Azoospermia - No sperm:

Current Scenerio

The infertile couple are not aware of existence of specialized centres for comprehensive management of infertile couple. 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 by the time ICSI is chosen as the mode of treatment and the cost involved. 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 up to 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 viz TDI/adoption.

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Case reports from MARC – Male Infertility

1. OBSTRUCTIVE AZOOSPERMIA – BILATERAL VASAL AGENESIS – (PESA-ICSI)

Case 1: Mr.S, 30yrs, Wife Mrs. S, 30yrs Married since 2 yrs clinical diagnosis . Bilateral absence of Vas . SA – Azoospermia- Trial PESA. Plenty of sperms . PESA & ICSI . Four Embryos Transferred- Pregnancy – Delivered Healthy Male Child.


Case II : Mr.RK, 32 yrs, wife : P, 32 yrs married 3 yrs clinical diagnosis – Bilateral Vasal Agenesis , SA Azoospermia – Trial PESA – Sperms Present – Oocyte aspiration – 3 Oocytes ICSI - 3 embryos - (2 x 8 cell) transferred Day 3. Wife delivered healthy Male Baby.

2. OBSTRUCTIVE AZOOSPERMIA – FAILED MICROVEA – AZOOSPERMIA – ICSI

Mr.S. 33yrs , Mrs. G 30 yrs married 2 yrs clinically obstruction to Cauda epididymis with Azoospermia. MicroVEA done – Not Successful . Testicular Sperms obtained by TESE Oocyte aspiration – Embryo Transfer – ( 3 x 8 cm) . Wife Pregnant and delivered .

3. OBSTRUCTIVE AZOOSPERMIA - BILATERAL CHRONIC EPIDIDYMITIS –
NOT SUITABLE FOR MICROVEA

Mr. TS 32 yrs , Mrs. S 30 yrs married 6 Yrs Clinically gross thickening of epididymis & Vas. Prostate normal. SA- Azoospermia TESE – 6.8 sperm HPF. Oocytes Retrieved ICSI – 6 x 4 cell . ET (Day2) . Wife Pregnant and delivered

4. SEVERE FORM OF OLIGO ASTHENO TERATOSPERMIA – ICSI – EJACULATE

Case I : Mr. K.A.32 yrs Mrs.K. married 5 yrs clinically both testes & Epididymis normal – Vas present .SA Ejaculate with only 2 -3 / hpf. Oocytes retrieved – ICSI – 6 fertilised – Day 3 Embryo Transfer . Wife Pregnant and delivered.

Case II : Mr.PA 36 yrs wife Mrs. C , 32 yrs – married 8 years. H/O two failed attempts with IVF . Clinically normal findings – S/A – 3 million – 10% P3 .Oocytes retrieval – ICSI with ejaculate sperms. Wife Pregnant & delivered male baby.