What Is Azoospermia (No Sperm in Semen)? Fatherhood with Micro-TESE
Does the complete absence of sperm in semen (azoospermia) make fatherhood impossible? Obstructive vs non-obstructive azoospermia, micro-TESE surgery and treatment paths explained.
Azoospermia is the complete absence of sperm cells in a semen analysis (spermiogram). It is found in about one percent of men, and at a higher rate among couples unable to conceive. When first heard it feels like devastating news to most men; yet azoospermia does not mean you cannot become a father. Today, with correct diagnosis and appropriate surgery, a significant proportion of these men can have their own biological child.
How many types of azoospermia are there?
The most important distinction that determines treatment is the source of the problem:
- Obstructive azoospermia: the testis produces sperm, but there is a blockage in the ducts that carry it out. The duct may be congenitally absent, or inflammation or previous surgery may have closed it. In this type the chance of retrieving sperm from the testis is high.
- Non-obstructive azoospermia: sperm production in the testis is severely reduced. Hormonal disorders, genetic causes (for example certain chromosome or Y-chromosome changes), previous mumps, chemotherapy or a history of undescended testis may play a role. Even in this type, sperm production may continue in some regions of the testis.
Which tests are done in azoospermia?
Assessment does not rely on a single test. At least two separate semen analyses, hormone tests (FSH, testosterone and others as needed), physical examination and, in selected cases, genetic tests and ultrasound are evaluated together. The aim is to determine the type of azoospermia and to identify any reversible cause (such as a hormonal deficiency). Correct classification is also the key to avoiding unnecessary surgery.
What is micro-TESE?
Micro-TESE (microsurgical testicular sperm extraction) is a surgery performed under an operating microscope in non-obstructive azoospermia. Testicular tissue is examined at high magnification; fuller, healthier-looking tubules where sperm production is present are selected and sampled. Compared with classic methods in which tissue is taken as random fragments, this technique aims both to increase the chance of finding sperm and to minimise damage to the testis. The retrieved sperm is used in IVF (ICSI microinjection).
What is the chance of finding sperm with micro-TESE?
The likelihood of retrieval varies markedly with the cause of azoospermia and the state of the testis; it is not right to quote a single figure for everyone. In obstructive cases the chance is high, while in non-obstructive cases it varies with the cause and hormonal status. In experienced hands, microscopic technique and correct patient selection aim to maximise this chance. What matters is a realistic, honest discussion with the couple before surgery.
What is the procedure and recovery like?
Micro-TESE is usually performed under anaesthesia and completed as a day-case or short stay in most patients. It is often planned to coincide with the partner's egg-collection day, or the retrieved sperm can be frozen for use in later IVF attempts. Mild swelling and tenderness are normal during recovery; adherence to the surgeon's care programme is important.
Is micro-TESE the only chance of fatherhood?
No. In obstructive cases duct repair may sometimes be an option; in selected patients with a hormonal deficiency, medication can support sperm production. The treatment plan is individualised according to the type of azoospermia, the couple's age and previous investigations. Setting out with a correct andrology assessment, rather than losing hope, is the most important step.
Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; azoospermia and male infertility assessments are carried out with individualised planning and full confidentiality.