By BSc, MSc (embryologist).
Last Update: 12/14/2018

A natural pregnancy is not possible in women whose partner has azoospermia, whether it is the secretory/non-obstructive or the obstructive type. However, when this infertility problem cannot me solved with treatment, Assisted Reproductive Technology (ART) offers a wide range of options to allow pregnancy through IVF techniques. Find more info about them herein.

Sperm aspiration

In males with obstructive azoospermia, we cannot see sperm in the ejaculated semen, although there is sperm production in the testicle.

A possible option is to retrieve sperm directly from the testis or the epididymis. By doing this, we can obtain a sperm sample, although the sperm count, motility and morphology are likely to be poor.

As a result, as long as sperm are retrieved by aspiration, the technique of choice is ICSI (Intracytoplasmic Sperm Injection).

ICSI is a type of IVF whereby a single spermatozoon is enough for fertilization to be possible. During the procedure, the andrologist inserts the sperm directly into the egg.

There exist different procedures for sperm extraction:

MESA

Microsurgical Epididymal Sperm Aspiration (MESA) is used in patients with a blockage in the reproductive tract. Through MESA, a small incision in the epididymis is done to retrieve sperm directly from it.

MESA is a technically challenging procedure, and therefore the costs are elevated. For this reason, although is allows for a greater number of sperm to be collected in comparison to PESA, it is rarely the technique of choice.

PESA

Percutaneous Epididymal Sperm Aspiration (PESA) is less technically challenging and invasive than MESA. Furthermore, the expertise required is not as demanding. It is done under sedation.

A needle attached to a syringe is inserted through the scrotal skin into the epididymis. The main pitfall of PESA is that needle insertion is done blindly. Thus, even though it is not so common, it might happen that no sperm cell is found.

TESA

Testicular Sperm Aspiration (TESA) is done percutaneously as well, as in the case of PESA. The difference between TESA and PESA is that the former is done in the testes instead of the epididymis.

TESA is the option of choice when none of the above are successful (MESA and PESA), and in cases where the problem is related to an absent or blocked epididymis.

Testicular biopsy

Testicular biopsy, also called Testicular Sperm Extraction (TESE), is done using a local anesthetic and involves the following steps:

  • Using a scalpel, the specialist opens the different testicular layers until he or she reaches the testicle, where small pieces will be retrieved. On average, between 2 to 3 cm of testicular layers are opened, which will be closed with one or two points of suture.
  • Once the biopsy is done or simultaneously, the tissue retrieved is examined microscopically to find spermatozoa, which will be used later for ICSI technique.

Although it is indicated for patients with obstructive azoospermia, it can be used in cases of non-obstructive azoospermia as well. In many cases, even if no sperm are produced in the testicles, still sources of spermatogenesis could be found. In other words, if the search is done thoroughly, sooner or later sperm are found.

In any case, the chances of achieving a pregnancy with ICSI with the sperm or few sperms found after a testicular biopsy in patients with non-obstructive azoospermia are low.

One should not forget that a testicular biopsy is not only the option of choice to achieve pregnancy, but also a diagnostic test that allows us to distinguish between non-obstructive and obstructive azoospermia.

Sperm donation

The procedures mentioned above can be effective in cases of obstructive azoospermia, but are useless in males with non-obstructive/secretory azoospermia. In the latter group, if spermatogenesis is not recovered with different treatment options, using donor sperm recommended.

It involves doing an Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF) with sperm donated by a young, healthy man. Sperm donors are medically and psychologically pre-screened to verify their state of health and confirm that their sample is in optimum conditions for being used.

Choosing between IUI or IVF depends on the characteristics of the female partner, including age, tubal patency, etc.

The success rates with donor sperm are considerably high. However, on the other side of the coin, it presents a major disadvantage: the intended father will not share his DNA with the child. Children conceived with donor sperm inherit the genetic material of the donor.

Do you need donor sperm for your fertility treatment cycle? Then we recommend that you get your Fertility Report now to find the most suitable clinic for you. Our thorough selection criteria when it comes to recommending clinics plus your particular needs equal the best fertility center for you. You will receive in your inbox a detailed report with the clinics that we recommend for your particular treatment, as well as the conditions that they offer for each program.

FAQs from users

Is sperm donation the only option to have children if husband has non-obstructive azoospermia?

By Andrea Rodrigo BSc, MSc (embryologist).

If it is a case of untreatable or irreversible non-obstructive/secretory azoospermia, then the answer is yes.

In the most severe cases of non-obstructive azoospermia, obtaining viable sperm is highly unlikely. For this reason, the only option to have children with this sperm disorder is sperm donation.

Can sperm be found with a testicular biopsy if husband had a vasectomy 11 years ago?

By Andrea Rodrigo BSc, MSc (embryologist).

A testicular biopsy (Testicular Sperm Extraction or TESE) allows for sperm to be directly collected from the testicle, where sperm production takes place. However, after such a long period of time with a voluntary obstruction, it is likely that the organism has decreased the number of sperm it produces. The good news is that, since ICSI technique could work with just a single sperm, a woman could get pregnant with only few sperm retrieved after TESE.

In any case, one should bear in mind that it is possible that zero sperm are found in the sample after a testicular biopsy.

Suggested for you

Throughout this article, we have read about the options an azoospermic man has to conceive in spite of this sperm disorder. Want to learn more about the different treatment options available? Click here: Treatment of Azoospermia.

On the other hand, we have made several references to testicular biopsy as a diagnostic test to detecting azoospermia. To learn more about the diagnostic tests used before rendering a diagnosis of azoospermia, read: How Is Azoospermia Diagnosed?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015 Nov;104(5):1099-103.e1-3.

Deruyver Y, Vanderschueren D, Van der Aa F.Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology. 2014 Jan;2(1):20-4.

Dineen T, Waterstone J, Cullen I. Non-Obstructive Azoospermia and the Impact of MicroTESE. Ir Med J. 2016 Sep 9;109(8):447.

Dohle GR, Elzanaty S, van Casteren NJ. Testicular biopsy: clinical practice and interpretation. Asian J Androl. 2012 Jan;14(1):88-93.

Faure A, Bouty A, O'Brien M, Thorup J, Hutson J, Heloury Y. Testicular biopsy in prepubertal boys: a worthwhile minor surgical procedure? Nat Rev Urol. 2016 Mar;13(3):141-50.

Franco G, Scarselli F, Casciani V, De Nunzio C, Dente D, Leonardo C, Greco PF, Greco A, Minasi MG, Greco E. A novel stepwise micro-TESE approach in non obstructive azoospermia. BMC Urol. 2016 May 12;16(1):20.

Hao L, Li ZG, He HG, Zhang ZG, Zhang JJ, Dong Y, Li ZB, Han CH. Application of percutaneous epididymal sperm aspiration in azoospermia. Eur Rev Med Pharmacol Sci. 2017 Mar;21(5):1032-1035.

Morita T, Komatsubara M, Kameda T, Morikawa A, Kubo T, Fujisaki A, Kurokawa S, Kawata H, Tanaka A. A new simple technique of epididymal sperm collection for obstructive azoospermia. Asian J Androl. 2016 Jan-Feb;18(1):149-50.

Văduva CC, Constantinescu C, Radu MM, Văduva AR, Pănuş A, Ţenovici M, DiŢescu D, Albu DF. Pregnancy resulting from IMSI after testicular biopsy in a patient with obstructive azoospermia. Rom J Morphol Embryol. 2016;57(2 Suppl):879-883.

van Wely M, Barbey N, Meissner A, Repping S, Silber SJ. Live birth rates after MESA or TESE in men with obstructive azoospermia: is there a difference? Hum Reprod. 2015 Apr;30(4):761-6.

Vloeberghs V, Verheyen G, Haentjens P, Goossens A, Polyzos NP, Tournaye H. How successful is TESE-ICSI in couples with non-obstructive azoospermia? Hum Reprod. 2015 Aug;30(8):1790-6.

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Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo

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