Non-Obstructive Azoospermia and MicroTESE

Azoospermia is among the causes of male-factor infertility. In its simplest definition, it is the condition where no measurable live or dead sperm is found in the semen. Under normal conditions, sperm produced in the testes located in the scrotum pass through the male reproductive tract and combine with other fluids that make up the semen.

The two basic situations we encounter in azoospermia patients are related to the production and transport of sperm. In the presence of azoospermia, sperm production may not occur in the testes, or the produced sperm may not be able to combine with other fluids forming the semen or cannot be expelled from the body. All these mechanisms leading to the absence of sperm in the semen have a decisive importance on the type of azoospermia and treatment options.

What is Non-Obstructive Azoospermia?

It is a type of azoospermia characterized by little to no measurable sperm production in the testes. Non-obstructive azoospermia (NOA) can arise due to many different reasons. Genetic factors, Y chromosome microdeletion, karyotype abnormality, exposure to radiation or toxins, medications used, hormonal issues, and varicocele disease (the importance of which I frequently emphasize) are among the causes of non-obstructive azoospermia.

It is critically important to diagnose obstructive and non-obstructive azoospermia in detail. In men whose semen does not contain sperm in at least two performed semen analyses (spermiograms), diagnostic methods such as hormone tests, genetic screening, and reproductive system imaging can be resorted to in order to determine the type of azoospermia. After the performed diagnostic methods, it is possible to resort to Assisted Reproductive Technologies (ART) for couples wishing to have children.

MicroTESE Surgery for Non-Obstructive Azoospermia Patients

The most advanced treatment method for non-obstructive azoospermia patients is MicroTESE (Microdissection Testicular Sperm Extraction) surgery. With MicroTESE, the sperm retrieval rate (SRR) can reach levels of 60%.

The operation has significant advantages due to its technique. One of these advantages is that it allows for a detailed examination of all seminiferous tubules that are likely to contain sperm in the testes, and another is that it causes minimal damage to the testicular tissue. Our main goal in non-obstructive azoospermia patients is to find a single sperm cell capable of fertilizing the egg cell (oocyte) and making quality embryo formation possible. Therefore, the operation process is quite important.

During MicroTESE surgery, the testes are examined in detail using high-powered operating microscopes. Samples are taken from seminiferous tubules that have a high probability of harboring sperm. While the operation continues, the samples collected from the patient are sent to the laboratory.

MicroTESE surgery, in which both testes are examined in detail, can take around 2 hours. General anesthesia is preferred to maximize the patient's comfort during surgery. After MicroTESE surgery, which is performed with a microsurgical technique where tissue damage is minimized, patients are usually discharged on the day of surgery and can leave the hospital by walking.

It is important for patients to apply cold compresses (ice packs) to the area in the post-operative period, avoid intense exercises that will increase the risk of bleeding in the early period, use antibiotics and painkillers prescribed by physicians, and comply with sexual abstinence for the recommended period.

Although the sperm retrieval rate in non-obstructive azoospermia patients with MicroTESE surgery can reach up to 60%, it would not be accurate to say that sperm will be found in the first operation for every patient. While the general tendency is that MicroTESE surgery can be performed up to 3 times on patients, it is possible for this number to increase. A minimum period of 6 months must be left between two operations.