#FightInfertility : FREE Webinar/Healthcast scheduled on 7th-May-2016 by Doctors’ Circle in association with Manipal Ankur
1 in 6 couples face infertility problems today. There is an age old misconception in society that mostly Infertility problems are with women. Study suggests that in 40% of infertile couples , male partner is either sole cause or a contributing cause to infertility.
It’s also believed that people should only bother about infertility issues after they get married , Dr. Vasan SS, the first qualified Andrologist of India, of Manipal Ankur argues that prevention and treatment should begin much before and in some cases even during teen age.
There could be various reasons of infertility. One of the major reason is Azoospermia (“No Sperm Count”). Following article captures the causes, prevention and treatment of Azoospermia shared by Dr. Vasan SS. Dr. Vasan SS has been practicing from last 36 years.
Azoospermia, which is present in 5% of men, (commonly referred to as “no sperm count”) is a common condition causing fertility problem.
The cause for no sperms in the ejaculate could be:
- Problem with sperm production in the testis: Production problem
- Production is happening and there in blockage to the sperm to come out in the passage and does not reach the urinary passage: Blockage
Important aspect of Azoospermia
Although no sperm are found in the ejaculate, there are often usable sperm found in the testis, even in men with production defects, as not all sperm that are made in the testis actually make it into the ejaculate.
There is a “threshold” effect with sperm production, such that if production of sperm is high enough in the testis, then sperm “spill over” into the ejaculate.
However, if that critical level of sperm production is not met, there may still be mature sperm in the testis that do not make it into the ejaculate.
Confirming azoospermia with minimum 2-sample evaluation needs to be done initially.
A comprehensive history and need based examination will be performed. Hormonal assessment to understand whether the 2 primary cells (Sertoli cell and Leydig cell) in the testis are functioning effectively.
This is done through assessment of FSH and LH hormone levels. Additionally in some men Testosterone is assessed. Inhibin B is a new marker of spermatogenesis, especially in men with failure of sperm production.
If no sperm are found, then the semen sample undergoes an additional evaluation in which the sample is “spun” down in a centrifuge to concentrate small numbers of sperm at the bottom of the tube. This “pellet” of the ejaculate is then examined thoroughly for sperm. The value of finding even a small number of sperm in the pellet analysis is very significant because:
- It means that complete obstruction is unlikely, and
- It means that men may have the option of using ejaculated sperm for conception if sperms are found and may be able to avoid sperm retrieval procedures.
Based on this evaluation, if it is not entirely clear as to whether there is a problem with sperm production or a blockage, then further testing may be needed.
Common causes for Azoospermia
- Genetic causes
- Infections causing blockages in the sperm tract
- Hormonal imbalances
- Post viral, mumps and infective damage to the testis
- Gross varicocele effect
- Drug induced
- Diabetes with retrograde ejaculation
Azoospermia due to Blockage
Clinically / through investigations detection of possible presence of sperm is done is by assessment of epdidymal fullness / head size on ultrasound.
- Microsurgery to clear the blockade
- Day surgery with minimal discomfort
- Success rate 55-70%
Post surgery sperm can appear in the ejaculate in 2 – 12 months
Our outcomes of microsurgery for obstructive Azoospermia
||Mean patient age
||Return of sperm count
||Natural pregnancy rate (after 9 months)
|Invagination Epididymovasostomy (VEA)
Azoospermia due to production problem
Also called non-obstructive azoospermia in which sperm is not being produced normally in the testis. The cause for abnormality or absence of sperm production may be due to inherent damage to the testis by birth or during the phase of development between 5 – 14 years.
Clinically / through investigations detection of possible presence of sperm is done is by assessment of epdidymal fullness / head size on ultrasound: Thin or collapsed epididymis with diameter of less than 7 mm in the mid part of the head of epididymis. Soft or Small testis & Elevated hormonal levels
Generally Biopsy is not needed to make a diagnosis of either obstructive or non-obstructive azoospermia. Modern technology permits 99% accurate diagnosis through non-invasive methods. Even in difficult situations, where treatment dilemma exists, in centers where comprehensive technology exists, accurate decision can be made during the surgery time.
Medication / Injections if it is due to a developmental defect due to low hormonal levels
Microsurgery – Testicular sperm extraction (M-TESE) to identify micro surgically minute pockets of sperm producing area and retrieve the sperm and cryo-freeze them for future use.
Day surgery with minimal discomfort
Success rate of finding sperm varies from 25-70%, depending on the cause of non-obstructive azoospermia.
Dr. Vasan SS of Manipal Ankur will be answering all infertility queries in a FREE LIVE WEBINAR/HEALTHCAST on 7th May 2016 at 11.30 AM. You can ask your queries and watch webinar live either in Youtube or in Doctors’ Circle app - http://drcl.in/infertility
Dr. Vasan has 36 years of experience as Andrologist.