azoospermia
Azoospermia is the condition in which there are no sperm in the semen and is one of the most severe forms of male infertility. There are two types of azoospermia;
Although sperm is produced, sperm cannot be transported from the male reproductive system to outside the body (obstructive) or there are sperm production problems (non-obstructive).
- Obstructive Azoospermia: It accounts for 40% of all azoospermia cases. Sperms produced in the testicular tissue of the body cannot be expelled due to blockage in the duct system. This blockage may be in the vas deferens or epididymis.
- Non-Obstructive Azoospermia: Non-obstructive azoospermia accounts for 60% of all cases. Sperm cannot be produced in the testicular tissue within the body. It is usually the result of hormonal imbalances.
What is the incidence of azoospermia?
Azoospermia affects only 2% of the general male population, but accounts for 10 to 20% of male infertility. These men have little or no sperm in their semen.
Are there any symptoms of azoospermia?
Unfortunately, azoospermia has no symptoms. The semen will most likely be a normal color and appearance. It can only be diagnosed by sperm count.
Is there a test that shows sperm production in the testicles in men with azoospermia due to production disorders?
Some genetic tests can be performed. Today, except for the loss of some genes (genes in the AZFa and AZFb regions) in Y microdeletion, we cannot predict whether sperm is produced in the testicle with any test or imaging method.
Sperm Production Problems
As a result of the dysfunction of the testicles, sperm production becomes impossible. To produce sperm, the appropriate cells must be present in the testicles and the appropriate hormones must be released to trigger sperm production. Common reasons for unsuccessful sperm production are;
- Some diseases, such as hormonal imbalances or Cushing's Syndrome, can also lead to azoospermia.
- Cryptorchidism or undescended testicle is the condition in which the testicles do not descend into the bags called scrotum. It is usually corrected by surgery in childhood, but if not corrected, it causes azoospermia.
- Vascular Trauma: Impacts to the testicle or veins can also cause azoospermia. Expansion of the vessels in the testicle, that is, varicocele, causes blood to pool there and sperm production to deteriorate. Varicocele impairs sperm production by causing an increase in temperature, disrupting the oxygenation of the tissue, and causing the accumulation of harmful wastes from the kidney and adrenal glands.
- Chemotherapy and radiotherapy
- chromosome diseases
- Toxic substances, substance abuse, alcohol
Azoospermia Due to Obstruction
The sperm produced in the testicles cannot reach the urinary tract, which we call the urethra, and a blockage in this path prevents the sperm from being expelled. These reasons are;
-Vasectomy: It is the ligation of the channels called vas deferens, through which sperm is transported.
-Congenital absence of vas deferens: Some men do not have these channels from birth, in this case, some genetic tests must be performed on the man.
-Infections: Some diseases, especially sexually transmitted; Chlamydia, like gonorrhea, causes blockage in these channels.
treatment
Replacement therapy may be considered in azoospermia due to hormonal deficiency. Microsurgery may be necessary in cases of azoospermia due to obstruction. It can be tried especially in men who have undergone vasectomy, but today, techniques for obtaining sperm surgically have developed after microinjection was introduced into the treatment. These techniques;
MESA (microepididymal sperm aspiration)
PESA (Percutaneous sperm aspiration)
TESA (Testicular sperm aspiration)
TESE (Testicular sperm extraction)
MICRODISECTION TESE (microTESE)
Among these techniques, TESA TESE and microTESE are the most preferred methods. The preferred method for non-obstructive azoospermia is microTESE surgery.
What is microTESE surgery?
The testicle is completely opened with a single incision, the tissue is magnified 20 times with a microscope, areas with sperm production are detected and tissue samples are taken from those areas. Therefore, the chance of success is higher than the multiple biopsy method used in the past and it is possible to obtain a higher number of sperm. With this method, tissue loss from the man's testicles is less, the testicles suffer the least damage from the operation, and it minimally affects the secretion of testosterone hormone. Another advantage of the microsurgical method performed under the microscope is that the vascular structure in the capsule surrounding the testicular tissue is seen and the incision is made without damaging the vessels feeding the testicle.
The operation is performed under general anesthesia. After the micro TESE operation, patients are kept under observation until the effect of anesthesia wears off and then they are discharged. It is recommended that the patient not drive when going home after the operation. Continuous bed rest is not required, but it is recommended to reduce normal activity for two to three days after surgery. The dressing must be renewed 48 hours after the surgery. You can take a shower on the 3rd day after the operation. There is no need to remove stitches as the stitches will dissolve on their own in about a week. It is recommended that patients use tight briefs or suspensions for 10-15 days after the operation. Heavy physical activity and sexual intercourse are postponed for up to 15 days.
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