Treating Azoospermia through IntraCytoplasmic Sperm Injection (ICSI) treatment
What is Azoospermia?
It is the medical condition of a man when there are “NO SPERMS” in a semen sample. Azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations.
Classification:
1. Pre-testicular azoospermia
It is characterized by inadequate stimulation of otherwise normal testicles and genital tract. Typically, follicle-stimulating hormone (FSH) levels are low (hypogonadotropic) commensurate with inadequate stimulation of the testes to produce sperm. It is seen in about 2% of azoospermia and is a kind of non-obstructive azoospermia.
2. Testicular Azoospermia:
The testes are abnormal, atrophic, or absent, and sperm production severely disturbed to absent. The condition is seen in 49–93% of men with azoospermia. Testicular azoospermia is a kind of non-obstructive azoospermia.
3. Post-testicular Azoospermia:
Sperms are produced but not ejaculated, the main cause is a physical obstruction (obstructive azoospermia) of the post-testicular genital tracts. This condition that affects 7–51% of azoospermic men. Ejaculatory disorders include retrograde ejaculation and anejaculation; in these conditions, sperms are produced but not expelled.
4. Genetic:
It has been estimated that genetic abnormalities account for up to 30% of the cases of severe male factor infertility, most of which are present either as azoospermia or oligoasthenoteratozoospermia. Micro deletion of the distal end of the Y chromosome is present in 13–20% of men with azoospermia or oligospermia. This region is also called as the AZF (the azoospermia factor) region. Azoospermia may also be due to numerical (e.g. Klinefelter syndrome) or structural chromosomal abnormalities (e.g. translocations), and genetic mutations in several monogenic conditions such as mitochondria or androgen receptor genes. Thus, defective spermatogenesis may be a manifestation of various genetic defects.Congenital absence of the vas deferens is responsible for at least 6% of cases of obstructive azoospermia and accounts for 1–2% of cases of infertility in men.
5. Unknown:
Idiopathic azoospermia is where there is no known cause of the condition. It may be a result of multiple risk factors, such as age and weight. For example, a review in 2013 came to the result that oligospermia and azoospermia are significantly associated with being overweight (odds ratio 1:1), obese (odds ratio 1:3) and morbidly obese (odds ratio 2:0), but the cause of this is unknown.
How Is Azoospermia Diagnosed?
We know that diagnosis of azoospermia as a cause of infertility is deeply disturbing for many men. It is usually detected by doing Semen Analysis at least on two separate occasions and blood tests like Serum FSH, which will help to differentiate between various causes of azoospermia.
During semen analysis if “NO SPERMS” are observed then the semen sample needs to be centrifuged and the pellet should be examined to confirm if sperms are present or not. The aim of centrifugation and examining the pelleted semen sample is to exclude cryptozoospermia, which is presence of very small number of live sperms in the pellet. This is important to avoid labelling severe oligospermic men as azoospermic. Usually in pathology labs they don’t do follow centrifugation process to confirm azoospermia, hence it is advised to get a semen analysis done at an IVF clinic where there is an experienced in-house Embryologist.
Treatment
Most of these patients will require advanced reproductive technologies. With the introduction of advanced treatment options like In vitro fertilization (IVF) and IntraCytoplasmic sperm injection (ICSI) in the 1990s, many of these men can now father their own biologic children. IVF-ICSI combined with sperm extraction techniques are now considered standard practice and are conducted routinely worldwide.
To get the sperm to be used in IVF /ICSI, a needle aspiration of the testis or from epididymis could be carried out under local anaesthesia in circumstances of obstructive Azoospermia.In few men with azoospermia even if sperms are successfully retrieved, there is a significant chance that there will be no usable sperm for ICSI. The failure to obtain sperm is up to 50% in men with non-obstructive azoospermia.
However, in cases of genetic mutations or other things that are not easily treatable, use of donor sperms may be the most viable option for couples who wish to conceive. As there are chances of the genetic mutation being transferred to their offspring and may be expressed more severely in the offspring, for example Y chromosome microdeletion.
We at Dr Sudha Tandon IVF Clinic have fully equipped ART lab with all advanced equipment for such procedures. We have successfully treated many such patients and have a good success rate.
Patient selection for treatment of azoospermia according to the clinical classification of azoospermia.
Category of azoospermia | Clinical pointers as to the likely predisposing factors of azoospermia | Type of treatment |
| Obstructive azoospermia | Vasectomy, swollen testis, distended epididymis, absence of vasa deferentia, absence of epididymis, semen pH <7, presence of sperm agglutinins | MESA, PESA, TESA |
| Azoospermia due to ejaculatory duct dysfunction | Low semen volume (<1 ml), diabetes mellitus, retroperitoneal lymphadenectomy/ bladder/ neck surgery, spinal injury | ICSI with spermatozoa retrieved from alkalinized semen sample |
| Azoospermia due to hypogonadotrophism | Kallmann’s syndrome, endocrine disorders, low FSH/LH | gonadotropins or GnRH pump |
| Primary testicular sperm disorder | Idiopathic, chemotherapy, radiotherapy, malignant disease, cryptorchidism, orchidopexy torsion of the testis, mumps, orchitis, abnormal karyotype, testicular atrophy (≤12 ml),micro deletions of Y chromosome | TESE / Micro TESE |
| MESA = Microsurgical Epididymal Sperm Aspiration; PESA = Percutaneous Epididymal Sperm Aspiration; TESA = Testicular Sperm Aspiration;TESE = Testicular Sperm Extraction; Micro TESE = Micro Testicular Sperm Extraction IUI = Intrauterine Insemination; IVF = In-Vitro Fertilization; GnRH = Gonadotropin-releasing hormone; FSH =Follicle-Stimulating Hormone;LH = Luteinizing Hormone | ||
What Causes Azoospermia?
Azoospermia can be caused by a variety of conditions, these include:
- A blockage in the genitalia, also known as “obstructive azoospermia”
- An infection within the male reproductive system
- Injury to the genitalia
- Effects from surgery to the male reproductive system – including effects from radiation and chemotherapy treatments
- Genetic causes
- Other potential causes include: undescended testes, Varicocele, medications such as steroids and antibiotics, excessive alcohol consumption, and illegal drug use
Is There A Cure For Azoospermia?
Treatment options for azoospermia are entirely dependent on the type and cause of the condition. If the no sperm count is caused by a blockage then your doctor may attempt to correct the blockage through a surgical procedure. However, the result of surgery is not satisfactory. Hence these men are best candidates for aspiration of sperms from testis or epididymis. If the issue is more hormonal in nature, then your doctor may prescribe medications to correct hormonal balances or clear up and infection.
Where Can I Go To Receive Azoospermia Treatment?
We at Dr. Sudha Tandon IVF/ Fertility/ Endoscopy and Maternity Clinic (Chembur and Vashi) have experienced and knowledgeable doctors for the treatment of male fertility issues, like azoospermia.Our role is to test, diagnose and provide treatment options for azoospermic patients and many other conditions that contribute to male infertility. Dr. Sudha Tandon, an experienced gynecologist and fertility specialist, is renowned for using first-rate medical technology and state-of-the-art techniques in order to fulfill the dreams of patients who wish to have a family.