Male infertility in azoospermia

Author: Urologist Vladlen Petrishchev

Usually, a woman undergoes examinations when planning pregnancy. However, quite often, when trying to get pregnant, a couple faces difficulties precisely because of men's health problems.

One of the most common problems leading to male infertility is azoospermia.

What is azoospermia?

Azoospermia is a disorder in which there are no spermatozoa in the sperm: it is for this reason that attempts to conceive a child are unsuccessful. 

There are two types of the disease. In obstructive azoospermia (OA), male germ cells are produced in the testicles, but cannot leave them due to obstruction of the vas deferens. In the case of the non-obstructive form (NA), the production of spermatozoa in the testicles is disrupted: male germ cells are either completely absent or are formed singly.

Treatment of azoospermia

Is it possible to cure azoospermia? Modern medicine has reached such a level that today it is possible to help most men with this problem.

In the simplest cases, when the pathology has arisen as a result of a previously performed ligation of the vas deferens for the purpose of surgical contraception, doctors perform a reconstructive operation. Azoospermia, which occurs against a background of low hormonal levels, is also well treatable.

However, most patients with azoospermia are infertile due to reasons for which therapeutic options are not yet available. Sometimes it's a genetic malfunction or an unknown cause. But modern medicine can also help such patients.

Today, methods of extracting sperm directly from the testicle are used, followed by their use in the IVF program (ICSI). This procedure for obtaining male germ cells is called a biopsy.  Thanks to her, from 30 to 60% of patients can receive the joy of fatherhood.

The success of a biopsy depends primarily on the severity of the azoospermia. Examination of the patient allows an experienced andrologist to get a preliminary idea of the nature of azoospermia and the chances of obtaining sperm. Based on the data obtained, the doctor chooses the optimal biopsy technique that is most effective in each specific case.  

Biopsy techniques

Aspiration biopsy techniques

In favorable cases, it is often sufficient to puncture the wall of the epididymis/ testis with a thin needle (PESA or TESA procedure). These manipulations are performed under general or local anesthesia, take minutes, and the patient can drive home within an hour after the procedure.

Open biopsy techniques

In more complex cases, it may be necessary to extract more tissue to detect sperm cells, in which case an open biopsy is used. Through a centimeter incision in the skin of the scrotum, doctors receive one or more pieces of testicular tissue the size of a grain of rice (TESE procedure). At the end of the procedure, the doctor applies one or more absorbable sutures to the incision site. 2-3 hours after the procedure, the patient can leave the clinic.

In this case, it is usually necessary to use a special innovative technique - microsurgical testicular biopsy (micro-TEST). In this case, a larger incision of the skin of the scrotum is performed, allowing for a complete systematic search for spermatozoa. Thanks to the use of an operating microscope, the surgeon manages to find dilated seminal tubules containing live spermatozoa.

The total time of the patient's stay in the hospital after the procedures is no more than 2-3 hours.

What to expect after the operation?

• the statement is made on the day of the procedure, usually 1-4 hours after the operation;

• there may be a feeling of some discomfort, swelling in the area of surgery for several days;

• sexual and physical activity is limited - exclude sports for 2 weeks;

• pain medication is required (e.g. Nurofen) on the first day after surgery at night;

• diet: no restrictions after surgery

Working with the obtained spermatozoa

The biopsy material falls into the hands of an embryologist. The results of the procedure largely depend on the ability of the embryologist to process the resulting tissue, isolate spermatozoa and perform fertilization. By this point, an experienced reproductologist should have received enough cells from the partner so that the chances of a successful pregnancy are high. The remaining live sperm can be frozen for possible further use.

Advantages

The European Medical Center employs a well-coordinated team of experienced experts in the field of male reproductive medicine, who, together with other leading EMC specialists - reproductologists, embryologists, geneticists - provide the couple with the maximum chance of getting a successful pregnancy. Our specialists train at leading foreign medical centers and universities - the University of Munich, the Kato Clinic in Tokyo, the Origio Training Center in Copenhagen, the Vitrolife Laboratory in Gothenburg, etc.

The presence in the EMC of a multidisciplinary hospital with an operating unit equipped with the latest technology (including equipment for microsurgical operations), and an embryological laboratory with its own cryobank ensure the effectiveness of treatment and patient safety. 

All this allows us to help patients even in the most severe cases, including with azoospermia.