Azoospermia: Causes, Types, Treatment, TESA, MESA, PESA and more

Azoospermia: What is it?

Azoospermia is the medical term used to refer to the condition when there are no sperm in the ejaculate. It may either be “obstructive”, that is, where there is a blockage that prevents sperm from entering the ejaculate; or “non-obstructive”, that is, when it is due to the decreased production of sperm by the testis.

Azoospermia: Is it common?

The answer to this is YES. Approximately 10% of infertile men and 1% of all men have azoospermia. 

Azoospermia: What are its causes?

There can be several potential causes of azoospermia, that can include certain lifestyle habits; genetic conditions, such as Klinefelter’s syndrome; medical treatments, such as radiation or chemotherapy; recreational drugs, such as some narcotics; and anatomical abnormalities, such as varicoceles or absence of vas deferens on each side. However, the most obvious cause would perhaps be a vasectomy that prevents sperm from joining other fluids in the ejaculate. Yet in most of the cases, the factors of azoospermia are not fully understood, such as environmental toxins, genetic conditions, or poor testicular development as a foetus/child.

Azoospermia: Types & Treatment?

Azoospermia can be of two types:

1. Non-Obstructive Azoospermia (NOA)
2. Obstructive Azoospermia (OA)

Non-Obstructive Azoospermia (NOA)

Non-Obstructive Azoospermia (NOA) refers to a group of disorders that cause abnormal sperm production in man. All these factors either lead to decreased sperm production or no sperm production at all.

Treatment of Non-Obstructive Azoospermia (NOA)

Regardless of the causes of Non-Obstructive Azoospermia (NOA), its treatment is done in the same way. The treatment starts with a semen analysis and male endocrine profile (blood work) followed by the drugs/medication treatment. In case of low bioavailable testosterone, the medication usually starts on clomiphene citrate or clomid. The patient remains on this drug for four months, after which another semen analysis follows.

Generally, in one out of nine men, the sperm returns to the ejaculate after taking medication to return their testosterone to the normal range. However, exception exists everywhere.

Moreover, the chances of finding sperm during a surgical sperm extraction procedure called Microsurgical Testicular Sperm Extraction (Micro TESE) gets doubled after taking medication for normalizing testosterone.

Obstructive Azoospermia (OA)

Obstructive Azoospermia (OA) is when a man’s testes produce enough sperm, but there is a plumbing problem preventing the sperm from ejaculating out of the testes and entering the ejaculate in the urethra/penis.

Treatment of Obstructive Azoospermia (OA)

The following are the treatment methods available for Obstructive Azoospermia (OA):

TESA: Testicular Sperm Aspiration or TESA is a method of Testicular Sperm Extraction (TESE) that is performed by inserting needle in the testis and drawing out the fluid and tissue by a vacuum. This is followed by processing the tissue.

MESA: Microsurgical Epididymal Sperm Aspiration or MESA is a technique of treating Obstructive Azoospermia which involves incision of a single tubule by dissecting the epididymis. The fluid that overflows from the epididymal tubule is then drawn out. Due to the large number of vessels in the epididymis, this method sometimes lead to contamination by blood cells, that may affect sperm fertilizing capacity in IVF.     

PESA: Percutaneous Epididymal Sperm Aspiration or PESA is a method of treating Obstructive Azoospermia, where no surgical incision is required. Here, a small needle is passed through the skin of the scrotum directly into the head of the epididymis and the fluid is drawn out.  

Once the fluid aspiration is complete in all the above techniques (TESA, MESA, & PESA), the embryologist collects the sperm cells and prepares them for IVF (In-Vitro Fertilization) where egg and multiple sperms are left in a petri dish to fertilize on their own; or ICSI (Intracytoplasmic Sperm Injection) where a single sperm is directly injected into the egg.

In case you have any male infertility related queries, feel free to contact our experts at Vasundhara Hospital.

Medically Reviewed By:

Dr. Sanjay Makwana having more than 25 years of enriching experience in the field of Infertility, training exposure from Genk, Belgium, Germany, Italy. One of the Best &Most Senior Infertility Specialist heading the department of Assisted Reproductive Technology and has set a benchmark for Best IVF Clinic & Infertility Management in Rajasthan. He has been felicitated with various awards and recognition’s in the field of Infertility.