Treatment of azoospermia

The absence of sperm in a man's ejaculate is called azoospermia and is one of the causes of infertility. Azoospermia can occur for various reasons, including genetic disorders, hormonal imbalances, inflammatory processes, trauma, or issues with passage in the seminal pathways. The condition can take an obstructive or secretory form. In the first case, sperm cannot enter the ejaculate due to the obstruction of the seminal ducts. In the second case, azoospermia is associated with an abnormality in the process of producing reproductive cells in the testes. Depending on the form of the condition, the urologist develops the therapeutic choice.

Treatment Methods for Azoospermia

In the obstructive form of the condition, it is possible to restore the permeability of the seminiferous ducts through micro-surgical manipulations. In this case, the couple has a chance to conceive naturally. The treatment of azoospermia associated with inflammatory diseases in men involves anti-inflammatory therapy. In the case of obstructive azoospermia, the surgical intervention aims to eliminate the causes of the obstruction in the seminal pathways, which allows for the restoration of the process of sperm release into the ejaculate and, consequently, the possibility of natural conception.

The secretory form of the condition generally leaves no chance for natural conception. However, there are assisted reproductive techniques such as in vitro fertilization (IVF) that can help achieve pregnancy even in these difficult cases. In cases where the process of sperm production in the testes is impaired, assisted reproductive techniques such as IVF using sperm obtained by testicular biopsy can be used to achieve pregnancy.

Azoospermia cannot be determined by oneself. Such a diagnosis can only be made by a urologist or andrologist based on the results of a spermogram. The spermogram is an analysis of the ejaculate that allows for the evaluation of the number, motility, and morphology of sperm, as well as identifying their absence in the sample.

Testicular Biopsy in Cases of Azoospermia

The procedure of testicular biopsy involves surgically extracting sperm from the testis or the appendix. Before the intervention, it is advisable for the patient to consult a doctor to discuss all the steps of preparation, including blood tests, avoiding certain medications, and following dietary and lifestyle recommendations. This helps minimize risks and increase the chances of successful sperm retrieval. The biopsy is performed in cases of azoospermia associated with pathologies such as Klinefelter syndrome, orchitis, testicular torsion, cryptorchidism, bilateral aplasia, inguinal hernia, vasectomy, and obstructive aspermia. The biopsy is an important method for the diagnosis and treatment of azoospermia, as it allows for the retrieval of sperm that can then be used for fertilization.

Testicular Biopsy Methods

Testicular biopsy for azoospermia can be performed using the following methods:

• TESA (Testicular Sperm Aspiration through the skin): this method involves using a special needle to aspirate sperm from the testicular tissue through the skin. It is a minimally invasive procedure that can be performed on an outpatient basis.
• TESE (Testicular open biopsy for reproductive cells): this procedure involves making a small incision on the testis to obtain a tissue sample containing sperm. This method allows for the direct examination of the structure of the testicular tissue to detect the presence of sperm.
• PESA (Percutaneous Epididymal Sperm Aspiration): a procedure similar to TESA, but aimed at obtaining sperm from the epididymis. It is used in cases where sperm do not reach the ejaculate due to obstruction of the ejaculatory ducts.
• MESA (Microepididymal Sperm Aspiration): a microsurgical procedure that allows for the extraction of sperm directly from the epididymis. This method is particularly effective in cases of obstructive azoospermia when the obstruction affects the area between the testis and the epididymis.

The most effective and modern method is the testicular biopsy Micro TESE. Through the use of an operating microscope and careful examination of the seminiferous tubules, this method allows for the retrieval of nearly twice as many sperm as previous techniques. At the same time, the amount of testicular tissue aspirated is much lower, which reduces health risks for the man and contributes to a faster recovery after the procedure.

After the operation, the patient usually remains in the department for 2 to 3 hours under the supervision of doctors, after which he can return home. It is recommended to avoid any physical activity for a few days, wear supportive underwear, and follow all the doctor's instructions to reduce pain and prevent potential complications.

The sperm obtained by Micro TESE can be used in an in vitro fertilization (IVF) protocol or be frozen for later use. It is important to note that the cryopreservation of sperm preserves the reproductive cells for future fertilization attempts, which is particularly important in the presence of factors that may negatively affect fertility in the future.

The Specialists at NatuVitro Clinic

The treatment of azoospermia requires a comprehensive approach, including both drug therapy and surgical intervention methods. It is important not to delay consulting a specialist in case of suspected infertility, as timely screening and treatment of azoospermia significantly increase the chances of success. The urologists and andrologists at NatuVitro Clinic will help determine the most appropriate treatment method and provide advice on assisted reproductive techniques that can be used to achieve the desired pregnancy.