Surgery of Azoospermia

A new surgical technique known as Micro TESE has been developed to detect sperm in the testicles of men who have poor sperm production (non-obstructive azoospermia). Prior to the era of intracytoplasmic sperm injection (ICSI), these men were considered sterile.

The most predictive factor that we currently have is a testicular biopsy. A biopsy is a minor 30 minute procedure where a small window is made in the testicle through which a tiny rice kernel-sized segment of testicular tissue is obtained.

These are different procedures used to withdraw sperm from the testes in certain cases of male infertility. Any one of these procedures is performed in obstructive azoospermia: congenital or acquired due to infection or vasectomy. It is a minor, day procedure done under local anesthesia on the day female partner’s eggs are retrieved.

Description

If sperm are not found in the ejaculate, then there is either obstruction or blockage in the reproductive tract or sperm is not being made at levels sufficient to get into the ejaculate. A blockage can be due to prior infection, surgery, prostatic cysts, injury or congenital absence of the vas deferens (CAVD). Except for cases of congenital absence, most cases are of obstruction are repairable with microsurgical or endoscopic reconstruction o Conditions that cause azoospermia are listed in BELOW. If at all possible, treating the specific condition that is causing the azoospermia may reverse the process and lead to sperm production. This is especially true for azoospermia due to hot tubs or hot baths or testosterone supplements. In other cases, such as genetic infertility, this is not possible and assisted reproduction offers the best solution to family building.

Conditions That Cause Azoospermia
  • Primary testicular failure Klinefelter syndrome
  • Y chromosome microdeletions
  • Genetic infertility due to abnormal chromosomes (karyotype)
  • Unexplained genetic infertility
  • Secondary testicular failure Kallman Syndrome
  • Unexplained gonadotropin deficiency
  • Hypothalamic/pituitary tumor
  • Hyperprolactinemia
  • Cancer treatment (chemotherapy, radiation, surgery)
Varicocele Effect
  • Pituitary suppression Drug induced (anabolic steroids, alcohol, glucocorticoids)
Testosterone Supplements
  • Congenital adrenal hyperplasia
  • Severe illness (cancer, kidney or liver failure)
  • Diabetes mellitus
  • Sickle cell anemia
  • Hemachromatosis
  • Sperm autoimmunity
  • Pesticide/toxin exposure (including hot tubs and baths)
  • Undescended testicles at birth
  • Obstruction Congenital absence of the vas deferens (CAVD)
Ejaculatory Duct Obstruction
  • Epididymitis
  • Scrotal trauma or surgery
  • Young syndrome