Azoospermia is absence of sperm in the ejaculate. But, it needs to be confirmed by 2 semen examinations on 2 different occasions 6 weeks apart. Azoospermia Treatment in Delhi is the cause of infertility in 15% of infertile men. 40% of azoospermia cases happen due to obstruction in ductal system of reproductive tract. Despite obstruction, nature has been kind in the sense that normal or near normal spermatogenesis still continues inside the testicle in most of these cases. This is the window of opportunity for experts in male infertility. An expert Urologist (Andrologist) can retrieve sperms directly from testicle and process the same in his lab to isolate most healthy ones for ICSI (Intra-Cytoplasmic Sperm Injection). The technique is relatively new and experts doing this kind of work are limited in number.
Surgical correction of Obstructive Azoospermia has been attempted and practiced by surgeons world over. Various reconstructive techniques were
devised. But, most of these procedures ended up in failure and finding viable sperms in the ejaculate after surgical correction of
azoospermia is rare and still rarer is actual pregnancy after such a surgical procedure. After the evolution of direct surgical harvesting
of sperms by newer techniques like TESE/mTESE, corrective procedures like Vaso-Epididymal Anastomosis and Vaso-Vasal Anastomosis have become
part of history.
The doctor opts for hormonal treatment in cases where infertility is caused by hormonal disorders of the reproductive glands which result in high or low levels harmones.This condition is detected in the course of infertility investigation. Firstly the IVF experts try to know the root cause of this problem by having the information related to exposures, past surgeries, medications and family history. After the collection of information the physical examination is done by the doctors then blood test is also taken that include the testosterone and follicle stimulating hormone. After that two semen samples are taken with the standardized semen analysis. In case male infertility with no sperm then the semen sample is taken for additional evaluation in which semen sample is centrifuged and spun. If there is even one sperm in the pellet analysis then the conditions of reproductive tract obstruction are disapproved.
How do you diagnose Obstructive Azoospermia?
Criteria to label Obstructive Azoospermia are:-
Options in case of Azoospermia
During the last century, gynaecologists used to manage azoospermia by using donor semen. And, out of compulsion, this was acceptable
to the poor lady who had to bear the brunt of childlessness. With the turn of century, situation changed dramatically due to easy availability
of DNA testing. Infertile male can no more be replaced by confidential un-indicated use of sperm donor.
These developments paved the way for more scientific procedures which are summarized below:-
Percutaneous aspiration of sperms was practiced before the evolution of TESE/mTESE. It is a simple procedure and involves aspiration of intra-testicular fluid using a thin needle and then searching for mature sperms in the fluid. The technique went into disrepute due to low success rate caused by degradation of highly delicate sperms induced by negative suction pressure in the aspiration kit. Unfortunately, it is still practiced by gynecologists who do not have access to help from uro-andrologist.
Percutaneous Aspiration of Epididymal Sperms is mentioned only to be condemned. It is a blind procedure.
Microsurgical Aspiration of Epididymal Sperms still remains a viable option in a case where urologist finds a dilated tubule on Exploratory Scrototomy. In such a situation, sperm retrieved from epididymis scores over sperm directly retrieved from testis in the sense that epididymal sperm is more mature and aggressive.
Direct surgical harvesting of testicular tissue (TESE) or sperms under microscope (mTESE) has proved to be a boon for patients of Obstructive Azoospermia and it is the ultimate tool in the hands of experts in male infertility. With these procedures, sperms are procured directly from their site of production with no damage to the delicate anatomy of the gamete. Harvested spermatogenic tissue can be law-fully preserved for 5 yrs., however, sperms remain viable much longer even after that if maintained in proper environment. As and when eggs are available from female partner, frozen sperm is thawed and used for ICSI. In NCR, probably, ‘UROGYN’ is the only fertility centre where these procedures are done routinely, primarily due to in-house availability of experts in male infertility.