Azoospermia carries important changes in male fertility and prevents natural conception; if it is not reversible and a surgical approach is proved to be unfeasible, the couple should consider the use of assisted reproduction treatments
The likelihood of having biological offspring is determined by the type of azoospermia a man is suffering. Those with obstructive azoospermia can become a biological parent in 100% of the cases, provided that other infertility alterations are not involved, whereas a patient with secretory azoospermia only has 50% chances to conceive naturally.
In men with obstructive azoospermia to therapeutic strategy is to extract the sperm and later perform an ICSI. ICSI is the right technique, as it does not require a large amount of sperm, just the one with the best morphology will be selected and injected in the egg, thus easing fertilisation.
There are two procedures to extract sperm:
- MESA (microsurgical epididymal sperm aspiration): used in patients with their reproductive tract blocked, it is a complex and expensive operation.
- PESA (percutaneous epididymal sperm aspiration): this intervention is less complex than MESA. A needle is injected through thekin, but that injection is performed blindly. This is the major disadvantage of PESA, as an injection might not extract spermatozoa (although such cases are infrequent).
In patients with secretory azoospermia, despite the actual lack of sperm production, there might be traces of spermatogenesis; a spermatozoid can be found if looking thoroughly. A frequently used strategy is to freeze the spermaotozoa found, so when they reach a reasonable number (10-15), an ICSI is performed.
Testicular biopsy is performed with under anesthesia and sedation, is a fast intervertion and while the urologist is removing internal tissue of the testicle, a specialist in assisted reproduction observes them under the microscope, looking for spermatozoa. When the specialist considers he has found enough spermatozoa, the urologist stitches the incision up.