Treatment Options for Azoospermic Men
There is very little role for medical therapy in Obstructive Azoospermia. However use of Anti-oxidants, Vitamin D and Steroids for a short period is used with limited benefits.
Vaso-Epidydimal Anstomosis (VEA) helps create an alternative outflow in cases with obstructive Azoospermia. There are several factors to be considered before predicting the prognosis and outcome of this surgical procedure. Couples are encouraged to see a Urologist / Andrologist for discussing the various options available.
In couples where VEA surgery fails (No sperms in ejaculate or no conception even after 3-6 months of surgery) might need surgical sperm retrieval techniques followed by ICSI for conception.
Role of medical therapy is again limited but treating any underlying cause should be considered.
Hormone replacement therapies like using Clomiphene citrate, Letrozole, Tamoxifen citrate, hCG injections, Gonadotrophins like FSH and LH have been used with limited benefits. Urologist/Andrologist will be the right person to decide the choice of therapy and also to predict the prognosis.
Testicular sperm aspiration is a small office procedure which can be done under local anesthesia (cord block). As a part of this procedure a small needle is passed into the testis and aspirated multiple times and the extract is examined in the lab for presence of spermatozoa. If no sperms are seen then the seminiferous tubules or the extracted tissue is sent for histo-pathological examination for further examination and interpretation. Trial TESA before starting the ART process is quite helpful in predicting the prognosis.
Testicular sperm Extraction involves getting a small chunk of testicular tissue through a minor incision. The testicular tissue is teased under microscope and looked for spermatozoa.
Microscopic TESE is a very exacting search for sperm under high magnification in cases of extremely low sperm production.
Choice of Assisted Reproductive Technology (Art) In Azoospermic Men
Considering the poor sperm parameters recovered from testes or epidydimis ICSI (Intra-Cytoplasmic-Sperm –Injection) is the preferred method of ART.
Role of Counseling In Management of Azoospermia
Considering the guarded success rates, unproven safety of the off springs and the risk of transmission of infertile genes to the next generation counseling is mandatory for all Azoospermic couples undergoing ICSI with surgically retrieved sperms.