Azoospermia is the complete absence of sperm in the semen. Azoospermia is diagnosed after a series of microscopic analyses of the ejaculate. Complete azoospermia occurs in one out of a hundred men and is the primary cause of infertility.
There are two types of sperm absence in semen:
- Obstructive, or Excretory Azoospermia (OA)
- Non-obstructive, or Secretory Azoospermia (HOA)
Obstructive azoospermia is characterised by preserved spermatogenesis in the testicles. The absence of spermatozoa in the ejaculate, in this case, can appear due to mechanical blockade preventing sperm transportation, inflammatory processes, injuries, complications of surgical interventions, congenital developmental pathology or retrograde ejaculation.
Non-obstructive azoospermia is characterised by the absence of spermatozoa in the sperm. Main reasons for sperm absence in such cases appear due to genetic abnormalities, iatrogenic causes, toxic effects, irradiation, endocrine disorders, etc.
Surgical sperm retrieval can be performed with the help of TESA (testicular sperm aspiration) or TESE (testicular sperm extraction). Both of those reproductive methods are done under local anaesthesia.
The TESA, TESE is the least traumatic IVF techniques, requiring no special equipment and microsurgical skills, accompanied by fewer complications in the form of impaired vascularisation and postoperative inflammation.
TESA/TESE appears to be the first logical step in trying to obtain spermatozoa in patients with a non-obstructive form of azoospermia.
In the case of the ineffectiveness of TESA, the amount of surgical intervention is logically expanded to TESE.
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