If surgery is able to correct the obstruction causing azoospermia, couples may be able to conceive naturally without the help of fertility treatments. However, there are sperm retrieval techniques that can also allow for conception. Men with obstructive azoospermia may be able to father a child through retrieval of sperm directly through the testis or epididymis, followed by IVF with intracytoplasmic sperm injection ICSI.
During IVF, sperm retrieval can be performed on the same day as the egg retrieval , or it can be done some time before. Many fertility clinics prefer to use fresh sperm. Repeated sperm retrievals can be performed, though there is a recommended wait of 3 to 6 months between retrieval procedures. In most cases, ICSI—the process by which an embryologist physically injects a single sperm into an egg to promote fertilization—will be used to fertilize the eggs as retrieved testicular sperm does not have the number of motile sperm necessary to permit IUI or IVF without ICSI.
For the last 20 years, Dr. There are conflicting data regarding whether to surgically repair varicoceles. Varicocelectomy can help reduce the swollen varicose veins by tying off the affected veins are tied off and rerouting the blood flow through healthy veins but is generally reserved for severe cases. Previously, fertility doctors thought that men who have problems with sperm production could only create their family with donor sperm or through adoption.
However, testis biopsies in men with non-obstructive azoospermia have often shown sperm. Testicular sperm often have lower motility, but they can be used for intracytoplasmic sperm injection ICSI during in vitro fertilization IVF.
Testicular sperm extraction can be performed under local or general anesthesia. Sperm retrieved through this process can be used in IVF procedures. If a man has a diagnosis of a genetic cause for his non-obstructive azoospermia, genetic testing and counseling is recommended before IVF. She went on to c omplete her medi c al s c hool edu c ation at Duke University S c hool of Medi c ine.
There are numerous causes of non-obstructive azoospermia, including: Genetic abnormalities Hormonal imbalances Radiation and toxins Medications Varicocele Causes of Non-Obstructive Azoospermia Genetic Causes There are several genetic causes of male infertility that may result in non-obstructive azoospermia. Hormonal Causes of Non-Obstructive Azoospermia For the testicles to produce sperm, they must be stimulated by pituitary hormones.
Radiations and Toxins Exposure to toxic chemicals such as heavy metals, chemotherapy, and radiation therapy can all impair sperm production. The disorder may be congenital i. Sperm production may be entirely absent or may involve arrest during an early or late stage of sperm maturation. Read More Abnormal, atrophic, or rarely, even somewhat normal testicles in the presence of an elevated serum FSH and a normal or low testosterone level is consistent with this diagnosis, also called primary testicular failure.
In rare instances, a testicular biopsy may be carried out to better characterize the exact histology of the disease. A variety of genetic abnormalities may also impair sperm production. The two most common categories of genetic errors causing testicular azoospermia are:. Acquired Causes: Read More Testicular azoospermia may be acquired due to infection e. Azoospermia may also be associated with a varicocele an abnormal enlargement of the veins that drain the testicle , which may cause testicular hyperthermia overheating.
Other factors associated with testicular azoospermia include increasing age, low testosterone, and the frequent use of hot tubs or baths. Treatment: Read More The specific therapy to treat testicular azoospermia depends on the underlying cause of the disorder.
In some congenital cases of testicular azoospermia in which late maturation arrest results in abnormal sperm production, testicular sperm extraction TESE may be performed if isolated areas of mature sperm are found with an operating microscope.
However, the use of assisted reproductive technology in this setting is not without drawbacks. The couple must, therefore, be counseled on the risk of passing down compromised fertility to all male offspring.
Unfortunately, some cases of congenital testicular azoospermia are simply not amenable to treatment. These couples may wish to explore the use of donor sperm or adoption to achieve.
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