Azoospermia is a condition of no sperm is present in the semen. The reasons for azoospermia are; possibly hormonal or genetic disorders, undescended testicles in childhood or surgeries due to hernia, late realization of testicles that are not in proper position and having surgery in adult age or testicles still not in position (swinging from testicals to inguinal canal), having rheumatic infections (epidemic parotitis, meningitis, etc.) in childhood that can distort its functions by inflammation of testicles, exposed to chemotherapy or radiotherapy after surgery due to testicular tumor, various traumas (traffic accidents, injuries during sport), also naturally absence, underdevelopment or obstruction in of seminal ducts. At the present time, azoospermic males could have children by “micro-TESE”, named as “Microsurgical Testicular Sperm Extraction”.
Absence of sperms in male’s semen could be emerged from different reasons. Some of them are related with occlusion of duct system. In this case, besides no sperm production is seen in testicals, these sperm could not be ejaculated outside due to occlusion in the canals. This is called as absence of sperm related to occlusion. In the event of obstructive azoospermia, small particles are taken from ducts of testicular tissue by means of a thin needle. Finding a sperm within these particles is almost 100 percent.
Azoospermia Causes and Treatment
In cases not related to occlusion, either there is not any sperm production or it is very limited in specific areas. There are thousands of small tube-like structures in testicular structure and sperm production continues in these structures with different levels. While no production is seen is some tubules, a few sperm could be seen in others. Sperm cell could be found by examining numerous particles obtained from different parts testicals with surgical sperm screening methods. In such cases, MICROSCOBIC TESE method increases the chance of obtaining sperms. In this operation realized by means of surgical microscope to obtain sperm from testicals of males does not have any sperm in their semen, the sperm can be obtained more easily by determining the areas.
During general anesthesia, the testicals are opened and examined under microscope. Sperm production areas could easily be selected with this method and as the amount of tissue is so less in biopsy, particles can be obtained from wide range of areas. By an embryologist cutting and sorting these tissues spilled into ducts or bonded to the ducts, these tissues will be used in a microinjection operation.
Advantages of this method:
Increase in chance to find sperm by examining testicals with a microscope and great number of sperms can be obtained. As the rate of finding sperm was 30-40 percent with old techniques, sperm obtaining rate increases to 60-70 percent with this method.
Another important matter is tissue loss from patient’s testicals is 70 times less than old method. So, testicals suffer less damage and any operation that can decrease the level of testosterone hormone secrected within blood is avoided.
Another advantage of this method realized under microscope, resection can be made without harming vessels feeding the testicals. For this reason, side effects after surgery can be minimized. In the event of unsuccessful multiple biopsy and male having azoospermia due to genetic reasons such as Klinefelter syndrome, the chances of finding sperm increases more than 60 percent.
