The Best Treatment For Azoospermia

It is also important to realise that azoospermia does not mean you can never have biological children, but rather that you will require assistance to achieve a pregnancy with your partner.

Fortunately, this assistance is readily available at advanced fertility clinics such as the world-class Medfem Fertility Clinic.

What is azoospermia?

Azoospermia is a medical term that refers to the total absence of sperm cells in the ejaculate.

Sperm is made in the testicles and moves through the reproductive tract, mixing with the fluid in the seminal ducts to make semen: a thick, white ejaculate. If you have azoospermia, you may ejaculate, but it doesn’t contain sperm – or stated differently, it has no sperm count.

While only about 1% of men have azoospermia, it accounts for 10% to 15% of male infertility cases.

What are the different causes of azoospermia?

Azoospermia may exist from birth or may have developed later in life due to illness, injury, surgery or poor lifestyles.

There can be two reasons the semen contains no sperm: the first is that there is no sperm production in the testicles; the second is that the sperm is blocked by a blockage in the male reproductive tract or trapped inside the epididymis.

Where there is severely impaired or non-existent sperm production, the term “non-obstructive azoospermia” is used.

There are two types of non-obstructive azoospermia: pre-testicular azoospermia, which is caused by impaired production of the hormones responsible for creating sperm; and testicular azoospermia, which is caused by abnormalities in the function or structure of the testicles.

Common causes of damage to sperm production are testicular injury, undescended testes, a twisted testes, cancer treatments, varicocele and genetic problems.

An example of a relevant genetic disorder is the Kallmann syndrome, which affects the ability to produce gonadotropin-releasing hormone (GnRH) and, in turn, the ability to produce sperm.

Non-obstructive azoospermia can also be caused by damage to the hypothalamus or pituitary gland, certain medications or cancer treatments.

Other causes could include chromosomal abnormalities such as sex reversal syndrome, where a male has the sex chromosomes of a genetic female (ie XX instead of XY); Klinefelter syndrome, where a male has an extra X sex chromosome; chromosome rearrangements and deletions in the Y chromosome.

Testicular non-obstructive azoospermia could be caused by the absence of testicles; testicles that have not dropped; testicles that do not produce mature sperm or any sperm, or Klinefelter syndrome, where the male is born with chromosomes XXY instead of XY.

Where there is no sperm because of a blockage in the male reproductive tract, the term “obstructive azoospermia” is used, and this condition is also called post-testicular azoospermia. This obstructive type is present in about 40% of azoospermia cases.

The obstruction may be the result of a missing connection in the epididymis or vas deferens tubes that move and store sperm. Most men who have cystic fibrosis have obstructive azoospermia, because they were born without a vas deferens. Other causes of obstructive azoospermia include things like previous or current infection, cysts, injury, or vasectomy.

What treatments are available for azoospermia?

Thanks to advances in medical technology, there are a range of different treatment options for both non-obstructive and obstructive azoospermia, as well as procedures like IVF and ICSI that can help you achieve pregnancy with your partner.

Below is more information regarding the advanced and highly-effective treatment options available at Medfem Fertility Clinic.

Hormonal therapy: Hormonal treatments and medications may also help if the underlying cause is low hormone production, as is the case in non-obstructive or pre-testicular azoospermia, which is caused by impaired production of the hormones responsible for creating sperm.

A male hormonal disorder occurs when there is a deficiency in the luteinizing hormone (LH) and the follicle stimulating hormone (FSH) that control testicular function. Such imbalances may be successfully treated by injections of hormone preparations called gonadotrophins. Hormone treatments will cause the testes to increase in size and produce testosterone in normal amounts. Sperm should appear in the semen after several months of treatment.

Varicocele repair: A varicocele is a dilation of the veins of the scrotum which may interfere with the testicle’s production of sperm. Varicocele repair consists of tying or clipping the veins. This is performed through a small incision in the groin. Improvement can be seen in as little as a few months with most men achieving a significant improvement in their sperm production.

Sperm aspiration: This treatment is reserved for men who have the most severe types of male infertility including azoospermia. Sperm aspiration is the group of procedures used to obtain viable sperm from the male reproductive tract, described in more detail below. Sperm aspiration via the appropriate technique is usually a successful, minimally invasive procedure that allows men who make very few sperm to conceive a child of their own.

* Testicular sperm aspiration (TESA): In TESA a fine needle is passed through the skin of the scrotum into a testicle in order to extract sperm tissue. Sperm are then retrieved from the tissue. This is usually performed a number of times in different parts of the testes until an area where reasonable sperm production is found. It is an office procedure performed under local anaesthesia.

* Percutaneous epididymal sperm aspiration (PESA): PESA is a simple technique to obtain sperm in men who have an obstruction of the vas deferens either due to a previous vasectomy or some other obstruction. PESA involved inserting a needle attached to a syringe into the epididymis and then gently extracting sperm-containing fluid.

* Microsurgical epididymal sperm aspiration (MESA): MESA involves opening up the ducts of the epididymis and extracting fluid or a piece of testicular tissue in order to extract live sperm rather than just extracting fluid through a fine needle as is done with PESA. MESA is usually only done when PESA has been unsuccessful.

* Testicular sperm extraction (TESE): TESE is performed when there is an absence of sperm in the epididymis or if there is no epididymis. It involves making a small incision and removing a piece of testicular tissue to obtain sperm. This procedure can be performed in an operating room or office procedure room using a local anaesthetic.

Surgery: Obstructive or post-testicular azoospermia can be treated by reconnecting or reconstructing the tubes or ducts that aren’t allowing the sperm to flow. This may mean surgery or other procedures. There are a variety of surgical procedures available to treat anatomical problems, obstructions or abnormalities found in the male reproductive system.

Vasectomy reversal: A vasectomy reversal repairs a surgically removed section of the vas deferens (sperm duct) and is called a vasovasostomy. Semen analysis to note improvements in sperm count and motility can being about eight weeks after surgery. The results of a vasectomy reversal depend on how long ago the procedure was done. If 10 years or more have passed since the vasectomy, the chance of having sperm reappearing in the semen is greatly reduced.

Intracytoplasmic Sperm Injection (ICSI): ICSI is a procedure in which sperm are directly injected into the egg, used in the case of poor semen characteristics.

ICSI can be seen as one of the major break throughs in treatment of male infertility, since only a few normal sperm are needed and because of its rate of fertilisation of around 70%. Men who were previously seen as completely sterile now have an excellent chance to have their own child.

ICSI is usually offered to couples who have had poor or no fertilisation during standard IVF, or when fertilisation is less likely to occur with routine IVF. To date, tens of thousands of children have been born around the world as the result of ICSI.

What treatment is best for your azoospermia?

With so many possible causes of azoospermia and so many potential treatments, you may be wondering how to determine what has caused your particular type of azoospermia and which treatment would be best for you.

The best treatment for azoospermia depends on the cause of your particular azoospermia.

Male infertility tests such as semen analysis, ultrasound examinations and testicular biopsies will assist your fertility specialist in determining the exact nature and cause of azoospermia.

A semen analysis is usually one of the first tests done. A FSH, LH level as well as testosterone test would be helpful to determine if the testicles are functional and whether you have obstructive or a non-obstructive azoospermia. High levels of FSH and LH, as well as low levels of testosterone, indicates non-obstructive azoospermia. An ultrasound examination of the testes and prostate can be a useful diagnostic test. A testicular biopsy involves the removal of a small sample of the tissue from a testicle, allowing for direct inspection of the sperm making tissue.

These tests enable the precise treatment you require to be identified from the range of procedures and options available today. It requires a specialist with years of experience and advanced technology to pinpoint your specific condition from all the possibilities. But accurately determining the cause is the only way to ensure the best treatment for your azoospermia is chosen.

Your next step in pinpointing the best treatment for your azoospermia from the many possible treatments is a consultation with a fertility specialist.

During your initial 30 – 60 minute consultation at Medfem Fertility Clinic, a highly qualified and experienced fertility specialist will discuss with you your medical history, conduct a physical exam, advise you of your options, and start to plan your tests and treatments.

Simply click here or contact us on +27 (11) 463 2244 to book your initial consultation.

We look forward to meeting you!