Poor results from a semen analysis: Understanding the Absence of Sperm and Your Path to Fatherhood
A diagnosis of azoospermia, where there is the absence of sperm in a man’s semen, can feel overwhelming. However, it is crucial to understand that this is not a definite end point on your fertility. It is a medical condition with identifiable underlying causes and, often, effective treatment pathways to fathering your own child.
Understanding the Underlying Causes
Azoospermia is generally categorized into two main types, which dictate the treatment approach:
1. Obstructive Azoospermia (OA)
Here, sperm are being produced normally in the testicles but are blocked from reaching the ejaculate. Common causes include prior infections (like chlamydia), obviously, a previous vasectomy, congenital absence of the vas deferens (often linked to being a carrier of the Cystic Fibrosis gene), or as a result of injury.
2. Non-Obstructive Azoospermia (NOA)
This is a production issue. The testicles produce very few or no sperm. Causes can be hormonal (such as low FSH/LH), genetic (like Klinefelter syndrome or Y-chromosome microdeletions), a history of chemotherapy/radiation, or unexplained testicular failure.
Treatment Options
The treatment path is determined by the type of azoospermia and its specific cause.
For Obstructive Azoospermia
The goal is to retrieve sperm directly. This is often highly successful. Procedures include:
PESA/TESA
These are minimally invasive techniques to extract sperm from the epididymis or testicle. Your fertility specialist has the skills to perform this procedure. It is often undertaken as a trial procedure before the female has an IVF stimulation cycle so that the treatment team know that sperm is available
Microsurgical Reconstruction
For situations such as a prior vasectomy, a vas reversal can surgically reconnect the tubes, allowing sperm to return to the ejaculate. This is an option if the vasectomy has been performed less than 7 years ago. Beyond this time, antibodies in the man’s blood and semen mean that natural conception is unlikely, even if the reconstruction is successful.
For Non-Obstructive Azoospermia
The approach focuses on finding viable sperm within the testicular tissue itself. The usefulness of this procedure depends on results of hormone, genetic and ultrasound tests , so a careful “work up” is required
microTESE
This is the gold-standard surgical procedure. Our experienced reproductive urologist uses a high-powered microscope to meticulously search the testicular tissue for pockets of sperm production. Retrieved sperm are then used for ICSI (Intracytoplasmic Sperm Injection).
The journey begins with a thorough evaluation by fertility specialist and often referral on to our Reproductive Urologist. Advanced surgical techniques combined with IVF/ICSI, mean that many men with azoospermia can still achieve their dream of having a biological child.
A number of couples who have azoospermia as part of their fertility story will require donor sperm to achieve a pregnancy. Many healthy, and very generous men have donated sperm at Ballarat IVF to help others in need. We thank them for their kindness, and the acknowledge the massive change their gift can make to the lives of others.
We’re always happy to provide information to people regarding sperm (and egg!) donation.
