The finding of azoospermia (zero sperms in semen) on repeated semen examination is a great blow on the couple’s aspirations for parenthood. Fortunately science has advanced so much, to offer realistic hopes to these couples to father their own genetic child. Except for primary testicular failure, where spermatogenesis is arrested’ all other causes of azoospermia can be benefited by IVF-ICSI-TESE/PESA. Here sperms are retrieved from the testes or epididymus and injected into the cytoplasm of oocyte so as to fertilize them.
When the diagnosis of azoospermia is confirmed, complete evaluation including thorough history and physical examination is done by the urologist, so as to find out the cause of azoospermia. This needs to be backed by some investigations like S. FSH, S. Testosterone, S.LH, and USG scrotum etc. Finally to confirm whether mature sperms are there in the testes or not, testicular biopsy is required. This is done under general anesthesia and if mature sperms are found in biopsy, the testicular tissue is then frozen and saved so that it can be used in subsequent IVF-ICSI cycles, thereby omitting the need to do repeat TESE or PESA at the time of egg retrieval.
Percutaneous epididymal sperm aspiration (PESA) The procedure involves an insertion of a fine needle under general anaesthesia so that the sperm may be sucked out into a syringe from a small tube at the back of the testis.
Testicular sperm aspiration (TESA) Sometimes it is necessary to put the needle actually into the testes itself and suck out the seminiferous tubules so as to get the sperms. Or testicular biopsy is done where a small piece of testicular tissue is obtained to get the sperms.
Any sperm obtained may be used fresh, or frozen for later use in ICSI.