Testicular Mapping: Can You Still Extract Sperm With Azoospermia?

Testicular Mapping: Can You Still Extract Sperm With Azoospermia?

No Sperm, No Children?

Infertility is a growing challenge for American men, with about 10% struggling to start or grow families. Some infertile men have azoospermia, the medical term for no available sperm in a given sample. As a result, getting pregnant naturally is nearly impossible. Azoospermia can bring feelings of distress, yet testicular mapping is a way to work around this condition. This medical procedure allows fertility specialists to find and extract sperm for in vitro fertilization (IVF) or other techniques so couples can achieve pregnancy.


What causes azoospermia?

A healthy sperm count should have at least 15 million sperm in each sample. However, with azoospermia, there is no measurable sperm. However, an absence of sperm in the sample does not always mean the testes aren’t producing any. There could be a blockage that prevents the natural flow of sperm. Common causes of obstruction include vasectomies, cysts, scars, cystic fibrosis (CF), or surgical damage. In some cases, non-obstructive causes, like hormonal disorders, varicoceles, testicular cancer, or certain genetic conditions limit sperm production. While there are treatments that can help, some men still struggle to conceive naturally. Men with azoospermia can turn to assisted reproductive technology (ART) to have a baby, but the fertility team still needs to extract sperm.

Let’s map it out

Testicular mapping is an excellent option for men trying to conceive with obstructive and non-obstructive azoospermia. The procedure is a precursor to testicular sperm extraction (TESE) and has several benefits. Testicular mapping helps the fertility team to assess the fluid within the testes and even diagnose potential reasons for azoospermia. More importantly, the procedure maps out the best locations for sperm retrieval. Successful testicular mapping means a future TESE procedure will produce enough sperm for intracytoplasmic sperm injection (ICSI) or in vitro fertilization.

What to expect

Testicular mapping is a minimally invasive procedure to help optimize future sperm retrieval. The doctor can perform mapping in-office, and the patient typically receives local or general anesthesia accordingly. Next comes the extraction of samples from the testes. The doctor uses a tiny needle in multiple locations of the testicles. Once the doctor acquires the samples, the patient can leave after a short recovery period. The procedure takes less than an hour to complete. Men usually have to wait at least 6 months after a mapping procedure before extracting sperm for use.

Next steps

After the procedure, each sample is placed under microscope slides for assessment. The samples should provide insight into the best location for the highest concentration of sperm production. Testicular mapping is an innovative way to increase the chances of success during IVF or ICSI. Closer to the time for fertility treatment, the medical team can perform TESE to extract sperm with more confidence. The sperm is combined with the egg to create embryos. Additional sperm can be frozen for future use.

Benefits of mapping

The most significant benefit is the knowledge that patients with azoospermia can still extract sperm. Without mapping, the patient would require a painful biopsy. Studies show that when using TESE without mapping, the chances of finding sperm are much lower. With testicular mapping, the success rate of finding sperm increases to 95% or more. The process also provides cost savings to couples, limits recovery time after extraction, and reduces the need for donor sperm.

Don’t give up

An azoospermia diagnosis will discourage most men and couples from trying to get pregnant. With assisted reproductive technology, there is hope. Even then, ART requires a viable sperm sample, which is possible with sperm extraction. Sperm mapping allows fertility teams to find the best possible location for extraction ahead of time. This can significantly increase the chances of extracting sperm, even for men with an azoospermia diagnosis.

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