Azoospermia Meaning in Tamil – Tests & Treatment in Chennai

TESA / Micro TESE Treatments for Azoospermia

AZOOSPERMIA SIMPLIFIED by Dr Arun Muthuvel

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

Etiology

• 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

Etiology

• 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.

Azoospermia Meaning in Tamil