Testicular Sperm Extraction

Across the world, male-factor infertility is as common as female-factor infertility even though the latter is a lot more publicized and talked-about than the former.  However, the problem is increasingly being recognized across the globe, including in India. In fact, in 2007, the Urological Society of India initiated an effort to develop guidelines for the management of male infertility in India.

Among the many types of male infertility is azoospermia, a condition which we will discuss at length in this article.

What is azoospermia?

Azoospermia is a medical condition in which motile sperms are absent from the semen, resulting in a couple’s failure to get pregnant. Typically, of total male infertility cases, azoospermia is responsible for 10-15% of the cases.

Symptoms of azoospermia

1. Inability to conceive
2. Obesity
3. Hair loss
4. Change in the size of the male organ
5. Low sex drive

Azoospermia: Types

Based on the reason for the absence of sperm in the semen, azoospermia can be of two types — obstructive azoospermia and non-obstructive azoospermia.

Obstructive azoospermia

In obstructive azoospermia, the cause of the absence of the sperm is some blockage, preventing the sperm from entering the ejaculate.

Factors causing obstructive azoospermia

Genetic conditions

Infection in the prostrate or testicles

Trauma

Injuries within the genitalia

STDs

Varicocele

Genetic factors

Hormonal imbalances

Stress

Non-obstructive azoospermia

In non-obstructive azoospermia, on the other hand, the absence of the sperm is due to decreased sperm production by the testis or when the testicles stop producing sperms altogether. Male infertility in its most severe form can be caused by the non-obstructive azoospermia

Factors causing non-obstructive azoospermia

Smoking

Drinking

Drug abuse

Cancer treatment medication

Antibiotics

Steroids

Chemotherapy

Retrograde ejaculation

Mumps infection in childhood

Hormonal deficiencies

Azoospermia: Treatment

Before the advent of the more modern methods, patients suffering from azoospermia has to undergo surgery in case of obstruction azoospermia. If they were suffering from the non-obstructive types, they would have to rely on donor insemination to attain parenthood. In the first case, the surgical bypass used to be successful in only a small percentage of patients. Now, both types of azoospermia can be treated through testicular sperm aspiration (TESA), a comparatively newer sperm retrieval technique.

What is TESA?

TESA is a medical procedure used to directly retrieve sperm from epididymis or testis. Even among patients suffering from non-obstructive azoospermia, there are small pockets of sperm production in the testis, and this procedure helps obtain those sperms for harvesting.

Under this procedure, a fine needle is used to get sperm directly from the testis. A single incision is made in the middle of the scrotum to remove a small amount of tissue. Using a microscope fine tubules of the testis that may contain sperm are searched. These sperms thus retrieved are then transferred in the body of the female partner through the in-vitro fertilization process. The procedure is performed under local anesthesia or sedation and does not require hospitalization.  This procedure is coordinated with their female partner’s egg retrieval. The sperm cells can be frozen, stored, and then thawed to be used for infertility treatment at a later time.

In case TESA doesn’t provide enough tissue/sperm, an open testis biopsy is needed to retrieve the sperm.