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Male Fertility

Azoospermia

Azoospermia is the complete absence of sperm in the neat and centrifuged sample of semen. It is always important to remember that the semen analysis has to be repeated at least twice if a diagnosis of Azoospermia is to be entertained. The Etiology of Azoospermia can either be Obstructive or NonObstructive. In Obstructive Azoospermia there is an obstruction to the path the sperm travels from the testis to the penis. The obstruction could be in the testis, the epidydymis, the vas deferens (the vas could also be absent) or the ejaculatory duct.

Sites where obstruction can occur

obstruction

Obstructive Azoospermia

CONDN
S.FSH
TESTES
SE.VOL
FRUCT
Ej d obst
Norml
Norml
Vlow
Absnt
V apl
Norml
Norml
Vlow
Absnt
V obst
Norml
Norml
Vlow
Presnt
Ep obst
Norml
Norml
Vlow
Presnt
T obst
Norml
Norml
Vlow
Presnt

Fructose is an important component of semen which is produced by the seminal vesicles. Any obstruction / aplasia or absence of seminal vesicles will result in its absence.

In Non Obstructive Azoospermia, there is complete absence of spermatozoa with no obvious obstruction. This is indicative of Primary Testicular failure or Hypogonadotropic Hypogonadism . An entity called borderline Azoospermia may also be present.

Non-obstructive Azoospermia

CONDN
FSH
TEST SIZE
S. VOL
FEATURE
Hypo gon. Hypogonadis
Low or undetectable
Small
Normal
Hypo / anosmia
Semin tub failure
Raised
Small
Normal
Border lin Azoo
Normal, mild elevatn
Normal, Small
Norml
Hist: Mat arrest / Hvbosper

Medical Management
In patients with Azoospermia due to Hypogonadotropic Hypogonadism, treatment with hormones like HMG and HCG will help. Clomiphene citrate may also help in patients with hypogonadism.

Surgical Treatment
In Obstructive Azoospermia with epidydymal onstruction, various sperm retrieval techniques like Micro Epidydymal Sperm Aspiration (MESA), and Percutaneous Epidydymal Sperm Aspiration (PESA) are used. Reproductive microsurgery like Vaso Epidydymal Anastamosis, Vasovasal Anastomosis and Vaso Testicular Anastomosis are offered depending on the level of obstruction. In Non Obstructive Azoospermia Sperm Retrieval from the testis is planned by means of Testis Biopsy, Testicular sperm extraction (TESE) and Micro TESE. Typically, the yield from the testis is less than that of Obstructive Azoospermia. The spermatozoa obtained by these retrieval techniques are used for ICSI.