Do you have azoospermia and want to know about the best non obstructive azoospermia treatment? Through our cutting-edge therapies, some men with non-obstructive azoospermia may be able to have their eggs fertilised naturally, allowing them to become parents without the need of assisted reproductive technology (ART)
Despite the fact that numerous parts of the testicles are barren and our patients can not produce enough sperm to transmit via their reproductive tracts, we can detect pockets of sperm production in many other patients’ testicles.
What is Azoospermia?
Male infertility is caused by azoospermia, which is pronounced as a-zoo-SPER-mee-ah. It occurs when a man’s ejaculate (semen) contains no detectable sperm.
Normally, the testicles in a man’s scrotum are responsible for the production of sperm. In the male reproductive system, sperm travel through the bloodstream and combine with fluid to make semen. The thick, white fluid that is expelled from the penis during ejaculation is known as semen.
The condition known as azoospermia is observed in five to ten percent of males who are tested for infertility. It is possible that the condition is present from birth or that it develops later in life.
Stanford Health Care is a world leader in the treatment of azoospermia and the extraction of sperm. We develop a highly individualised treatment strategy for each patient in order to assist them in regaining their fertility.
Types of Azoospermia
1). Obstructive Azoospermia
The term “obstructive azoospermia” refers to the condition in which sperm production is normal but the reproductive canal for both testicles is clogged. This signifies that there is no detectable amount of sperm that can go into the sperm. Some people may have a separate condition on either side of the scrotum under different circumstances.
2). Non-Obstructive Azoospermia
Sperm production is weak in this kind of azoospermia because it is not obstructed. It is impossible for males to create enough sperm for a measurable quantity to appear in their sperm.
Nonobstructive azoospermia is still a difficult condition to treat, but breakthroughs in medical technology, such as those made by our experts and others, have made it possible to assist restore sperm to the sperm in certain situations.
Causes of Non-Obstructive Azoospermia
Genetic Factors
Non-obstructive azoospermia can be caused by a number of hereditary reasons of male infertility. Y-chromosome microdeletions and karyotypic abnormalities are examples of this. Klinefelter Syndrome is the most frequent karyotypic aberration, and it arises when a man has an extra X chromosome. Up to 10% of non-obstructive azoospermia individuals will have identifiable genetic defects that result in reduced sperm production.
Non-obstructive Azoospermia Caused by Hormones
Pituitary hormones must stimulate the testicles in order for them to create sperm. Sperm production is impossible if these hormones are deficient or absent. Men who use or have used steroids may have influenced the hormones required for sperm production.
Toxins and Radiation
Toxic substances including heavy metals, chemotherapy, and radiation therapy can all reduce sperm production. For this reason, sperm banking is suggested prior to chemotherapy or radiation treatment.
Medications
Certain drugs might also have a detrimental impact on sperm production. Taking testosterone supplements, for example, can interfere with the natural operation of the reproductive system.
Varicoceles
Varicoceles, or bulging varicose veins in the scrotum, can also impair sperm production. Varicoceles result in blood pooling in the scrotum, which reduces sperm production.
Azoospermia Diagnosed
Non-obstructive Azoospermia Treatment
Through our cutting-edge therapies, some men with nonobstructive azoospermia may be able to have their eggs fertilised naturally, allowing them to become parents without the need of assisted reproductive technology (ART).
Despite the fact that numerous parts of the testicles are barren and our patients can not produce enough sperm to transmit via their reproductive tracts, we can detect pockets of sperm production in many other patients’ testicles.
Because of our years of experience and competence in sperm extraction, we have had such great results.
In order to provide you with treatment suggestions, your doctor will discuss your individual problem with you. Changing one’s lifestyle, switching one’s medicine, or starting to avoid certain toxic substances may be sufficient solutions for some guys.
In addition, if you have had chemotherapy or radiation therapy, your reproductive system is quite robust; your body just needs time to recuperate from the treatment.
However, we may also advocate a more direct course of action. In any event, you must let your body 2-3 months to produce enough sperm thereafter before you would see a significant difference.
Hormone treatment
Depending on their current hormone levels, some men with nonobstructive azoospermia may benefit from therapy with certain hormones, which may coax sperm back to their sperm or increase the chance of finding sperm during sperm extraction and retrieval. These hormones are as follows:
- Hormone that stimulates the formation of follicles (FSH)
- Human chorionic gonadotropin is a hormone that stimulates pregnancy (HCG)
- Clomiphene
- Anastrazole
- Letrazole
Varicocelectomy
The scrotum of certain men may be affected by varicocele, a condition in which the veins are swollen and widening, which may impair sperm production.
In a microscopic varicocelectomy, we utilise an operating microscope to detect and tie off the problematic veins while keeping critical surrounding tissues safe and undisturbed (e.g., arteries, vas deferens, lymphatic channels).
With this operation, sperm may be returned to the sperm of up to 40% of men who undergo it. Those who have been unsuccessful in their attempts may consider sperm extraction. Find out more about our sperm extraction services.
More On Non Obstructive Azoospermia Treatment
We approach treatment the same way regardless of what is causing your non-obstructive azoospermia. We begin with a menstrual analysis and a male endocrine profile (blood work). Then one or more of the following therapies are used:
Drugs/Medications: We normally start you on clomiphene citrate or clomid if you have low bioavailable testosterone. You will be on this medication for four months, after which we will do another sperm analysis.
After taking medicine to restore testosterone levels to normal, one in every nine men will have their sperm return to the ejaculate. After taking medicine, some men’s sperm does not return to their ejaculate.
Taking testosterone-lowering medicine, on the other hand, increases the odds of finding sperm during a surgical sperm extraction process known as microsurgical testicular sperm extraction (microTESE).
Microsurgical Testicular Sperm Extraction (microTESE): Microsurgical testicular sperm extraction (microTESE) is recommended for males who have sufficient testosterone* following diagnostic tests. We also propose microTESE for men who have been using testosterone-lowering drugs for at least four months but are still not producing sperm after ejaculation.
Doctors can identify sperm 50-65 percent of the time using microTESE treatments.
Pregnancy and Non-Obstructive Azoospermia
Previously, fertility specialists believed that men who had sperm production issues could only have a family with donor sperm or via adoption.
However, sperm has been found in testis biopsies taken from males with non-obstructive azoospermia. Despite their reduced motility, testicular sperm can be utilised for intracytoplasmic sperm injection (ICSI) during in vitro fertilisation (IVF).
For men with non-obstructive azoospermia, a surgery termed testicular sperm extraction (TESE) with ICSI has been performed.
Extraction of testicular sperm can be done under local or total anaesthesia. The sperm obtained through this method can be used in IVF operations.
If a man has a genetic reason for his non-obstructive azoospermia, genetic testing and counselling are indicated before attempting IVF.
Management of NOA
Except for individuals with subsequent testicular failure, there is currently no medication that can restore spermatogenesis in the majority of NOA patients.
As a result, the only method for afflicted couples to become pregnant without using a donor is to extract spermatozoa directly from the testes through ICSI.
An ideal surgical method would allow for effective sperm retrieval while inflicting little harm to the testes. TESE and fineneedle aspiration are two sperm retrieval procedures that have been developed (FNA).
Multiple biopsies were used in TESE to boost the sperm retrieval rate (SRR), however substantial volumes of tissue were removed, which might lead to testicular atrophy after surgery.
Another approach to consider is FNA. It was originally employed for diagnostic purposes and is a less intrusive method of sperm retrieval than TESE, although most studies have indicated that FNA has a much lower SRR than TESE.
Schlegel originally described the technique of microdissection testicular sperm extraction (microTESE) in 1999.
During TESE, seminiferous tubules carrying spermatozoa may be seen using an operational microscope (magnification 15-25).
MicroTESE provides various advantages, including a better spermatozoa yield per biopsy, reduced testicular tissue removal, and identification of blood vessels to reduce vascular harm.
This treatment has been extensively proposed as a better way of sperm retrieval in NOA patients, and various studies have validated its superiority for testicular sperm retrieval. When microTESE is used on NOA patients, the sperm retrieval rate is reported to be 43-63%.
It should be emphasised that the surgeon’s experience influences the SRR of microTESE, particularly in patients with Sertoli cellonly syndrome (SCO).
To treat these individuals with severe infertility, experienced andrologists and embryologists are necessary.
NOA with undescended testis
Undescended testicle is a common congenital condition that is often discovered and treated in infancy. It affects 30% of preterm newborns and 3% of term infants globally.
When the testis is in an improper place (e.g., abdominal or inguinal), there is a risk of testicular cancer as well as spermatogenesis impairment.
This syndrome was assumed to be related with a 35 to 50fold increased incidence of malignant testicular tumours when compared to the general population, but subsequent investigations revealed a somewhat lower risk of malignancy (five to tenfold elevation).
Pharmacological treatment of non-obstructive azoospermia (NOA) makes sperm available for more patients compared to immediate sperm extraction
Objective
The purpose of this study was to see if endocrine medication enhances the incidence of sperm retrieval through ejaculation or surgical retrieval in individuals with NOA.
Design
Observational, non-randomized, controlled research.
Materials and Procedures
There were 612 NOA patients in the study. The control group consisted of 116 individuals who opted immediate microsurgical sperm extraction (micro-TESE).
The remaining 496 individuals were given clomiphene and categorised and treated based on their reaction to the medicine. The primary study group consisted of patients who had a rise in follicle stimulating hormone (FSH) and testosterone while taking clomiphene.
Human chorionic gonadotropin (hCG) was given to individuals who had an increase in FSH but a decrease or no increase in LH or testosterone. Clomiphene was substituted with hCG and hMG in individuals who had no rise in testosterone, LH, or FSH, or who had decreased testosterone.
Micro-TESE was done on individuals who remained azoospermic after 9 monthly semen tests. The chi-squared test was used to compare success rates to the control group.
Results
10.9% of individuals who received medical therapy produced sperm in their sperm. Patients who were treated but remained azoospermic received micro-TESE with a 57% success rate. In all, sperm was made accessible to 61.7% of medically treated patients vs 33.6% in the control group (P0.001), and each treatment group had a significantly higher rate of sperm retrieval compared to the control group (P=0.01).
Conclusion
A course of medical therapy for NOA patients may result in sperm in the ejaculate, increasing the chance of successful micro-TESE for those who remain azoospermic.