Management of Azoospermia – Investigations
Diagnosis of Azoospermia should not be done basing on one semen analysis. It’s preferable to repeat a second semen analysis 3 weeks later and if the second sample also shows no sperm production then the semen sample is centrifuged at a higher spexed and the pellet is further examined. If few sperm cells can be seen in the centrifuged pellet then we consider the sample as cryptozoospermic and not azoospermic.
Absence of cells confirms the diagnosis of Azoospermia.
The next step is to check whether Azoospermia is Obstructive or Non-Obstructive in origin. Hormone analysis and ultrasound scanning might be helpful in Azoospermia treatment.
Assessment of reproductive hormones FSH, LH, Testosterone, Inhibin- B, Prolactin, TSH, Estradiol helps us to arrive at a diagnosis. Cases of non-obstructive Azoospermia have raised FSH and LH and low levels of testosterone and Inhibin B. Normal hormonal values doesn’t necessarily mean that it’s obstructive Azoospermia and we will get sperms on surgical retrieval.
Helps us assess the testicular details like volume, texture and the blood flow patterns.
Trus – Trans Rectal Ultrasound
Helps appreciate the prostrate, seminal vesicles and the vas deferens. Might be helpful in Obstructive Azoospermia cases.
Post Ejaculate Urine Examination
This helps us diagnose cases of Retrograde Ejaculation.
This test helps to screen the chromosomes. Couples with chromosomal abnormalities might need the intervention of a genetic counselor to assess the risk in pregnancy and risk of transmission of the chromosomal abnormality to the offspring.
Y Chromosome Micro-Deletion
Deletions in the Y chromosome might affect the sperm and bring about Azoospermia or crytozoospermia or severe oligospermia. In all such cases along with karyotyping assessment of micro-deletion in Y chromosomes is preferable. Though the prevalence of these deletions are very low, screening is mandatory in the above mentioned cases as Y chromosome infertility has a Y linked inheritance (Male offsprings born to couples with Y chromosome micro-deletion might be infertile.)
Pregnancies can be achieved by in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI) in males with Y-chromosome infertility exhibiting oligozoospermia or Azoospermia with retrievable testicular sperm. The presence of a deletion has no apparent negative effect on fertilization or pregnancy and it does not increase the risk for birth defects in children conceived via assisted reproduction technology (ART).