The technical advancements and recent research developments in the medical field have made procreation possible for men with less or no sperm count.
In medical terms, this condition is commonly known as Azoospermia since it is associated with very negligible or no sperm in the semen. Said to affect about 1% of the total male population, this condition is one of the major reasons for male infertility.There could be two probable causes for this condition: non-production of sperms or presence of any blockages preventing the sperm from reaching the ejaculation phase.
While the second case is relatively easier to solve, a patient who has zero sperm count due to blockages or some genetic condition that prevents the release of sperms requires special surgical treatment and procedures to facilitate an intracytoplasmic sperm injection. Until recent times, the only two options available for a man suffering from azoospermia were either to adopt a child or utilize donor sperms. However, with recent medical advancements, there is a whole range of surgical and non-surgical procedures which can facilitate the process of pregnancy.
Procedures available
Some commonly known procedures available are Testicular Sperm Aspiration or TESA, Percutaneous Epididymal Sperm Aspiration (PESA), Percutaneous Biopsy of the Testis (Perc Biopsy), and Microsurgical Epididymal Sperm Aspiration (MESA).
TESA is an invasive procedure which involves a needle penetration through the epidermis of the scrotum which then aspirates the fluid inside the testicle. The Perc Biopsy is a similar technique done with a bigger needle to extract more sperm. In PESA, the needle is directly injected into the epididymis. MESA is an open surgical procedure wherein the tubules of the epididymis are located with the help of an operating microscope with a greater precision so as to aspirate a larger amount of sperm.
In case of patients who have zero sperm count and don’t have any blockages as well, there are certain advanced sperm retrieval techniques like Testicular sperm extraction (TESE) in which the scrotum is opened up surgically and large amount of testicular tissue is extracted from various parts of the testicles to check and isolate sperms from them. Another procedure called the Microdissection TESE involves a more focused dissection of the testicle tissue with the help of a microdissecting microscope. This process is less damaging and the impact on tiny blood vessels post surgery and the risk of cutting them is also considerably low in this procedure.
{{/usCountry}}In case of patients who have zero sperm count and don’t have any blockages as well, there are certain advanced sperm retrieval techniques like Testicular sperm extraction (TESE) in which the scrotum is opened up surgically and large amount of testicular tissue is extracted from various parts of the testicles to check and isolate sperms from them. Another procedure called the Microdissection TESE involves a more focused dissection of the testicle tissue with the help of a microdissecting microscope. This process is less damaging and the impact on tiny blood vessels post surgery and the risk of cutting them is also considerably low in this procedure.
{{/usCountry}}In conclusion
There is a study which shows that such procedures involving sperm aspiration have a 70% chance of fertilizing an egg successfully even when the sperm quality is quite low. In cases where the spouse has a high number of eggs of good quality, the pregnancy rate is more than 50%. There is thus a lot of hope today for every couple looking forward to starting a family but unable to do so due to male fertility issues.
(Dr. Hrishikesh D Pai is Medical Director, Bloom IVF Group & Secretary General of the Federation of Obstetrics and Gynaecological Societies of India)
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