The WHO (World Health Organization) defined azoospermia as the absence of sperm in the semen or ejaculate. This diagnosis should be based on at least two semen samples with a gap between them of about 4 weeks.
Its prevalence is 2% in the general population and 10-20% in men studied for sterility.
In practice, we distinguish two types of azoospermia: obstructive, in which sperm do not appear in the ejaculate due to an obstruction of the seminal duct, and non-obstructive, in which no sperm are produced in the testis, either due to a lack of hormones, or because of a congenital or acquired condition.
The minimum initial evaluation should include a complete medical history, physical examination and hormonal profile, including at least FSH and testosterone in blood. Genetic testing may be of interest and recommended in some cases (suspected Cystic Fibrosis, karyotype, microdeletions of the Y chromosome, etc.).
This protocol will depend on the initial assessment and FSH levels. Hormonal treatment can be included to stimulate sperm production or a testicular biopsy may be carried out.
If it is necessary, a testicular biopsy can be performed to obtain testicular sperm. Although there are different methods, currently the most used are TESE and microTESE. Both are usually performed under local anesthesia, but can be performed with sedation if necessary depending on the case, and on an outpatient basis (no need to be admitted to the clinic)
In borderline cases, in which sperm retrieval by biopsy is believed to be virtually impossible, or in cases where conventional biopsy or TESE failed in previous attempts, the MICRO-TESE can offer an additional percentage of successful sperm retrieval. According to some authors, the success rate increases from 45 to 65% with this technique, in which a search with surgical microscope is employed.
Página actualizada el