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Azoospermia Meaning & Treatment Chennai – Tamil

Azoospermia Meaning in Tamil – Tests & Treatment in Chennai

TESA / Micro TESE Treatments for Azoospermia

Azoospermia meaning in Tamil

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