What is azoospermia?
Azoospermia means no sperm in the semen. This problem is seen in 1% of men and 10-15% of men with infertility problems. It is very important to distinguish between azoospermia and oligospermia, which is the presence of a small amount of sperm in the semen. The reason for this is that a small number of sperm is used through microinjection. In this way, there is no need to try to obtain sperm. Therefore, azoospermia cannot be diagnosed without microscopic examination of the sediment after centrifugation of at least two semen samples. In men with azoospermia, although the sperm transport channels are usually open, the production of mature sperm in the testicles is not at a sufficient level. In the case defined as testicular failure, defects in the testicles or diseases in the pituitary gland, which secretes hormones that stimulate the testicles for sperm, should be considered. In 40% of patients, the cause of azoospermia is experienced during the phase in which mature sperm produced in the testicles are expelled from the body through the channels.
How is azoospermia diagnosed?
Men diagnosed with azoospermia should have a detailed history and be examined physically. The cause of azoospermia can be determined through laboratory tests. During this evaluation, FSH and testosterone hormone levels should be determined. In addition, the collecting ducts called vas deference should be evaluated during the physical examination. Kidney defects may accompany their congenital absence. Some of these patients may also have a gene defect that can cause cystic fibrosis. If the expectant mother also has this gene, it is likely that the baby to be born will have cystic fibrosis. Therefore, the expectant mother should be screened for CFTR mutation. Sperm production in these patients is normal. Sperm can be obtained through TESA, PESA and TESE. The size of the testicles should be checked during the physical examination of the patients. If the testicles are smaller than normal, the problem can be determined with hormonal tests performed at the beginning. If there is primary testicular failure, genetic examination should be performed since there will be chromosomal defects. Since patients with normal testicular volume, hormone levels and excretory ducts but low semen volume may have ejaculation problems, the problem is usually caused by a blockage in the last part of the excretory system.
Who is affected by azoospermia?
Chromosome defects are detected in 7% of men with infertility problems as a result of a chromosome examination of the white blood cells. Chromosome defects are inversely proportional to sperm count. While the rate in men with azoospermia is 10-15%, it is 1% in those with normal sperm counts. Chromosome anomalies in men with chromosome problems usually belong to the sex chromosome. When there are chromosome defects in men, pregnancies are more likely to end in miscarriage. In addition, children with congenital defects are more common. In these cases, genetic examination of sperm obtained by microinjection should not be neglected.
How is azoospermia treated?
In men with azoospermia, using sperm obtained from the testicles or appendages in microinjection does not permanently cure the problem, but pregnancy can be achieved. These men cannot conceive by their own efforts. If this problem is caused by the pituitary gland or hypothalamus, the underlying cause must be treated. In addition, patients must be given hormone therapy to gain masculine physical characteristics and sperm production must be achieved. These treatments take a long time. In addition, couples must not have any other defects other than azoospermia, which causes them to have babies. Since this process takes a long time, the woman will get older, and even microinjection may not be able to achieve pregnancy. Therefore, such treatments should be used to eliminate problems other than sperm production in men. There is no known permanent treatment for the absence of sperm production in the testicles. Using sperm obtained from the testicles in microinjection is the only option. In cases of a problem such as obstruction in the carrier channels, it should be known that eliminating this with microsurgery is a situation that requires both experience and advanced training.
In experienced centers, the pregnancy rate with microinjection is currently between 25 and 40%. In addition, a successful pregnancy can be achieved in approximately 12 months. This method is only successful when the cause of infertility is azoospermia. Surgical sperm retrieval is performed under general or local anesthesia. However, general anesthesia is generally preferred. Hospitalization is not required during this procedure and the procedure is completed in half an hour at most. Patients can return to their daily lives after the procedure. The procedures can be performed at a suitable IVF center. The samples are examined in the laboratory and the presence of sperm is determined. If sperm is found, the procedure is terminated.
How to obtain sperm in case of azoospermia?
In most patients, sperm production is achieved, but it cannot be expelled from the channels. In these patients, sperm is usually obtained using the TESA, TESE and PESA methods. In the micro TESE method, the testicle is examined with a microscope and a small tissue sample is taken. This sample is taken only from the area where the sperm is. A small incision is made in the sac containing the testicles and the tunica albuginia, which surrounds the testicle. In this way, the chance of finding sperm increases and since a small amount of tissue is removed, the testicle and the testosterone hormone are not harmed. After the procedure, the incisions are closed with stitches. The surgery is performed under general anesthesia by urologists.
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