I. Analysis of the etiology of azoospermia
About half of the azoospermia cases are caused by blockage of the vas deferens. Common factors causing blockage include: inflammation of the genitourinary system (e.g. epididymitis, reproductive tract tuberculosis), developmental abnormalities (e.g. vas deferens, seminal vesicle defects), medical injuries (e.g. vasectomy, inguinal hernia device surgery), etc. The non-obstructive causes of azoospermia are more complex, with common etiologies: genetic abnormalities (e.g., Crohn’s syndrome, Y chromosome microdeletion, certain chromosomal translocations), cryptorchidism, mumps combined with orchitis, endocrine abnormalities (e.g., congenital Kaman syndrome, or acquired pituitary surgery), various radiotherapy injuries, and unexplained testicular dysplasia.
Patients who visit the clinic are most concerned with two questions.
1. whether or not I can find sperm and have my own offspring.
2. whether there will be serious offspring abnormalities due to the male partner’s etiology.
To answer these questions, it is necessary to improve the relevant tests and first find the answer from the cause of azoospermia.
For azoospermia, the following tests are routinely performed.
1. Routine semen analysis and post-centrifugal examination (at least three times) Significance: to confirm the absence of sperm in semen; because the semen examination results themselves fluctuate greatly, in the case of very low sperm count, there is a possibility of missing sperm in a single laboratory test, and rechecking, together with post-centrifugal observation, will increase the probability of finding sperm.
2. Significance of seminal plasma biochemical examination: to understand whether azoospermia is caused by obstruction of the vas deferens, and to evaluate the site of obstruction and the possibility of correcting azoospermia through surgery.
3.Sex hormone examination significance: to assess the spermatogenic function of the testes and to understand whether there are endocrine causes that can be corrected; for some patients with significantly lower FSH and LH, it is very possible to gradually produce sperm through hormone treatment.
4. Genetic examination (karyotype, Y chromosome microdeletion) Significance: To understand whether azoospermia may be caused by genetic abnormalities, to assess the success rate of testicular biopsy for sperm retrieval and the safety of having offspring.
Depending on the condition, scrotal ultrasound and urine examination to find sperm may also be required.
Second, how can azoospermia find sperm for conception?
For patients with azoospermia caused by obstruction of the vas deferens, we can help them conceive by aspirating sperm from the testicles or epididymis and then performing intracytoplasmic single sperm injection (i.e. “second-generation IVF”) with the female partner; the aspiration procedure takes less time, causes less damage, does not require hospitalization and can be left after half an hour of rest. In the case of azoospermia due to testicular spermatogenic dysfunction, testicular sperm aspiration can also be attempted to obtain sperm. The probability of finding sperm varies depending on the cause of the disease and must be evaluated in conjunction with the preoperative examination.
Repair of vas deferens obstruction
In order to meet the patient’s desire for natural fertility, in addition to in vitro fertilization (i.e. “IVF”) technology, patients with azoospermia due to epididymal and vas deferens obstruction can also be scheduled for epididymal-vas deferens anastomosis and recanalization surgery. This surgery is mainly for patients with azoospermia caused by inflammation of the epididymis or vasectomy, and even for couples who choose IVF in the future, the successful repair of the vas deferens can reduce the pain of repeated puncture for sperm retrieval by the male partner.
4. Cryopreservation of scarce sperm
For patients with severe sperm production disorders, finding sperm is as difficult as finding a needle in a haystack, and in many cases, there may only be one or two chances to find sperm.
How can we avoid the risk of the female partner being forced to discontinue treatment on the day of egg retrieval for fertility because sperm cannot be found again?
To reduce the risk of the male partner not having sperm available on the day of egg retrieval, in addition to routine testing for the presence of sperm for outpatient testicular puncture, sperm can be frozen and preserved as a backup for the female partner to use on the day of egg retrieval to minimize the occurrence of accidents. For some cases where the female partner has reduced ovarian function and the number of eggs retrieved in each IVF session is small, freezing the sperm can also reduce the pain and psychological stress caused by the male partner’s need for repeated punctures to retrieve sperm.
V. Donor sperm for in vitro fertilization
In cases where sperm is not successfully obtained through various treatments or where the male partner is diagnosed with severe genetic abnormalities, couples may choose to receive donor sperm for fertilization, which is determined by the degree of patency of the female partner’s fallopian tubes.