general anaesthesia, depending on the specific collection technique used. You will not feel any pain during the surgery. However, if the surgery is done under local anaesthesia you may feel some discomfort during the procedure, such as pulling sensation.
Patients typically recover quickly from the sperm extraction surgery. You may feel slight discomfort and tenderness on the scrotum for the first 24 to 48 hours. This can be relieved with medications. Bruising and swelling may also occur, which should subside within the first few days. You should be able to return to your normal activities within three to five days after the surgery, and expect a full recovery within two weeks.
What are the side effects of sperm aspiration: The side effects include discomfort, pain, bruising, bleeding and the risk of infection.
The more invasive MESA and MicroTESE sperm retrieval procedures carry a higher risk of side effects and may require an overnight stay in the hospital. You will receive antibiotics to prevent infection, and pain medications to help manage any soreness of the treatment area.
Sperm Retrieval Success Rates:Sperm retrieval surgeries have a high success rate. However, the success rate of the sperm aspiration surgery depends on your individual situation and the underlying cause for the surgery.
Retrieval rate is almost 100% in cases with obstructive azoospermia. Approximately 50% -60% retrieval ratesare possible in men with non-obstructive azoospermia.
Sperm Extraction-ICSI: Once the sperm is collected, it will be used to fertilize your partner’s egg via ICSI. Typically your partner’s eggs are collected the same day your sperm retrieval is performed. The egg is then fertilized in the laboratory with your sperm, and cultured for two to six days before being transferred to your partner’s uterus.
Sperm Retrieval & Artificial Insemination: Sperm extraction and artificial insemination are not typically done together. Sperm collected directly from the testis or epididymis is not “mature” enough to swim and fertilize the egg.
Sperm Retrieval & Sperm Freezing / Banking: After the sperm retrieval procedure, the sperm collected can be frozen and cryopreserved for later use. Sperm banking can help avoid the need for another surgical sperm retrieval process in the future. Many choose to freeze their sperm after sperm retrieval in case the first cycle of IVF is not successful and to keep their options should they want to father more than one child.
Transurethral Resection of Ejaculatory Duct in case azoospermia due to Ejaculatory duct obstruction:
This procedure eliminates obstruction in the ejaculatory duct which improves the chances of inflamed or chronically dilated areas within the ejaculatory duct to normalize.
(ART)ICSI and IVF:Intracytoplasmic sperm injection (ICSI) has overcome virtually all forms of male factor infertility. The ICSI procedure is when a single sperm is injected into each ripe female egg. The ICSI procedure has enabled most of these patients to conceive their own genetic offspring. Success rates from this treatment are quite high and the track record to date suggests that there are no significant increases in birth defects in children that result from this procedure.