Azospermia implies total absence of sperm in the ejaculate and it represents one of the most important causes of the male infertility. This condition is diagnosed in 1% of all men and it accounts for 10 to 15% of men with infertility problem.
Azospermia is treated by collecting sperm with surgical methods and using them in test tube baby procedures. Azospermia should certainly be differentiated from severe oligospermia that means very low number of sperm in semen. In severe oligospermia, it is possible to obtain sperm enough to be used for microinjection, when the semen is centrifuged. Thus, surgical method is not required to collect sperm.
Testicular specimens are biopsied during the procedure and the presence of sperm is investigated at laboratory settings. The procedure is ended when sperm is found.
Surgical sperm collection (retrieval) methods (TESE-TESA-microTESE) can be carried out under local or general anesthesia. Patients can engage in daily life activities after the procedure since the procedure does not require hospital stay or it is carried out at outpatient settings.
Surgical sperm collection/retrieval methods are as follows;
* PESA (Percutaneous Epididymal Sperm Aspiration):
A thin needle is inserted to epididymes, one of male reproductive canals where sperm is accelerated, and sperms are suctioned. A thin needle is inserted to the canal without need to incise the scrotum, the sac where testes are located. This procedure is helpful only in obstructive azospermia cases. If sperm cannot be found with this method, the sperm will be retrieved from testis.
* Testicular Sperm Aspiration (TESA):
Testicular tissue fluid is suctioned using a syringe under local anesthesia or general anesthesia, and the fluid is examined and sperm is investigated under microscope.
* Testicular Sperm Extraction (TESE):
A small incision is made on the sac, where testes are located, and testicular tissue is exposed. Small pieces are taken from the testicular tissue. Specimens are fragmented and the presence of sperm is searched under microscope.
* Microsurgical Testicular Sperm Extraction (MicroTESE):
A small incision is made on the sac where testes are located. Testicular tissue is examined under microscope in operating theater by surgeon and the areas are determined, where presence of sperm is highly probable; very small tissue pieces are obtained. The tissue piece is examined under microscope at laboratory settings and sperm is searched.
The In Vitro Fertilization implies fertilizing a human oocyte with a human sperm at the laboratory settings and transferring the resultant embryo into the womb.
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