No Sperm In Sight

Azoospermia is a medical condition when no sperm is present in the ejaculate. A man can have non-obstructive azoospermia (NOA), where normal sperm cannot be produced, or obstructive azoospermia, where sperm is prevented from leaving the testes. Both forms impact fertility significantly. However, assisted reproductive technology (ART) can help.

Causes of obstructive azoospermia

Around 1% of all men have azoospermia. The obstructive form occurs when a blockage prevents the sperm from leaving the testes and traveling to the ejaculate. The most common cause of obstructive azoospermia is a vasectomy. Congenital cysts and scarring from sexually transmitted infections (STIs) are other causes. Men with cystic fibrosis (CF) can have incorrect development of the vas and epididymis ducts, which affects the transport of sperm.

NOA causes

The non-obstructive form of the disorder can be caused by hormonal problems like hypogonadotropic hypogonadism and hypothyroidism. Certain medications can also negatively affect sperm production. Swollen veins in the scrotum, called varicoceles, can also lead to azoospermia. About 10% of men with the non-obstructive form have a genetic cause, such as Klinefelter Syndrome, that causes decreased sperm production.

Straight to the testes

Some of the conditions outlined above can be corrected to achieve pregnancy. For example, surgery can fix a varicocele, and medication can balance hormones. However, fertility is impacted for most men with azoospermia, and interventions are needed to get pregnant. Although sperm cannot reach the ejaculate, men with this condition can still produce immature sperm in the testes. Therefore, testicular sperm extraction (TESE) can be done to retrieve viable sperm.

Extracting sperm with TESE

To perform testicular sperm extraction, the male patient is given local anesthesia, and the surgeon inserts a needle into the testicle to remove sperm. The procedure takes about 10 minutes to complete. For men with more severe problems, a more invasive procedure called microTESE may be done under general anesthesia. During microTESE, a surgical microscope is used to increase the chances of finding good sperm.

Adding in ICSI

Since sperm retrieved with TESE are immature, additional assistance is required for the sperm to successfully fertilize the egg. With ICSI, a tiny needle is used to inject a single sperm directly into the egg, increasing the chances of fertilization. Next, in vitro fertilization (IVF) is done to insert the embryo directly into the woman’s uterus. What else is known about ICSI for azoospermia?

1. Useful for both forms

Men with both obstructive and non-obstructive azoospermia can benefit from the ICSI procedure. Although patients with obstructive azoospermia may have better-quality sperm, the microTESE approach allows doctors to extract viable sperm from most patients.

2. Same-day retrieval preferred

Men who plan to have TESE done will usually have the procedure on the same day the female partner is ready for IVF. This minimizes the time the sperm must be kept alive before being injected into the egg with ICSI, increasing success rates.

3. ICSI doesn’t always work

While helpful, ICSI doesn’t always guarantee a healthy baby. Research shows that 1 in 7 men who pursue TESE-ICSI end up having a child that is genetically related.

A single sperm

Azoospermia can be a difficult diagnosis for many men, but with TESE and ICSI, pregnancy is possible. Speak with a fertility specialist to determine the best IVF plan based on the specific azoospermia diagnosis. Only a single sperm is needed to make a baby.