AZOOSPERMIA TREATMENT CHENNAI INDIA

DR Arun with PGD IVF Baby

Top Azoospermia Specialist Doctor in Chennai, India.

Dr Arun Muthuvel has been rated as top Azoospermia and IVF Specialist Doctor in Chennai, Performed highest number of Azoospermia Treatment Cycles in Chennai. Presented numerous Infertility Papers in national and international conferences.

Education: MBBS, MS, MCh - Reproductive Medicine & Surgery

  • 1st few in India to have completed M.Ch (Reproductive Medicine and Surgery) degree which is the only recognised Super Speciality degree in Infertility by Medical Council of India.

  • India's only Fertility Super Specialist with highest Azoospermia experience.

  • Ranked among Top Azoospermia Specialists in India.

  • The Only Doctor from India to have made Oral presentation in Americal Society of Reproductive Medicine Conference held at Salt Lake city, USA.

  • Received Radiocity Chennai city Icon award 2018.

  • Received Young Achievers Award at Times Health Awards 2018.

Azoospermia videos in Tamil

Azoospermia Videos in English

Consult with Dr Arun Muthuvel MS, MCh who is a specialist in Azoospermia at Iswarya Fertility centers in Chennai, India.

International Trainings

  • Advanced IVF @ Boston IVF (Harvard University), USA

  • Natural Cycle IVF at Michigan IVF, USA.

  • PGD IVF & Embryo Biopsy from Cleveland Clinic, USA.

  • Andrology, Micro TESE for Azoospermia at Miami, USA

Qualifications

  • MBBS, MS – OBGYN, MCh – Reproductive Medicine & Surgery

Treatments

IVF - ICSI IVF Failure Treatments PGD Azoospermia TESA - Micro TESE Miscarriages

Blogs

PGD for Gender selection in India - Controversies

Storing embryos in your bedroom - the Future of IVF

IVF Success stories Chennai

International Trainings

  • Advanced IVF @ Boston IVF (Harvard University, USA)

  • Natural Cycle IVF at Michigan IVF, USA

  • Andrology, Micro TESE for Azoospermia at Univeristy of Miami, USA

  • PGD IVF & Embryo Biopsy from Cleveland Clinic, USA

Patient Success Stories

AZOOSPERMIA SIMPLIFIED



INTRODUCTION


  • Azoospermia is the medical term used when there are no sperm in the ejaculate.

  • Rare (approximately 1% of all men [1]),

  • Approx 10%–15% of all infertile men.


References: Stephen EH, Chandra A. Declining estimates of infertility in the United States: 1982-2002. Fertil Steril 2006;86(3):516–23. VOL. 109 NO. 5 / MAY 2018 781 Fertility and Sterility, Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989;142(1):62–5. 3.

DIAGNOSIS OF AZOOSPERMIA

no sperm is identified in the centrifuged pellet of two separate semen samples.

AZOOSPERMIA CLASSIFICATION - ETIOLOGICAL

  • Pre Testicular - hormonal

  • Testicular - intrinsic failure

  • Post Testicular - obstruction


AZOOSPERMIA CLASSIFICATION - CLINICAL

  • Obstructive

  • Non Obstructive

PRE TESTICULAR (HORMONAL)

  • Genetic abnormality

    • Kallmann’s syndrome

    • Prader-Willi syndrome

  • Idiopathic HH

  • Isolated FSH / LH deficiency

  • Prolactin excess - micro / macro

TESTICULAR (INTRINSIC FAILURE)

  • Genetic abnormality –Klinefelter’s syndrome, XYY, 46 XX male syndrome, Yq AZF gene deletion

  • Varicocele

  • Bilateral anorchism, cryptorchidism

  • Sertoli cell only syndrome

  • Gonadotoxic therapy : drug, radiation, chemical

  • Orchitis - mumps / Infections


OBSTRUCTIVE AZOOSPERMIA

Normal sperm production + obstruction


Causes

  • Previous vasectomy

  • Obstructions in Epididymis, Vas or Ejaculatory duct

  • Infections

  • Iatrogenic injuries during Scrotal/inguinal surgeries

  • Congenital anomalies


NON OBSTRUCTIVE AZOOSPERMIA

Due to abnormal sperm production

Causes

  • Sertoli cell only syndrome

  • Maturation arrest

  • Hypospermatogenesis

  • Klinefelter’s syndrome

  • Kallmann syndrome

  • Y-Chromosome microdeletions

  • Post mumps - orchitis, Post CT / RT

  • Torsion - testis / Cryptorchidism


EVALUATION OF AZOOSPERMIA


  • Semen Analysis - Repeat - Repeat ?

  • Clinical History

  • Physical exam - General & Local (vas*)

  • Imaging (USG Scrotum / TRUS)

  • Hormonal - FSH, LH, Total / Free Testosterone, Prolactin, Estradiol. FSH - >7.6 mIU/ml

  • Genetic - Karyo, Ych micro

Diagnostic evaluation of the infertile male: Practice Committee of the American Society for Reproductive Medicine, 2014


NEXT STEPS IN AZOOSPERMIA EVALUATION


  • Differentiate first


  • Is it Obstructive or non Obstructive ?


How do we differentiate Obstructive vs Non Obstructive Azoospermia ?

Childhood and Developmental history

  • Cryptorchidism, testicular torsion

  • Mumps - orchitis

  • Herniorrhaphy

  • Onset of puberty

  • Secondary sexual development

  • Onset axillary, pubic hair, start of shaving

  • Onset of masturbation


How do we differentiate azoospermia by clinical history ?


Medical history

  • Systemic illness: hepatic, renal failure

  • Gonadotoxic therapy - CT, RT, Steroids, Smoking, thermal, etc

Surgical history

  • Herniorrhaphy, bladder neck, orchidectomy, retroperitoneal surgery


How do we differentiate (by Dr Arun Muthuvel MS, MCh - Azoospermia Treatment Chennai)


Physical examination

  • General appearance

  • Gynecomastia

  • Axillary, pubic hair

  • Testis volume, consistency

  • Epididymis induration

  • Varicocele

  • Digital rectal examination


Semen analysis in Azoospermia


  • Repeat - Repeat

  • At least 2 times

  • Inspect Pellet after centrifugation at 1,500-2,000 rpm for 10 min

  • If ejaculatory vol < 1 ml – Postejaculatory urine should be examined


OBSTRUCTIVE AZOOSPERMIA

Semen Analysis

  • Complete proper collection ?

  • Semen Volume

  • pH

  • Fructose

  • Post ejaculate urine analysis



Ultrasound scan in azoospermia diagnosis and treatments

Scrotal

  • Testis volume / Varicocele / Testis tumor

TRUS - Transrectal USG

  • r/o or to confirm level of obstruction

  • Low volume azoospermia without absence of testicular atrophy


How do we differentiate ?

  • Clinical history

  • ExaminationTestis - N / smallVas, Epi N.Testis - N size

  • Vas,Epi N/Absent.

  • Semen analysis

  • pH, Fructose, Volume normal.

  • pH acidic ? Fructose absent ? Volume - low



Hormones

  • Hyper-hypo / Hypo - hypo / normal



Histological patterns of spermatogenesis in Azoospermia testicular biopsy


  • Tubular sclerosis - Absence of seminiferous tubules

  • SCOS - No germ cells within the seminiferous tubules

  • Spermatogenic arrest - Incomplete spermatogenesis, not beyond the spermatocyte stage

  • Hypospermatogenesis - All germ cell stages present including spermatozoa with a decline in no of germ cells

  • Normal spermatogenesis

  • Mixed pattern - different stages of spermatogenesis


Sperm Retrieval rate in Non-obstructive Azoospermia


  • Hypospermatogenesis 70-85%

  • Maturation Arrest 35-47%

  • Sertoli Cell-only 10-24%



Hormones - Non Obstructive Azoospermia



Clinical status


  • Germ cell aplasia - FSH ↑, LH and Testosterone - Normal

  • Testicular failure - FSH ↑, LH ↑, Testosterone - Normal or Low

  • Hypogonadotropic Hypogonadism - FSH, LH, Testosterone all are low



Treatment options in Azoospermia

    1. Obstructive vs Non obstructive

    2. Testicular biopsy


Diagnostic


  • Diagnose Obstruction vs Non Obstruction

  • Identification of mature sperm for ICSI

  • Identification of malignancy


Therapeutic

  • Harvesting of sperm for ICSI


Medical Treatment of Azoospermia


Hypogonadotropic hypogonadism

  • HCG / HMG / FSH

  • Combination / Step wise

  • Sperm count increase observed in 3-24 months


Varicocelectomy for Azoospermia


  • Only in clinically palpable cases

  • Severe hypospermatogenesis

  • ICSI vs varicocelectomy


Methods to Extract sperms in Azoospermia


  • PESA / MESE

  • TESA

  • TESE

  • Micro TESE


Conclusion


  • Azoospermia - common in Fertility Setup

  • Differentiate Obstruction vs Non obstruction Azoospermia

  • Medical vs Surgical

  • Right Surgical route

Consult with Dr Arun Muthuvel MS, MCh who is a specialist in Azoospermia in Chennai, India.