Azoospermia

Azoospermia is the absence of sperm in a man’s semen which in turn compromises his fertility.

Sperm recovery through epididymis aspiration or testicular biopsy is the best option to achieve pregnancy in patients suffering from azoospermia.

Although the number of retrieved sperm is usually relatively low, it is possible to combine these techniques with intracytoplasmic sperm (ICSI) as this technique requires only one good quality sperm to fertilize every egg.

What is azoospermia?

Azoospermia is the absence of sperm in a man’s semen. Between 10 and 15 percent of men with fertility problems present this disorder.

This condition is classified as:

  • Obstructive azoospermia: In 40 percent of azoospermic patients, sperm is produced  by the testicles, but cannot mix with the rest of the ejaculatory fluid due to blockage or absence of the vas deferens
  • Non-obstructive (or secretory) azoospermia: In 60 percent of azoospermic patients, the testes produce little or no sperm.

Azoospermia causes

Obstruction or absence of the vas deferens may be caused by:

  • Genetic disorders such as Klinefelter syndrome
  • Vas deferens congenital absence, common in cystic fibrosis gene carriers
  • Damage caused by seminal tract infections
  • Inflammatory processes such as epididymitis, prostatitis, parotitis and varicocele
  • Surgery or other trauma such as inguinal hernias, testicular trauma or vasectomy

Meanwhile, problems in sperm production can be caused by:

  • Hormonal changes related to follicle stimulating hormone (FSH)
  • Varicocele
  • Testicular problems
  • Genetic disorders such as Y chromosome deletions
  • Cancer treatments such as chemotherapy or radiotherapy

How is azoospermia diagnosed?

In addition to a medical history analysis and a quick and painless genital check-up, azoospermia can be diagnosed through a simple spermiogram (or semen analysis). This test is performed following a 3-5-day sexual abstinence period.

In some cases a blood test should be performed to measure follicle stimulating hormone (FSH) blood levels, which cause the testicular production of sperm. High FSH blood levels may indicate low sperm production.

Fertility treatments to achieve pregnancy in patients with azoospermia

Sperm recovery through epididymis aspiration or testicular biopsy is the best fertility treatment option to achieve pregnancy in patients suffering from obstructive azoospermia.

Although the number of retrieved sperm is usually relatively low, it is possible to combine these techniques with intracytoplasmic sperm (ICSI) as this technique requires only one good quality sperm to fertilize every egg.

In half of secretory azoospermia cases sperm can still be found during a testicular biopsy. If this were not the case, sperm donation is an excellent alternative.

Azoospermia patients also have a higher rate of structural genetic abnormalities, so a preimplantation genetic diagnosis ( PGD ) is highly recommended. In conjunction with ICSI, PGD allows us to select the genetically and chromosomally normal embryos, which are then transferred to the patient’s uterus.

This technique increases the chance of embryo implantation, having a normal pregnancy and, ultimately, of having a baby at home.