Project Description

Azoospermia & Sperm Collection Techniques

In cases of azoospermia, spermatozoa are obtained from the testicles. However, depending on the causes of azoospermia, there is a distinction between obstructive and non-obstructive azoospermia, there is a production of spermatozoa in the testes; nevertheless it is impossible for them to be exported to the sperm during ejaculation, since there is a barrier present at some point along the reproductive tract. In the case of non-obstructive azoospermia, the absence of spermatozoa is due to spermatogenesis problems in the testes and is the most severe form.

All methods for the collection of spermatozoa from the testicles are combined with the application of ICSI, since both the number and the mobility of spermatozoa are reduced, after they have been taken from the testicles. We also ought to point out that the quality of spermatozoa from the testes or from epididymis is bad, a fact which may affect the result of the IVF attempt.

  • MESA: The microsurgical sperm aspiration from the epididymis (organ located below the testicles, where the semen is stored) is usually performed in cases of obstructive azoospermia and always under narcosis. The scrotum (skin that cover the testicles) is cut open through an incision, thus bringing out the epididymis. Within the epididymis there are many spermatozoa, which are found in a small amount of liquid. Upon collection of the sperm fluid, the spermatozoa is isolated, whereas part of the sample is kept for cryopreservation, so that the procedure does not have to be repeated from the beginning.ν
    This method requires specialized equipment and can be performed only at clinics providing such services.

  • TESA: The sperm aspiration from the testis is done by means of an aspiration needle under local anesthesia. The scrotum covering the testicles is opened with an incision and the needle enters the testicle. This method is not widely used, since it is considered to display weakness in comparison to the other methods. The small amount of tissue that is isolated and the infliction of probable uncontrolled bleedings are two of the main disadvantages of this technique. In conrtrast with TESA the open testicular biopsy TEST is most often preferred.

  • TESE: In cases of non-obstrructive azoospermia the technique of open testicular biopsy (TESE) is recommended. An incision to the testicle is performed and a small portion of testicular tissue is removed. This section, is rich in seminiferous tubules within which the production of sperm takes place. The sample is delivered to the laboratory and dissected in smaller pieces. When the tissue is completely dissolved and the spermatozoa are released from the seminiferous tubules, the sample is observed under a microscope in order to recover the spermatozoa.

    Usually, tissue sections are taken from several points of the testicle, in order to identify more spermatogenesis regions. As already mentioned, due to the fact that the spermatozoa obtained with these methods have not gone through all the maturation and activation procedures, it is possible that their quality is lower than those of the spermatozoa, which would have followed the normal way of ejaculation. Because of this and depending on the possible infertility of the female partner, the success rates are slightly lower than those of the rest IVF cycles. In the case that spermatozoa are present, the pregnancy success rate ranges from 25% to 45% per attempt.


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