Obstructive Azoospermia | Banjhpan | Male Infertility | No Sperm Count

Obstructed epididymal, vasal, or ejaculatory ducts may cause azoospermia. The most prevalent reason is vasectomy. Scrotal or inguinal surgery, severe genitourinary infections, and congenital defects are all prevalent causes of obstructive azoospermia.

This condition occurs in fewer than 2% of all men1 and 15% of infertile males. Among the different causes of azoospermia, ductal blockage accounts for around 40% of cases. 

Methodology

The Male Infertility Best Practice Statement Panel has revised a set of best practise statements on male infertility (Appendix 1). Other names include Best Practice Statement on Optimal Evaluation of the Infertile Male, Azoospermic Male, and Varicocele and Infertility.

Both the American Urological Association’s Male Infertility Best Practice Policy Committee (AUA; Appendix ) and the American Society for Reproductive Medicine’s Practice Committee (ASRM) created the initial versions (2001). The two organisations decided to work together on important papers related to male infertility.

Treatment methods for obstructive azoospermia

Men with obstructive azoospermia may father children by 1) surgically removing the blockage, resulting in conception via intercourse and avoiding the need for assisted reproductive technology, or 2) retrieving sperm from the male reproductive system for IVF/ICSI.

Surgical treatment

In situations of ejaculatory duct occlusion, transurethral resection of the ejaculatory ducts is required (TURED). Before doing male microsurgery, the female spouse should be checked for female infertility causes.

Microsurgical reconstruction of the reproductive tract

Obstructive azoospermia generally responds well to microsurgical reproductive restoration. Following vasectomy reversal, sperm return to the ejaculate occurs in 70-95 percent of patients, and pregnancy happens in 30-75 percent of couples. The amount of years between vasectomy and attempted reconstruction affects the possibility of sperm returning to the semen and conception. 

 The obstructive interval and the risk of reversing a vasectomy are negatively connected. In addition to sperm in the intraoperative vas fluid, other parameters affecting vasectomy reversal success include: length of the vas segment between the epididymis and the vasectomy site; and existence or absence of a sperm granuloma at the vasectomy site. The age of the female spouse also influences the chance of conception following vasectomy reversal.

Transurethral resection of the ejaculatory ducts

Obstructive azoospermia should be diagnosed with ejaculatory duct occlusion. The ejaculatory duct may be resected transurethrally at the veru montanum, where it enters the distal prostatic urethra. Transurethral ejaculatory duct excision resulted in sperm in the ejaculate in around half to three-quarters of instances. This operation has a pregnancy rate of about 25%.

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection is an IVF supplement. Because the sperm extraction procedures used to gather sperm from these men seldom yield enough motile sperm for IUI or normal IVF, ICSI is virtually always performed. Injection of epididymal or testicular spermatozoa results in 45-75 percent fertilisation rates per injected oocyte. 7-13 Recent clinical pregnancy rates vary from 26-57 percent, and delivery rates from 18-75 percent. 9-13When using surgically obtained epididymal or testicular sperm for ICSI, most reproductive clinics predict clinical pregnancy rates of 30-40% and delivery rates of 25-30%.

Sperm retrieval

In situations of obstructive azoospermia, sperm retrieval may be used as a main therapy or as an adjuvant to microsurgical reconstructive operations.

The purpose of sperm retrieval is to recover high quality sperm in sufficient quantity for immediate use or prospective cryopreservation while avoiding reproductive system harm. The type of sperm retrieval chosen is based on the experience and preferences of both the physician and the IVF laboratory embryologist handling the material.

Recommendations:

1). Fertilization and pregnancy rates are not different between individuals with obstructive or nonobstructive azoospermia utilising fresh or thawed cryopreserved sperm.

2). There is no indication that the place or manner of sperm retrieval influences the result of in vitro fertilisation with intracytoplasmic sperm injection for patients with obstructive azoospermia.

3). Nonobstructive azoospermia requires open surgical testicular sperm extraction with or without microscopic magnification.