In cases of Male factor infertility,Azoospermia is an important cause in which sperm may not be present in the ejaculate.This can be either due to defective sperm production (Non obstructive Azoospermia) or obstruction in semen outflow during ejaculation.(Obstructive Azoospermia)
Obstruction can be due to infection,trauma or abdominopelvic surgeries.It can also be associated with an autosomal recessive condition called Cystic Fibrosis in which there is congenital bilateral absence of Vas Deferens(CBAVD).
Therefore genetic testing in azoospermia is very important to rule out conditions like Cystic Fibrosis,Klinefelter’s syndrome and Y chromosome microdeletion.
In cases of obstruction due to surgery or infection one can do microsurgical Vasovasotomy(VVA) or Vasoepididymostomy(VEA).In successful cases couples can conceive either naturally or through IUI or ICSI.If these procedures fail to produce sperms in the ejaculate one can do PESA or TESA to directly obtain sperms from the testis followed by ICSI.In rare cases one may have to perform TESE or MicroTESE.If these procedures also fail to produce any results one can always provide the couple with the option of Donor sperms.
In cases of Non obstructive Azoospermia with failed TESE procedure the husband is asked to avoid abstinence and then give repeated samples at least 2-4 hours apart.These samples are then centrifuged and seen under high power inverted microscope and few sperms can be found in an occasional ejaculate.These few sperms are then frozen in a new sperm freezing device called sperm VD.After enough sperms are frozen, the frozen oocytes and sperms are thawed and ICSI carried out.Our centre is the first to use sperm VD in India.
Usually patients of non obstructive azoospermia are initially treated with oral Clomiphene and when around 2-8 sperms are frozen in sperm VD either by repeated ejaculation or TESE or Microtese then oocyte pick up is done and embryos made.