Azoospermia is the absence of sperm in a man’s semen. This condition can be shocking and distressing for both men and their partners, especially for those who desire to conceive and start a family.

However, there is hope for treating zero sperm, as multiple techniques and procedures are available to treat many cases of these conditions.

In this article, we will discuss some of the options available for treating zero sperm, the most important of which is the (SIVCA) technique, which was invented and developed by Professor Dr. Adham Zaazaa, Consultant in Andrology and Reproductive Medicine and Surgery at the Faculty of Medicine, Cairo University, which is considered one of the innovative techniques that uses microscopic examination of sperm in cases of Zero sperm and lack of sperm in the semen, whether caused by dysfunction of the testicle or obstruction of the sperm ducts.

First, let’s explore the types and causes of azoospermia and how to diagnose the condition.

Types of Azoospermia:

Non-obstructive Azoospermia (NOA): The cause of this type is low sperm production in the testes themselves or testicular dysfunction.

Obstructive Azoospermia (OA): The cause of this type is an obstruction that prevents the transportation of sperm from the testes to the semen due to blockage in the seminal ducts of the male reproductive system.

Causes of Azoospermia:

1. Reproductive tract blockage: Blockage in the reproductive ducts, such as the ejaculatory ducts, can lead to azoospermia. Various factors can cause this blockage, including:
• Congenital or anatomical abnormalities such as the absence of the vas deferens or a severed epididymal duct.
• Infections or injuries that block the ducts and prevent sperm from reaching the vas deferens and, subsequently, the semen.

2. Production factors: There are factors related to sperm production that can lead to azoospermia. These factors may include testicular inflammation, radiation therapy, exposure to harmful chemicals or medications, or testicular varicocele (enlarged veins in the scrotum, which impairs natural sperm production).

3. Genetic abnormalities: Genetic abnormalities can be the main cause of azoospermia. Genetic changes can affect the formation or function of sperm, resulting in the absence of active sperm or a low sperm count. One well-known condition associated with azoospermia is Klinefelter syndrome.

4. Hormonal disorders: Hormonal imbalances and fluctuations in the body can be significant factors causing azoospermia. Sperm production depends on a proper hormonal balance. If there is a disruption in the hormones responsible for regulating the sperm production process, it can lead to a decreased sperm count or azoospermia.

5. Retrograde ejaculation: When semen enters the bladder instead of being expelled through the penis during ejaculation, this condition is known as retrograde ejaculation. It can occur in patients with uncontrolled diabetes or after prostatectomy.

Diagnosis of Azoospermia:

The accurate diagnosis of azoospermia begins with two semen samples collected at different times to account for natural variations.

Avoid ejaculation for two to five days before providing the sample to allow the body to produce an adequate number of sperm. The semen samples undergo initial analysis, and if no sperm are found, the samples are subjected to centrifugation to concentrate them and thus examine them more precisely

Other diagnostic procedures include:

Detailed medical history: Professor Dr. Adham Zaazaa asks the patient about personal and family medical history, medications, health and behavioral habits, and factors affecting fertility.

Hormone tests: Professor Dr. Adham Zaazaa requests tests to measure the levels of functional hormones in the testes that can affect sperm production, such as various forms of testosterone and pituitary gland hormones.

Imaging of the reproductive system: Magnetic resonance imaging (MRI), ultrasound, or computed tomography (CT) may be used.

Physical examination: The physical examination includes palpating the testicles to assess their size, position, and consistency. It is also important to rule out the presence of testicular varicoceles.

Genetic testing: Genetic testing aims to exclude syndromes that may affect the patient’s fertility, such as Klinefelter syndrome (47XXY).

Testicular sperm retrieval: This will be discussed in more detail in the following lines.

There are several available treatment techniques for couples dealing with azoospermia. Professor Dr. Adham Zaazaa selects the appropriate treatment based on the underlying cause of the problem and the medical assessment of the case. Here are some common treatment techniques:

– For obstructive azoospermia, the treatment depends on the specific cause of the blockage in the reproductive system. Possible treatments may involve minimally invasive surgical procedures to remove obstructions in the ejaculatory ducts within the prostate or techniques for retrieving sperm from testicular tissues for use in assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

– For non-obstructive azoospermia, assisted reproductive techniques such as ICSI can be utilized. ICSI is an effective method for achieving pregnancy in cases of azoospermia, where eggs are retrieved from the female partner and fertilized in the laboratory using sperm obtained from the male partner’s testicular tissue. The resulting embryos are then transferred to the woman’s uterus for pregnancy.

In all cases of zero sperm count, men undergo a treatment period ranging from 70 days to 9 months or more. If the sperm analysis remains zero after the appropriate treatment period for each case, further investigation for sperm within the testicle is necessary.

The most popular methods for searching for sperm from the testicle are:

Professor Dr. Adham Zaazaa, MD, Consultant in Andrology, applies the appropriate search method according to the individual case.

1. SIVCA technique without surgical opening:
One of the most common methods for searching for sperm within the testicle is the SIVCA (Standard IV Cannula Aspiration) technique without surgical opening. This technique allows for the extraction of sufficient amounts of tissue to search for sperm in cases of zero sperm count or absence of sperm in the semen without surgical opening. It involves using a thin, smooth, flexible tube made of polytetrafluoroethylene (PTFE) to extract the same amount of testicular tissue as a surgical opening but without actually opening it. It is performed under local anesthesia only, in an effective, safe, and simple manner, avoiding the risks of traditional surgery. Men can resume their daily activities within 48 hours of the procedure.

Professor Dr. Adham Zaazaa invented and developed this modern technology to avoid all the drawbacks and complications of other traditional methods of searching and prospecting for sperm in cases of zero sperm and lack of sperm in the semen. To learn more about SIVCA technology, click here.

2. Testicular Fine Needle Aspiration (TFNA) and Testicular Sperm Aspiration (TESA)
This procedure involves the extraction of sperm from the testicle using a solid needle made of stainless steel and suctioning the tissue using negative pressure. The sample is then processed in an embryology laboratory to extract the sperm for use in intracytoplasmic sperm injection (ICSI).

The procedure may cause some discomfort for a few days and may require multiple needle insertions to obtain an adequate amount of sperm. It is performed under local anesthesia, and hospitalization is not required.

3. Testicular Sperm Extraction (TESE):
This procedure is performed by surgically opening and removing a small amount of tissue. It is performed in the operating room, and the patient undergoes general anesthesia. The patient can return to his home after his health condition stabilizes and will resume his normal activities within a week.

Potential risks of the traditional surgery include bleeding, infection, and pain or discomfort after the procedure.

It is important to note that the success of these treatments may vary depending on the choice of the best andrologist, who takes into account individual factors such as the underlying cause of zero sperm, the quality of the extracted sperm, and the overall reproductive health of both partners.

In conclusion, although zero sperm may pose a major obstacle for couples wishing to conceive, there are treatment options that offer hope for pregnancy. Couples who suffer from this problem must seek the necessary medical support and work with a specialized medical team such as the team of Professor Dr. Adham Zaazaa, Consultant in Andrology and ICSI and Professor of Andrology and Fertility Surgery at Cairo University, to reach the best treatment options suitable for them.