Male azoospermia is the lack of sperm in the semen analysis.
Treatment of azoospermia is usually through surgical options like TESA (testicular sperm extraction or MESA (epididymal sperm extraction) are available.
Testicular Biopsy (TESA/MESA)
New technologies enable men with few or no sperm in their ejaculate to create genetically-related children. During in vitro fertilization (IVF) with ICSI, a single sperm is injected directly into the egg. If a sperm cannot be obtained from the ejaculate, it can often be withdrawn surgically directly from the testicle (TESA) or with microsurgical epididymal sperm extraction, where sperm is extracted directly from the epididymis (MESA).
It is common for a man who has had prior vasectomy to seek reversal of the procedure. While reversal is sometimes possible depending upon where and how the tubes were "cut," a vasectomy should be considered a permanent means of birth control. A full fertility evaluation, including ovarian reserve of the female partner’s, should be performed prior to considering vasectomy reversal.
Men with vasectomy can elect to undergo testicular sperm aspiration (TESA) to successfully achieve conception with the process of in vitro fertilization. This process eliminates the uncertainty of vasectomy reversal and is recommended in men whose partners are older than 35.
If reversal fails or is not feasible, IVF with TESA or MESA is usually very successful in assisting with conception.
What should the couple consider before a potential vasectomy reversal?
You should know that you have two different options: vasectomy reversal or going through In vitro fertilization.
The female partner should undergo general fertility evaluation, which should include ovarian reserve hormonal testing (eg, antimullarian hormone, FSH, estradiol). Pelvic ultrasound is helpful in determining the number of follicles (eggs) in the ovary. If the female partner has an underlying infertility condition, than you may want to consider in vitro fertilization (IVF) as the best option instead of having a vasectomy reversal. This treatment is more advantageous if the female partner is older than 35 years old. Often, the male partner undergoes a vasectomy reversal, and then the couple finds out that the female needs a fertility treatment such IVF.
If the male partner is older than 40 years old and has an underlying chronic condition such as hypertension, diabetes mellitus, hyperlipidemia, and obesity, IVF should be considered as well. These conditions may contribute to male infertility and low sperm count, which often result in the need for IVF even if the vasectomy reversal was successful. You should not assume that having children in the past guarantees that the man is still fertile. Men make new sperm every 72 days and sperm production reflects the man’s current health status.
The time elapsed after a vasectomy was performed also plays an important role in the success of vasectomy reversal. If the vasectomy is greater than 10 years old, the tissue of the vas deferens may have become weaker and harder to anastomose.
One effect of a vasectomy is that the body can actually cease to recognize its own sperm and can develop antibodies to it. If this has occurred, the probability that a vasectomy reversal will enable a man to impregnate his partner is low. With this condition, the couple may have to undergo IVF treatment.
Vasectomy reversal may not always be successful. A period of 6 months may be required after vasectomy reversal for the body to reestablish acceptable sperm count. The sperm count required for normal intercourse is around 20 million, and greater than 5 million is often needed for an intrauterine insemination. Waiting longer than 6 months may become a factor in reducing the chances of conception if the female partner is older than 35 years old, which is when the ovarian reserve begins to rapidly diminish.
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