One of the less common forms of male infertility is azoospermia, which is defined as a complete lack of sperm in a man’s ejaculate. It occurs in only about five percent of men with fertility problems. Treatment depends on the type of azoospermia a man has, but there is hope that he can still become a biological parent.
Causes of Azoospermia
Azoospermia may be caused by a blockage of the tubes that carry the sperm, or it can be due to defects in sperm production. Obstructions of the vas deferens, which are the tubes that carry sperm to the ejaculate, may be caused by injury, infection, vasectomy, or congenital effects (present from birth) such as absence of the tubes, called congenital bilateral absence of the vas deferens (CBAVD), which is often associated with cystic fibrosis. Recent research has found that more than half of the men with CBAVD have a genetic mutation on the same gene that causes cystic fibrosis, which doesn’t result in the respiratory symptoms of the disease but manifests itself in infertility.
Defects in sperm production may be congenital as well or caused by injury or infection later in life. Kleinfelter syndrome, when a man has an extra X chromosome (XXY instead of XY) drastically affects a man’s fertility. Use of anabolic steroids is another prominent cause, because it can shut down a man’s own testosterone production. Men with very low levels of sperm may still have enough sperm in their testes to be used for IVF.
Testing for azoospermia begins with a second semen analysis, just to make sure the first test wasn’t influenced by something like a recent infection. A blood test to determine hormone levels, a scrotal Doppler ultrasound, and a transrectal ultrasound are often part of testing to determine what is causing the infertility issue. Genetic testing may be used to screen for Kleinfelter syndrome.
Sperm Retrieval
If a man has sperm in his testes that aren’t present in his ejaculate, sperm retrieval can harvest sperm for use in IVF. Sperm retrieval may be done in advance of the IVF cycle because the sperm can be frozen, but some IVF labs prefer to work with fresh sperm. Your fertility specialist will recommend what is best for both partners’ treatment plans and schedules.
The type of technique used for sperm retrieval depends on the nature of the fertility issue. Simple sperm retrievals are usually performed the day of egg retrieval. They are performed in men with blockages in their testicles who produce sperm without a problem. More complex retrievals which require general anesthesia are either coordinated with egg retrieval or performed in advance. The types of sperm retrieval are:
- Testicular sperm aspiration (TESA)—Performed with local anesthesia, a needle is inserted in the testicle and sperm is aspirated for use in IVF.
- Percutaneous epididymal sperm aspiration (PESA)—This procedure is used for men who have obstruction from a prior vasectomy or infection. It is done under local anesthesia, and is coordinated with the female partner’s egg extraction.
- Testicular sperm extraction (TESE)—In TESE, a small incision is made in the testes and the tubes are examined for the presence of sperm. This procedure is usually done under sedation, and sperm are frozen.
- Microepididymal sperm aspiration (MESA)—A procedure done when a man has an obstruction or CBAVD, it is carried out under general anesthesia. Sperm is usually frozen so there is a quantity for future use.
- Microdissection testicular sperm extraction (Microdissection TESE)—This procedure is performed for men who have a sperm production problem. Performed in the operating room with general anesthesia, it is usually timed for the day before the female partner’s egg retrieval. Many patients have donor sperm as backup in case no sperm are found.
All these technical terms may sound a bit intimidating, but rest assured that your fertility specialist will develop a treatment plan personalized for you and your partner. The good news is, many men with azoospermia actually have sperm that can be retrieved, and they can become genetic parents through IVF.
Is IVF Treatment For You?
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