Azoospermia is a medical term for “Zero sperm in the ejaculate”. It is very important that this condition is differentiated from Cryptozoospermia - where sperm is present but very few in number. These few sperms would then be seen under the microscope if the raw sample is spun in a centrifuge for sufficient time. So the first thing that any good Embryologist should do when coming across a zero sperm sample is to at least centrifuge it and observe it again. Many of the so-called “Azoospermia” patients would be discovered to be wrongly diagnosed!
Again, we, at Janini IVF, the best Azoospermia Treatment center in Delhi NCR, follow the criteria recommended by the latest WHO recommendation for semen analysis. Accordingly, any patient who’s found to have zero sperms in one sample should ideally give another sample and only when both samples have no sperm a diagnosis of Azoospermia is made.
Azoospermia is seen in about 2% of all males in general population and about 10% of males with fertility problems.
In males the two testes are responsible for sperm production as well as producing the male sex hormone Testosterone. Azoospermia tells us that the sperms are not seen in the ejaculate. But it doesn’t always mean that the sperms are not being produced. Let us elaborate further.
Azoospermia results from one of the three reasons below :-
Pre-testicular cause - here the brain is not producing hormones like FSH and LH which are required for the testes to start functioning. Without the brain signalling the testis to produce sperm, the sperms won’t be produced and the couple will be infertile. Medically we call this condition as “Hypogonadotropic Hypogonadism” Testicular cause - this is the true testicular reason for absent sperm. Here the testicles have undergone serious damage due to any reason like exposure to chemicals, radiation, chemotherapy, etc. or due to genetic condition. Whatever the reason maybe, the testes have failed. There is no production at all (rare) or very less production not enough for sperms to come out of the ejaculate sample (common). We call this condition medically as “Non-Obstructive Azoospermia” or NOA Post testicular cause - here the brain is functioning well, the testes are perfectly normal, but unfortunately there is a block somewhere between the testes and the urethra where the sperms come out. Because of the block the sperms are retained inside and we find no sperms in the ejaculated semen sample. Medically this is defined as “Obstructive Azoospermia” and this is commonly found in patients who’ve had past infections, previous surgeries on pelvic organs or genital injury sometime in the past.Usually, no. Diagnosis of Azoospermia comes as a rude shock to most men. However, if someone had an injury or exposure to certain medicines or reduction in semen volume he would know. Sometimes rarely there could be symptoms like pain while ejaculating or yellowish/reddish discolouration of the semen. Apart from these there are hardly any symptoms.
Since presence of sperm is necessary for a natural conception, you would not be able to conceive on your own. But thankfully today the Artificial Reproductive Technologies have advanced to such levels that you can very well have a baby with your own sperm. This is true to even those patients with Non-Obstructive Azoospermia or sperm production problems.
Now one may ask that if the testes are not producing sperms at all and there are zero sperms in the ejaculate how can one get pregnant? Well the answer to that is - even in cases of NOA (sperm production problem) 70-80% of those cases have certain pockets of testis where sperm production is going on. A single testis has about 1 million seminiferous tubules where sperm production take place. Such local pockets of sperm production will be missed out if we do a random biopsy or take a one small piece of testis at a site where there are no good tubules. And this is where the role of a miracle treatment comes in. This miraculous new advent in IVF treatment is called “Micro-TESE”.
Micro-tese is done by opening the testis completely, observing the inner structure of the testis through an operating microscope (40x magnification) and selecting those tubules that appear thick and dilated, detaching them from the testis and passing them to the laboratory where the most experienced and skilled embryologist who’d scan those tubules for the presence of sperm. This process is repeated on other tubules until we succeed in finding sperms. These sperms can then be used in ICSI procedure - where one sperm is taken to be injected inside a single egg and that’s how we can have many embryos created. Excess sperm if found at micro-TESE are frozen and stored safely.
Out of the three major causes of Azoospermia mentioned above, the pre-testicular and post-testicular are most treatable. In other words, if there is indeed testicular damage due to some reason and you have Non-Obstructive Azoospermia, it is likely you might not ever be treated. But nothing to worry, as mentioned we can still take sperm from the scant pockets of sperm production by the micro-TESE procedure and help you achieve pregnancy with your own sperm.
Pre-testicular Azoospermia is mainly due to hormonal problems and can be treated by administering certain injectable hormones.
Post-testicular Azoospermia is due to blocks and depending on the site and type of blocks, there are reconstructive surgeries available to remove those blocks. But even if the blocks can’t be removed, we can easily harvest sperms from the passages before the block exists and use those sperms in an IVF or ICSI procedure with excellent success rates. Such simple procedures are called PESA (per-cutaneous epididymal sperm aspiration) or MESA (Micro-surgical epididymal sperm aspiration). Dr. Dalal has extensive experience in performing both these procedures and in these cases there is 100% chance of successful harvest of sperm as the production is normal.
Dr. Rutvij Dalal, the best ivf specialist in Delhi, has had the privilege of learning the art and skill of a delicate procedure like micro-TESE from one of the best Andrology centres of the world - Androfert at Brazil. Again, while his super-specialty FNB degree course at Lilavati Hospital, Mumbai he had been fortunate to be around with some of the most renowned micro-TESE experts in the world like Dr. Rupin Shah. With this expertise and a passion for treating male infertility, Dr. Dalal wants to now offer this advantage to his patients at Janini IVF.
Perhaps the most important person in the entire micro-TESE procedure is the embryologist. A surgeon will just give the tubules, but the most painstaking process would be to tease those tubules under microscopic vision and try and harvest sperms out of them. It needs a great deal of dedication, skill and experience to handle micro-TESE samples in the laboratory and this is exactly what Dr. Akanksha Mishra has. An Oxford University post-graduate, she comes with over 15 years of experience in helping patients with Azoospermia have a baby with their own sperms.
At Janini IVF, providing the best infertility treatment in Delhi, are quite proudly mentioning that this doctor - Embryologist combination along with the best equipment is nothing short of excellence in bringing the best possible results in male infertility.
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