For many men struggling with infertility, azoospermia is one of the most frustrating diagnoses. The shock and disappointment of learning your semen contains no sperm can be devastating. However, there is hope.

While azoospermia was once thought to be an automatic infertility sentence, microsurgical techniques developed in recent decades have made retrieval of sperm possible for some men.

In this post, we will review the latest research on the success rates of microsurgical epididymal sperm aspiration (MESA) and microsurgical testicular sperm extraction (microTESE) procedures in achieving live births.

We will discuss factors that influence outcomes and give you a realistic sense of what to expect from these operations. Most importantly, we hope to provide hope and guidance to any men considering surgery as a way to potentially overcome azoospermia and realize their dream of biological fatherhood.

Azoospermia Basics

Azoospermia, defined as the absence of sperm in the semen, is a condition that affects about 1% of all men and is responsible for approximately 10-15% of male infertility cases.

This condition can be caused by several underlying issues which can be broadly categorised as pre-testicular, testicular or post-testicular.

Pre-testicular causes relate to issues with hormone production that stimulate sperm creation. Testicular causes involve physical damage or abnormalities within the testes themselves, preventing them from producing sperm.

Post-testicular causes are due to obstructions or blockages in the male reproductive system that prevent sperm from being included in the ejaculate.

Symptoms of azoospermia are often subtle and may not be immediately noticeable, as the volume of ejaculate may not be affected. The primary symptom is the inability to conceive a child.

Some men may also experience signs related to the underlying causes of azoospermia, such as hormonal imbalances, genetic conditions, or physical abnormalities.

Read more: Azoospermia: Causes, Symptoms and Treatment

Azoospermia Surgery

Azoospermia surgery is a medical intervention aimed at retrieving sperm directly from the testes or epididymis in men diagnosed with azoospermia.

Two prominent procedures include Microsurgical Epididymal Sperm Aspiration (MESA) and Microsurgical Testicular Sperm Extraction (microTESE).

MESA involves extracting sperm from the epididymis, while microTESE involves removing a small amount of testicular tissue from which sperm is extracted.

These procedures are typically performed under local anaesthesia and are minimally invasive. In the case of MESA, a small incision is made in the scrotum to expose the epididymis, and sperm are aspirated using a fine needle.

MicroTESE, on the other hand, involves the removal of small pieces of testicular tissue under a microscope to locate and extract sperm.

Eligibility for azoospermia surgery largely depends on the individual’s specific diagnosis and the underlying cause of their azoospermia. Men with non-obstructive azoospermia, where the testes are not producing sufficient sperm, are typically candidates for microTESE.

Those with obstructive azoospermia, caused by a blockage in the reproductive tract that prevents sperm from reaching the ejaculate, may undergo MESA.

Prior to surgery, a thorough evaluation of the patient’s medical history, as well as hormonal and genetic assessments, are usually carried out to determine the most appropriate surgical intervention.

Success rates of azoospermia surgery

The success rates of azoospermia surgery can vary significantly based on the type of azoospermia and the specific procedure used.

Studies show that the sperm retrieval rate stands at approximately 58% for MESA and can reach up to 63% for microTESE in men with non-obstructive azoospermia.

However, it is vital to note that these rates are averages, and individual results may differ depending on factors such as the patient’s age, overall health, and the extent of their condition.

Experts in the field echo these statistics, highlighting that while these surgeries often offer a viable path to biological parenthood for men with azoospermia, they do not guarantee success.

They emphasise the importance of comprehensive preoperative evaluation and individualised patient care to optimise outcomes. 

Moreover, even with successful sperm retrieval, the chances of a successful pregnancy may still depend on other factors such as the woman’s fertility and reproductive health.

Couples should consult with a fertility specialist to discuss all possible options and outcomes before proceeding with azoospermia surgery.

Preparing for azoospermia surgery – Tips for improving chances of success

Proper preparation is key to enhancing the chances of successful azoospermia surgery. Here are some useful tips:

1. Maintain a Healthy Lifestyle: Regular exercise, a balanced diet, and quitting unhealthy habits like smoking can boost overall health, including reproductive health.
2. Avoid Heat Exposure: Increased scrotal temperature may adversely impact sperm health. Avoiding hot tubs, saunas, and tight clothing can help maintain normal temperature.
3. Reduce Stress: High-stress levels can impact hormonal balance, indirectly affecting sperm production. Consider relaxation techniques such as yoga, meditation, or counselling.
4. Follow Doctor’s Instructions: Ensure to follow preoperative instructions closely, including any recommended medication or dietary restrictions.
5. Take Antioxidants: Certain antioxidants, such as Vitamin C and E, may improve sperm health. Discuss with your healthcare provider before starting any supplements.

Remember, every individual’s situation is unique, and these tips may not be universally applicable. It’s always best to consult with your medical practitioner for personalised advice.

 

Future advancements in azoospermia surgery

The field of male infertility treatment is  continually evolving, and researchers are constantly exploring new techniques and technologies to improve success rates for azoospermia surgery. 

One promising development is the use of stem cells in regenerative medicine to rejuvenate testicular tissue and restore sperm production. This approach has shown promising results in animal studies, but further research is needed before it can be considered a viable option for human patients. 

Additionally, advancements in imaging technology and surgical techniques have led to improved precision and accuracy during sperm retrieval procedures. This means that surgeons can now target specific areas of the testes with greater precision, potentially increasing success rates and reducing complications.

Also read: Surgical options for Azoospermia

Conclusion

Azoospermia surgery offers hope for men with azoospermia to achieve biological parenthood. While success is not guaranteed, advancements in medical technology and techniques are continually improving outcomes for patients.

However, it is crucial to undergo a comprehensive evaluation and consult with a fertility specialist before proceeding with surgery to understand all possible options and potential outcomes.

With the right approach and expert care, men with azoospermia can increase their chances of successful sperm retrieval and ultimately achieve their dreams of parenthood.

  So, it is essential to keep an eye out for future advancements in the field of azoospermia surgery and continue to support and invest in research that can lead to better treatment options for male infertility.

With determination and perseverance, we hope to see more men becoming fathers through this revolutionary surgical procedure.

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• About Author

  Dr. Supriya Puranik

  Gynaecologist & IVF Specialist

Dr. Supriya Puranik, a renowned gynaecologist and infertility expert, leads the IVF & Gynaecology department at Sahyadri Hospitals Momstory in Shivaji Nagar, Pune. She is committed to helping couples overcome infertility challenges.