AZOOSPERMIA

AZOOSPERMIA – Complete absence of sperm in the ejaculate


AZOOSPERMIA – Complete absence of sperm in the ejaculate

Histopathological Findings of Testis in Azoospermia

Most men with this condition assume that there is no possibility of ever conceiving a child. With new surgical methods of sperm retrieval from Testis (Micro Tese) and Epididymis ( MESA) and Intracytoplasmic Sperm Injection (ICSI) could be performed .When successful the couple have satisfaction of achieving pregnancy with his own sperms.

We at MARC do not advocate Donor Sperm Insemination as method of choice.

The infertile couple are not aware of existence of specialized centres for comprehensive management of infertility. Many treating physicians prescribe all forms of medical treatment advertised by medical companies. In cases of Azoospermia & Severe Oligo Asthenospermia any form of medical treatment would be waste of time and money. In todays context ICSI is the ultimate option for Non- Obstructive Azoospermia . However, the limiting factor could be the advanced age of the female partner. The enclosed case reports of couples treated at MARC would justify ICSI as the ultimate treatment for Male Infertility with Azoospermia & Severe OAT.

Note : - In cases of men with Obstructive Azoospermia the Testicular Biopsy shows normal spermatogenesis with maturation upto sperms. Even in cases of Non Obstructive Azoospermia ( NOA) with Testicular Biopsy showing sperm maturation arrest, fibrosis, hyalinization , SCOS etc there could be occasional tubule with normal spermatogenesis .TESA – Testicular Biopsy would facilitate the choice of treatment with ICSI before considering other options.

MICROSURGERY IN OBSTRUCTIVE AZOOSPERMIA

Prof. A. Rajasekaran – Urologist – Andrologist with his long experience or treating 'MALE INFERTILITY' has undergone speciality training in Microsurgery as HARI BUNKE LABORATORY.

SAN FRANSICO & observed SHERMEN SILBER ( ST .Louis) and MARC GOLDSTEIN ( New york) performing MICROSURGICAL VAS – EPIDIDYMAL RECONSTRUCTION in cases of Obstructive Azoospermia . Prof.A.Rajasekaran is one among the four Micro surgeons from India chosen for Govt of India /AVSC / UNFPA / project to perform Microsurgical recanalisation of vas and epididymis.

Prior to the invention of Intracytoplasmic Sperm Injection (ICSI) by POLERMO ET AL of Belgium (1992) Obstructive Azoospermia cases were treated only by Microsurgery. With the invention of ICSI cases of failed MicroVVA / MicroVEA are advised Epididymal or Testicular Sperm Aspiration & Intracytoplasmic Sperm Injection ( ICSI – TESE) with remarkable success.

Our vast experience has shown Obstructive Azoospermia could be successfully treated by Microsurgery / or ICSI with Micro TESE. A word of caution for infertile couple.

Since woman's age is critical for child bearing the cases of Male infertility should be treated before the woman reaching 35 years. Many infertile couple misdirected and ill informed postpone treatment for Male Infertility very late beyond 35 yrs of woman's age.

MARC INFERTILITY – 'NO SPERMS' – BLOCKS IN SPERM PATHWAYS.

How do we manage men with 'NO SPERMS' on routine Semen Analysis ?
OBSTURCTIVE AZOOSPERMIA :- means sperms are produced adequately in the testes – but 'No Sperms' appear in semen.

Case Report from MARC :-

1. Obstruction at epididymis Testis normal

Treatment : - No medical treatment, Microsurgical Vaso – epididymal Anestomosis (VEA) . If not successful – Testicular Sperm extraction (Microtese)+ Intracytoplasmic Sperm Injection (ICSI)

2. Tuberculous Epididymitis:

Anti TB drugs Therapy – since Epididymis only affected, Testicular Sperm Aspirations(TESE ) + ICSI performed.

Please note :- OBSTRUCTIVE AZOOSPERMIA CANNOT BE TREATED WITH ANY MEDICAL TREATMENT. FALSE CLAIMS ARE MADE THROUGH MEDIA THAT SUCH CASES COULD BE CURED BY DRUGS.

Both testes normal , Semen Analysis 'No Sperms' , Vas absent both sides. These cases are not suitable for Micro surgery.

3. Congenital absence of Vas ( CAVD)

Treatment : - Sperm retrieval from Epididymis / Testis & Intracytoplasmic Sperm Injection.

Since testes contain adequate no of mature sperms - Epididymal / Testicular sperm aspiration. PESA /MESA / TESA technique used aspirated sperms are injected into each egg retrieved from wife 's ovary.

TESE – ICSI ( Intracytoplasmic Sperm Injection)

The sperm & egg fertilize and produce 'Blastocyst'. Embryo transfer into the uterus result in pregnancy

VERY SUCCESSFUL IN MOST CASES.

4. Obstruction of Ejaculatory Duct

Trans Rectal ultrasound confirm obstruction

Treatment : Trans uretheral Resection of Ejaculatory duct orifice performed only by Urologists experienced in Transuretheral Surgery

B.R.S Hospital, #28, Cathedral Garden Road, Nungambakkam, Chennai - 600 034

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