What are the chances of pregnancy when the man has no sperm?
Infertility affects around 15-17% of couples worldwide, with up to 50% of cases attributed to a male factor. In the majority of cases, the exact aetiology of male infertility remains unclear.
A subset of men with infertility have no sperm in the seminal fluid (a condition known as azoospermia, which can be further classified as obstructive or non-obstructive azoospermia) . The majority of cases with non-obstructive azoospermia are idiopathic, however some known etiologies include:
- Genetic disorders
- Chemotherapy or radiation to the testicles,
- Developmental or structural abnormalities
- Hormonal disorders
Despite the often unclear etiology behind the dysfunction leading to non-obstructive azoospermia, sperm can often be surgically extracted from the testicles for use in assisted reproductive techniques (ART) with some success.
Causes of Non-obstructive Azoospermia
- Hormonal causes
- Klinefelter’s syndrome (in which the sperm produced are minimal to non-existent).
- Chromosomal diseases
- Malignancies, Chemotherapy and Radiation
- Cryptarchy
In addition, non-obstructive azoospermia can be caused by several reasons, including infections of the genitourinary system, such as post-pubertal mumps orchitis or various types of medication. Common classes of drugs with documented negative effects on fertility include exogenous testosterone or other androgen-regulating drugs, psychiatric drugs and antihypertensive drugs, which affect the hormonal environment resulting in reduced or absent sperm production.
Treatments
When a man has azoospermia it does not mean that it is impossible to have a child. There are different treatment approaches depending on the cause of azoospermia.
In the case of obstructive azoospermia, surgery may be possible to open the site of the obstruction to restore sperm flow. In addition, the more recent the obstruction, the better the chances of the operation being successful.
Effective management of infertility in men with non-obstructive azoospermia requires sperm retrieval from the testicles as well as assisted reproductive technology (ART) in the form of ICSI. Given that sperm retrieval involves finding one of the very limited sperm-producing sites in a highly dysfunctional testis of a man with non-obstructive azoospermia, it is not surprising that the technical approach used for sperm retrieval can substantially affect the likelihood of finding sperm.
A wide range of approaches have been used for attempted sperm retrieval, including fine needle aspiration of the testicle (FNA), surgical retrieval of sperm from the testicles (“conventional” TESE) and finally guided surgical retrieval of sperm from the testicles using a microsurgical approach (microTESE).
With the combination of these methods, the treatment of obstructive and non-obstructive azoospermia is successfully carried out in up to 40% of men who achieve the desired result of having a child.
