Azoospermia

A 24 year old man with semen showing complete azoospermia(no sperms) on two occassions.
Detailed history –Normal ,
Physical examination—small size testes
Hormonal evaluation—normal
Genetic testing –normal.
His wife is 20 yrs with all reports normal .

How to proceed??

Options…

Testicular biopsy followed by ICSI if sperms retrieved.
Advantages –can use his own sperm.
Disadvantages –sperms may not be available for use/may not be worth using /less chance of success/expensive.
IUI with donor sperms.
Advantages—less expensive/easy process.
Disadvantage –not his own sperm.

What is azoospermia?
Azoospermia is a lack of sperm in seminal fluid. About 1% of all men and 10%-15% of infertile men have azoospermia.
Azoospermia can be grouped into three major types:1) Pre-testicular causes (non-obstructive) 2) Testicular causes (non-obstructive)3) Post-testicular causes (obstructive)
 In 30-40%cases no male infertility associated factor is found —idiopathic vareity

Testicular biopsy….
Testicular biopsy may be part of the diagnostic process of infertile men, but usually testicular histology does not explain the real cause of infertility. It merely confirms a disturbance of spermatogenesis in men with low sperm concentrations and elevated follicle-stimulating hormone.
Intracytoplasmic sperm injection (ICSI) is the only alternative if viable spermatozoa are present.
In about 50%–60% of men with NOA and in 100% of men with OA, spermatozoa can be retrieved from the testes and used for ICSI.
Testicular biopsy can be performed under local and general anaesthesia. 

Donor sperm…..
couples use donor sperm (Donor Insemination) when the husband/partner has no sperm or a very poor semen analysis (azoospermia, oligospermia, poor motility), or when there is a genetic problem which could be inherited from the male. Single women who want a biological child also use Donor sperm.
Couples or individuals usually have the right to decide which donor to use. Information about a donor’s physical characteristics, race, ethnic background, educational background, career history, and general health is available.The donor is screened as per the ICMR guidelines.
Success rates vary from 60-80% but achieving pregnancy may take few cycles if the female partner has no associated problem.