Azospermia is the condition where a man does not have any sperm in his ejaculated semen. For a number of reasons this does not necessarily mean that he is not producing any sperm at all and it is quite possible that sufficient sperm for IVF or Intra Cytoplasmic Sperm Injection (ICSI) can be surgically obtained from his testes. Other men may produce so few sperm in their semen, or those sperm that are present are not alive, that IVF or ICSI is not possible. It is often found that more sperm, and particularly live sperm, can be extracted surgically from their testes. Causes of azospermia include .
Obstructions in the vas deferens (the tubes leading from the testes to the penis) prevent sperm from reaching the penis for ejaculation. The most common cause of obstructive azospermia is a vasectomy however obstruction can result from a number of medical and surgical conditions. In such cases plenty of sperm are usually still being formed in the testes and they may be accumulating in the sperm storage area, the epididymis, on the side of each testis.
Very Low Sperm Production or Sperm Maturation Arrest
In some men, the seminiferous tubules in which sperm are formed in the testes may have very low numbers of sperm producing cells, or the growth of these cells to mature sperm may stop at a particular stage before tails develop. In a large number of such men, small areas can often be found within the testes where some sperm production and maturation is still occurring. While these sperm lack the ability to fertilise an egg by themselves (IVF) they can be successfully injected into eggs (ICSI) to obtain fertilisation.
Approaches to Sperm Retrieval From The Testes
All cases are different and, depending on the man’s history, one of two approaches may be taken to retrieve sufficient sperm for injection into eggs from the female partner. Both are performed in an operating theatre and will require either a local or a general anaesthetic. Although these sperm are easier to use when fresh, they can be frozen for later use and therefore the procedure can be performed sometime prior to egg pick-up from the female if necessary.
Testicular Sperm Aspiration (TESA)
A fine needle is passed through the skin of the scrotum into the testes and suction is used to pull out some of the seminiferous tubules. This is usually performed a number of times in different parts of the testes until an area where reasonable sperm production is found. A scientist examines the tubules and tells the doctor when sufficient sperm have been obtained. If more are found than is required, and their quality is reasonable, they may be frozen and stored in liquid nitrogen for future use. Depending upon how difficult it is expected to be to find sperm, the procedure may be done under a local or a general anaesthetic. Post-operatively there will be some pain and some bruising. Time off from work will almost invariably be necessary.
Micro Epididymal Sperm Aspiration (MESA) or Testicular Biopsy
This is an “open” procedure, performed under a general anaesthetic, where the scrotum is opened to expose the testis and its epididymis. The epididymis may be surgically opened and its fluid aspirated to see if it contains live sperm, or a piece of testicular tissue may be surgically excised. This is passed to a scientist who dissects out the tubules looking for live sperm. Post-operatively there will be some pain and some bruising. Time off from work will invariably be necessary.
Testicular sperm retrieval provides a very successful approach to treating infertility in couples where the male partner has very few or no sperm in his semen. There is always a small possibility that no viable sperm will be found. It also should be remembered that some very poor semen quality may have a genetic basis and could be inherited by any male children of the affected man. You should discuss this possibility with your doctor.