Testicular Sperm Extraction: Nonobstructive Azoospermia

The advent of new sperm retrieval methods has made it possible for successful sperm extraction to be carried out among patients diagnosed with non-obstructive azoospermia. TESE, or Testicular Sperm Extraction, helps to extract sperm among men with extremely diminished levels of fertility and even those who are sterile. The extracted sperm are then injected into the female egg using ICSI (Intracytoplasmic Sperm Injection).

Effectiveness of Testicular Sperm Extraction for Non-Obstructive Azoospermia

Azoospermia refers to a medical condition wherein the male lacks enough sperm cells in this semen. Within the niche of azoospermia, two categorizations are made—obstructive azoospermia and non-obstructive azoospermia (NOA). Please note that men with obstructive azoospermia can be treated with other options and TESE might not be necessary for them. This is because such men produce an insufficient amount of sperm in their semen. This is due to an internal blockage that can be cured with other treatments like a surgical correction.

However, men with non-obstructive azoospermia present a more serious problem, i.e. their semen doesn’t have any sperm. Here, the sperm cells are destroyed within the tubules of testes during their maturation process or in the ejaculatory pathway. Causes of non-obstructive azoospermia include:

  • Cryptorchidism (absence of sufficient testicular tissue)
  • Environmental hazards like radiation effects
  • External, physical trauma
  • Excess of hormones like prolactin and glucocorticoids
  • Deficiencies of hormones like Gonadotropin-Releasing Hormone
  • Radiotherapy or chemotherapy trauma
  • Thyroid abnormalities
  • Testicular cancer
  • Varicocele
  • Drug addiction

Thus, in non-obstructive azoospermia sperm has to be extracted from the site within the testicular tissue where sperm cells are originally produced. This is done via sperm extraction in the form of TESE.

TESE Basics

TESE depends upon using a biopsied section of the testicular tissue. The testicular tissue is extracted from a marked site in the testes that lacks intensive vascular supply. This helps to minimize the chances of bleeding or surgical trauma. The extracted tissue sample is sent to the laboratory technicians who work upon extracting a few, healthy spermatozoa (sperm cell) from it and use them for ICSI.

TESE Pre-testing & Preparation for Non-Obstructive Azoospermia

All patients who have been diagnosed with azoospermia and are seeking TESE are put through a thorough medical examination. This is done to ensure whether the azoospermia is actually non-obstructive or not. Please understand that differentiating obstructive azoospermia from non-obstructive azoospermia is critical.

If NOA is confirmed, the fertility clinic counsels the couple regarding the low probability of finding healthy sperm cells and the underlying need for repeated biopsies done as a part of TESE. Men who are diagnosed with NOA azoospermia are more likely to carry genetic abnormalities and the couple needs to be informed about such risks. One such risk is that of the cystic fibrosis gene that is common to many men with NOA.

Men with non-obstructive azoospermia are likely to undergo repeated ICSI procedures since the overall health of the sperm is less likely to be appropriate. This also raises the cost that is incurred for longer and repeated cryopreservation cycles of extracted sperm.

Non-obstructive azoospermia diagnosis is commonly done through some minor biopsies prior to sperm extraction. Some reasons of non-obstructive azoospermia like carcinoma of the testes are easily identifiable through this method. If it is found that the NOA is somehow manageable through options like hormone treatment, the clinic does not proceed with sperm extraction. Similarly, even if the patient is confirmed to have NOA, the clinic might recommend some hormone supplementation for a few months prior to TESE session. This is done to raise the probability of finding healthy spermatozoa in the testicular tissue.

Have specific questions?
ASK A DOCTOR

All Article Categories

Suggested Doctors

Sorry, there are no matching doctors in your area
Please choose a different location

,

,

See more Suggested Doctors

Recently Asked Questions