About 25% of infertility cases are due to male factors. This may be due to the male partner either having no sperm in the semen (termed azoospermia) or reduced numbers of sperm in the semen (oligozoospermia). Provided that there are some sperm in the semen, men still have the option of undergoing IVF treatment. In cases of azoospermia the cause may be due to an obstruction (obstructive azoospermia, OA) or sue to impaired sperm production within the testicle itself (non-obstructive azoospermia, NOA).
From the clinical history and examination together with additional hormonal blood tests, the two conditions can be differentiated.
If the cause of obstruction is a blockage to the transport of sperm from the testicle then reconstructive surgery can be performed. The blockage can be anywhere from the testicle to the prostate. (see Surgery for Ejaculatory Obstruction). However, some individuals would prefer to undergo IVF treatment in which case sperm can be retrieved directly from the epididymis using a technique called PESA or directly from the testicles using a technique called microdissection TESE.
NOA means that there is a problem with sperm production within the testicles. This can be due to conditions called Sertoli Cell Only syndrome or Maturation Arrest. However, before undertaking any surgical sperm retrieval, patients undergo chromosomal studies and a genetic test called a Y deletion. This is because there are chromosomal abnormalities such as Klinefelters syndrome which are associated with NOA. Following this a microdissection TESE procedure uses an operating microscope to analyse the tissue within the testicle and dissect out the tubules which are likely to contain sperm.
The procedure is performed in conjunction with embryologists in theatre who analyse the tissue until sperm is found. LMC works closely with andrologists at Andrology Solutions who also provide facilities for the storage and transport of sperm. Once the sperm has been identified, it can be used for ICSI treatment.