Being told that you have no sperm can be a distressing and confusing diagnosis. Does it mean you can never have children of your own? Does it mean your only chance of a family is to use donor sperm?
Here we look at the diagnosis of ‘azoospermia’ and what we can do about it:
What is azoospermia and what causes it?
Azoospermia is the medical term for when you have no sperm present in your ejaculate. There can be a number of reasons why you’re not producing any sperm: a blockage in the tubes that transport the sperm, vasectomy, or low or no sperm production in the testicle.
What if my tests show I have azoospermia?
If your semen analysis shows that you have azoospermia, you will undergo thorough evaluation and investigation by our Consultant Urologist, who has specific expertise in male-factor fertility issues. Dependent upon the exact cause, we can then plan appropriate treatment to give you the best chance of using your own sperm to have a baby.
What are my treatment options?
The most common treatment for azoospermia is a technique called surgical sperm retrieval – known as SSR. There are different techniques which collect sperm from different areas, and the identified cause of your azoospermia will dictate which technique is right for you.
Sperm are produced within tiny tubules (seminiferous tubules) in the testes and pass from the tubes into the epididymis, where they complete their development. At ejaculation, sperm passes from the epididymis along the vas deferens, collecting fluid from the prostate gland and seminal vesicles, before emerging externally as semen.
Surgical sperm retrieval techniques collect sperm from the vas deferens, epididymis or testes. In some cases, SSR cannot help because spermatozoa are not being produced at all in the testes, so there is no sperm we can try to retrieve. In these cases the only option would be the use of donor sperm.
The different SSR techniques are:
Percutaneous Epididymal Sperm Aspiration (PESA): PESA is recommended when there is a blockage in the sperm transport tubes . It is done by inserting a fine needle through the scrotum into the epididymis. A sample is aspirated from the epididymis, which is then sent to the laboratory to see if it contains motile sperm.
PESA can be performed without an anaesthetic. Although it is uncomfortable, most men can tolerate the operation. However, we recommend ananaesthetic as occasionally no sperm is retrieved using PESA and so it may be necessary to proceed to TESE.
Testicular Sperm Extraction (TESE): In some cases sperm is produced but does not reach the epididymis. When this happens, sperm may be obtained by taking small biopsies from the testes. This technique can be a closed procedure using a biopsy gun, or an open procedure. The testicular material is processed in our laboratory to release the sperm from the seminiferous tubules.
Micro-epididymal Sperm Aspiration (MESA): MESA is an open procedure that requires general anaesthetic. This is usually done at the same time as a reversal of vasectomy. Instead of using a needle, a cut is made through the scrotum and into the epididymis. Any fluid found in the area is drained and sent to the laboratory for analysis.
All SSR techniques are day-case procedures and you will be able to go home the same day.
If you manage to retrieve sperm, what happens next?
Sperm collected by PESA and MESA is frozen and stored at once. Sperm collected from TESE is kept in the laboratory for at least 24 hours before being frozen. Sperm is stored under liquid nitrogen at such a low temperature (-196°C) that is does not deteriorate during storage.
In all cases, a tiny amount of sperm is thawed to assess if enough sperm have survived the freezing and thawing process. Any sperm which survive can then be used for Intracytoplasmic Sperm Injection (ICSI) treatment, a form of fertility treatment similar to IVF, where a single healthy sperm is injected directly into the egg to fertilise it.
IVF isn’t recommended in cases where sperm has been obtained through SSR, simply because the number of sperm retrieved is usually low and so ICSI gives the best chance of pregnancy.
What are the success rates from SSR?
Surgical sperm retrieval is successful for the majority of men with obstructive azoospermia. If the cause of the azoospermia is unknown then the success rate depends on the hormone level and size of the testes. However, whether the sperm then fertilises the egg is dependent upon a number of factors, including the age of the female patient, number of eggs and egg quality.