Azoospermia: A common reason for male infertility

NT Correspondent

I nfertility is often associated with women, and seldom are men considered infertile. However the ground reality is different from common perception. Among infertile couples, in 40 per cent cases the problem is with men, 40 per cent with women and in 20 per cent cases both have problems.

Azoospermia, a condition where a man ejaculates semen but that doesn’t contain any sperms, is a common problem that affects 15 per cent of infertile men. In India, around 5 per cent of adult males suffer from infertility.

There are two types of Azoospermia - Obstructive and Non-Obstructive. In cases of Obstructive Azoospermia, there is normal sperm production in the testis but an obstruction hampers the flow of the sperms. The blockage could be anywhere between the testis and the urethra (urine passage). Infection, injury or surgery (for hernia or hydrocele) of the genital tract may result in this condition.

As a result, sperms are not seen in the ejaculated semen. Treatment options in such cases are straightforward and the blockage can be bypassed by surgery or sperms can be obtained using a fine needle directly from the testis.

Speaking about the treatment for Obstructive Azoospermia, Dr Rajsekhar Nayak of Gunasheela Surgical and Maternity Hospital, said, “Surgical bypass is successful in only a small percentage of patients. Hence, many patients opt for obtaining sperms from the testis using methods called Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA). Here, a fine needle is used to obtain sperm directly from the testis. It is simple, painless and does not need admission.”

Sperms are retrieved in almost 100% of patients. These sperms can then be used for injecting the patient’s wife’s eggs during a procedure called IVF –ICSI.

Non-obstructive Azoospermia
In cases of Non-Obstructive Azoospermia, there is a problem with the production of sperms in the testis. “The exact cause is unknown in most of the cases but radiation, chemotherapy, mumps infection in childhood, hormonal deficiencies may result in this condition. Traditionally, it was thought that men with non-obstructive Azoospermia were incapable of producing any sperms. Therefore, the only option available was insemination with donor semen or adoption,” Dr Nayak said.

Sperm retrieval
However, studies have now shown that even in non-obstructive Azoospermia, there are small pockets of sperm production in the testis. A new procedure known as Microdissection Testicular Sperm Extraction (Micro – TESE) is used to retrieve sperm so that these men can have their own biological child. Using Micro-TESE sperms can be obtained in up to 60 per cent of these patients.

The sperms obtained by either technique are used in a procedure called IVFICSI (test-tube baby). The pregnancy rate from this technique is similar to that achieved in IVF-ICSI using normally ejaculated sperms. Many patients have been treated this way successfully and Gunasheela Surgical and Maternity Hospital have had the first baby in the state with the Micro-TESE surgical procedure, added Dr Nayak.

As part of the treatment, under Anaesthesia, the testis is opened. Using the operating microscope under 25X magnification dilated opaque tubules is identified. Small bits of these tubules are taken and sent to the lab to look for sperms.

Utmost care is taken to not injure the blood vessels of the testis. This high precision surgery requires training and experience. The sperms retrieved are used for IVF-ICSI. Patients are discharged the following day. The risks and complications of this procedure are minimal and do not lead to any problems in the future.

Causes of Azoospermia
Blockage in the ejaculatory tubes
Injuries within the genitalia STDs, Varicocele, and other male sexual infections
Genetic factors
Hormonal imbalances, stress, and trauma
History of surgery, especially of the male reproductive organ