Surgery for Zero sperm count (Azoospermia)

Azoospermia occurs in 1% of the general population, and in 10-15% of the infertile male population. It may be functional or non-obstructive (NOA) or Obstructive (OA)

NOA: The management of NOA depends on finding sperm in the testes and retrieving the sperm surgically so it can be used in IVF treatment. This is because men with NOA may have patchy areas inside the testes where there is some sperm production that is not enough to appear in the ejaculate.

At City Fertility we offer the best and most advanced technique of finding sperm in men with NOA, that is Micro-dissection testicular sperm extraction (Micro-TESE) which is superior to any other technique in men with NOA. This technique uses state of the art surgical microscope, under high magnification an experienced microsurgeon will identify the areas that are most likely to contain sperm and selectively take tiny pieces from these areas to give it to the embryologist.

Most units do not offer this technique because it requires an experienced microsurgeon, an expensive microscope, and theatre time as it may take the surgeon up to 2 hours to find sperm.

OA: Some of the causes of obstructive azoospermia can be treated by microsurgical procedures (epididymo-vasostomy in epididymal blockage and vaso-vasostomy in blockage of the vas deferens), these procedure aim at reconnecting the seminal ducts and bypassing the blockage. In cases of ejaculatory duct obstruction (EDO) transurethral resection of the ejaculatory ducts (TURED) is performed to resect the blockage.

If this is not indicated or fails, surgical sperm retrieval is offered and the sperm is extracted for use in IVF.

Several techniques may be used depending on the site of obstruction such as per epididymal sperm aspiration (PESA), Micro-surgical sperm aspiration (MESA), testicular sperm aspiration (TESA), percutaneous testicular sperm extraction (Perc TESE) and window testis biopsy.

Sperm retrieval in OA is easier than NOA because sperm production is normal.

Mr Raheem is an experienced microsurgeon with special interest in male infertility. His skill and advanced techniques offer males with zero sperm count the best chances of fathering their own child.