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Azoospermia (No Sperm)

What is Azoospermia (No sperm in the ejaculate)?

Approximately 1% of all men in the general population suffer from azoospermia. Azoospermic men constitute approximately 10 to 15% of all infertile men. Thus, this group of patients represents a significant population in the field of male infertility. This is a condition where men have no sperm in their ejaculate. A thorough medical history, physical examination and hormonal profile are essential in the evaluation of azoospermic males. Imaging studies, a genetic workup and a testicular biopsy (with cryopreservation) may augment the workup and evaluation.

What causes Azoopsermia?

A number of factors may lead to azoospermia. These may range from genetic and physiologic to environmental causes. The careful evaluation and examination of azoospermic patients is geared to assess any of these possible causes and to rectify them if possible. We offer some unique techniques to overcome congenital obstructive conditions.

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Can Azoospermia be treated?

Azoospermia could be due to obstructive or non-obstructive causes.
Obstructive causes can usually be treated; for example, congenital epididymal obstruction could be corrected with surgical reconstruction. Non-obstructive azoospermia usually requires a procedure called micro-TESE to try to find sperm in the testicle (used with assisted reproductive techniques – ART). The following section goes over treatment options.

What kind of treatment options do we offer?

Our center has made a serious commitment to the development of new diagnostic and surgical treatment options for men with azoospermia. Our group performed the first robotic TESE (procedure for sperm collection from the testicle) in July 2007. In August 2007, our group performed the world’s first 3D Target Scan Trans-Rectal imaging of the seminal vesicles and ejaculatory ducts with vasodynamics – a new modality to detect ejaculatory duct obstruction in some infertile men.

We offer a full spectrum of treatment options for azoospermia:

  • Robotic assisted microsurgical vasal reconstruction for congenital vasal or epididymal obstruction
  • Robotic micro-TESE (Testicular Sperm Extraction)
  • Retrieving sperm in men who have no sperm in their ejaculate
  • Doppler flow mapping to assess areas of better sperm production within the testicle
  • PESA (Percutaneous Epididymal Sperm Aspiration)
  • MESA (Microsurgical Epididymal Sperm Extraction)
  • Testis Biopsy
  • Sperm Cryopreservation

Doppler Duplex Flow Testicular Mapping

Previous studies have shown that in men who are azoospermic (no sperm in ejaculate) there may be areas of the testicle with better blood flow that harbor sperm, which could be used in combination with assisted reproductive techniques (In-vitro fertilization – IVF) to achieve a pregnancy. Our center currently offers a technique utilizing a novel Doppler Duplex flow mapping device that allows us to map the testicular blood flow and possibly predict areas that may harbor sperm for extraction.