Dear tuta,
Researchers are very reluctant to answer questions which are of a
personal medical nature as we are neither qualified nor able to make
diagnosis or recommend treatment. However, we can research the medical
condition and try to find enough information in order to help you be
less intimidated with medical specialists and procedures, and be able
to ask informed questions and make informed decisions. To that end, I
have decided to take on your question, not to make you feel better by
giving you false hope, but to ease your mind by giving you the tools
you need to become an informed patient. I'm sure much of the
information you already know, but it's best for me to start at the
beginning because it is impossible for me to assume what you know and
what you don't know. Also, I've not tried to post all of the
information here - many of the websites are large and I trust that you
will visit them and follow the links you'll find there. I've stayed
away from technical journals and abstracts meant for the medical
profession, because I think there is enough info available online for
the layman without having to use links that require a medical
dictionary and encyclopedia by your side to intrepret it.
>>>>>>DEFINITION AZOOSPERMIA
"The complete absence of sperm in the ejaculate. It can result from
obstruction of the vas deferens (the duct that takes the sperm from
the testicles to the urethra) or from failure of the testicles to
produce sperm."
Obstructive Azoospermia -
"The result of obstruction in either the upper or lower male
reproductive tract (epididymis, vas deferens, seminal vesicles or
ejaculatory ducts)..."
Non-obstructive Azoospermia -
"Severely impaired or non-existent sperm production in the testicle..."
http://www.tylermedicalclinic.com/Azoospermia.htm
>>>>>>MEDICAL TESTS
I. WHAT IS AZOOSPERMIA AND HOW IS IT EVALUATED?
Azoospermia is the complete lack of sperm in the ejaculate. It occurs
in approximately 5 10% of infertile men who are evaluated. The first
step in figuring out the problem is to make sure that the man truly
has no sperm in the ejaculate; if 10 sperm or even 1 sperm is present,
then conditions in which the reproductive tract is obstructed are
painlessly disproved. So, in all men with azoospermia, the entire
volume of the ejaculate should be spun down (centrifuged) and the
pellet of material at the container bottom inspected for any sperm. If
he is truly zero by this measure, then either (or both) of two
conditions are present: a) there is a problem with sperm production b)
there is a blockage such that normally made sperm cannot reach the
ejaculate. The minimal essential elements in the evaluation of the
azoospermic man include:
1. A thorough review of medical problems, past surgeries, medications,
toxin exposures and family history.
2. A well-performed physical examination of the genitals.
3. Blood tests that should include a testosterone and FSH levels
4. A reliable semen analysis with a spun sample to look for sperm in the sediment."
"If, based on the above evaluation, it is not entirely clear as to
whether there is a problem with sperm production or one of a blockage
in the ducts of the reproductive tract, then the next step is to have
a testis biopsy performed. A biopsy allows us to directly inspect a
small piece of testis and determine"
http://urology.ucsf.edu/patientGuides/pdf/maleInf/Azoospermia_Diagnosis.pdf
>VASOGRAM
"The vasogram is an X-ray of the vas deferens and is performed in
theatre under a general anesthetic. The procedure consists of a
special dye being injected into the vas deferens (the tube connecting
the testis with the seminal vesicles) and then x-ray films are taken.
The aim is to pinpoint the exact site of any blockage in the vas."
http://www.ivf-infertility.com/infertility/investigations/male/vasogram.php
Vasogram Radiology Images:
http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/radiology/xray/vasogram.html
>ULTRASOUND
The use of ultrasound waves to examine the scrotum and check for
abnormalities. For example, varicocele and cysts.
http://www.ivf-infertility.com/infertility/investigations/male/scrotum.php
"Transrectal Ultrasound (TRUS). TRUS has replaced incisional
vasography as diagnostic
technique of choice in the evaluation of male pelvic reproductive anatomy."
http://urology.ucsf.edu/patientGuides/pdf/maleInf/Diagn_Surgery_Infertil.pdf
>MAR
"Mixed agglutination reaction. This test is done on the semen sample
in order to check the presence or absence of antisperm antibodies and
the type of these antibodies (IgA, IgG or IgM). Antibodies that bind
to sperm may reduce fertility. If the test is negative, this is
reassuring."
http://www.ivf-infertility.com/infertility/investigations/male/mar.php
>HORMONE TESTS
"Measuring the blood levels of FSH, LH, testosterone and prolactin are
essential in selected cases. Normal sperm production and sexual
function are dependent on normal hormonal environments. The
measurement of FSH and LH levels can be valuable in distinguishing
patients with azoospermia. Those patients who have azoospermia due to
an obstruction have normal FSH levels, meanwhile those patients whose
testes are not making sperm have raised FSH levels. Low levels of FSH
and LH may indicate that the pituitary gland is not producing enough
hormones and there is therefore the possibility of effective hormone
treatment."
http://www.ivf-infertility.com/infertility/investigations/male/hormone.php
>BIOPSY
"The testicular biopsy is a minor surgical procedure that is usually
performed under a local anesthetic. A small incision is made in the
scrotum (the bag that carries the testicles), then a tiny piece of
testicular tissue is removed and examined under the microscope to see
if there are sperm present. Bruising and discomfort may occur after
the operation, but wearing tight under wear for about two days helps
to prevent this.
When surgery is carried out outside a treatment cycle, any sperm found
may be stored for future use in an ICSI treatment cycle."
http://www.ivf-infertility.com/infertility/investigations/male/testicular_biopsy.php
"A biopsy is generally done with local anesthesia and takes about
30-45 minutes. It is considered a minor operation and complications
from the procedure are rare, but can include: bleeding, infection
swelling and pain. It is also known that a small subset of patients
can develop antisperm antibodies from a testis biopsy, but the long
term significance of this response of the body to a biopsy is unclear.
Patients can generally return to work a day or two following surgery."
http://urology.ucsf.edu/patientGuides/pdf/maleInf/Azoospermia_Diagnosis.pdf
>GENETIC SCREENING
"This includes genetic screening for chromosome count and structure, Y
chromosome microdeletion and cystic fibrosis gene mutations. These
screening tests are recommended for men with no sperm (excluding those
who have no sperm because of vasectomy) or have a severely low sperm
count (count of less than 5 million per ml)."
http://www.ivf-infertility.com/infertility/investigations/male/karyotype.php
>Additional tests
"There are additional tests which may provide more information about
male infertility. These tests include semen culture to check for
infection, biochemical analysis of the semen to measure certain
chemicals in the semen such as fructose, and vital staining to
determine the number of live and dead sperm. The peroxidase staining
test is used to differentiate immature sperm form white blood cells."
http://www.ivf-infertility.com/infertility/investigations/male/additional_tests.php
>>>>>>MEDICAL TREATMENTS
Are there any treatments for azoospermia?
"Yes. There are several new highly effective treatments for
azoospermia. As long as there are still a few sperm being produced in
one or both testicles, there is a chance for pregnancy using sperm
aspiration techniques. These techniques involve aspirating sperm from
the epididymis, the tubule that carries sperm from the testicle to
outside the body, or from the testicle, the male organ that produces
sperm."
"For treating obstructive azoospermia, a procedure called Percutaneous
Sperm Aspiration, or PESA, is used to aspirate sperm from the
epididymis."
"For treating nonobstructive azoospermia, a procedure called
Testicular Sperm Extraction, or TESE, is used to obtain sperm directly
from the testicle, where the sperm are being produced."
http://www.mayoclinic.org/ivf-sct/malefaqs.html
Male Infertility / Sperm Retrieval Techniques
* Assisted Reproduction Technique
http://www.cornellurology.com/uro/cornell/infertility/srt/art.shtml
* ICSI
http://www.cornellurology.com/uro/cornell/infertility/srt/icsi.shtml
* Surgical Sperm Retrieval
http://www.cornellurology.com/uro/cornell/infertility/srt/ssr.shtml
* Microsurgical Retrieval of Epididymal Sperm
http://www.cornellurology.com/uro/cornell/infertility/srt/epididymal.shtml
* Non-obstructive Azoospermia and TESE
http://www.cornellurology.com/uro/cornell/infertility/srt/azoospermia.shtml
* Non-Surgical Sperm Retrieval
http://www.cornellurology.com/uro/cornell/infertility/srt/non_surgical.shtml
* Congenital Bilateral Absence of Vas Deferens
http://www.cornellurology.com/uro/cornell/infertility/srt/congenital_bilateral.shtml
* Electroejaculation
http://www.cornellurology.com/uro/cornell/infertility/srt/electroejaculation.shtml
* Ejaculatory Duct Obstruction
http://www.cornellurology.com/uro/cornell/infertility/srt/duct_obstruction.shtml
* Percutaneous Sperm Aspiration
http://www.cornellurology.com/uro/cornell/infertility/srt/aspiration.shtml
Surgical Sperm Retrieval: Which Method to Use?
*Evaluation of Azoospermic Men
Serial semen analyses (with centrifugation and pellet examination)
Complete history
Physical examination
Serum hormones:
Follicle-stimulating hormone (FSH)
Testosterone( T)
Ancillary testing:
Postejaculate urinalysis
Transrectal ultrasound
Scrotal ultrasound
*Evaluation for Non-obstructive Azoospermia
History:
Cryptorchidism; Chemotherapy; Genetic abnormalities
Physical Examination:
Small, soft testes ( <15 ml); Empty or flat epididymis
Semen Analysis:
Normal volume; Fructose present; No spermatozoa
Hormone Levels:
Elevated levels of follicle-stimulating hormone
Borderline to low testosterone
Borderline to elevated estradiol
http://www.maleinfertility.org/new-retrieval4.html
Male Infertility Microsurgery Video Clips Library:
Microdissection TESE: Sperm Retrieval in Non-Obstructive Azoospermia
MESA - Microsurgical Epididymal Sperm Aspiration for ICSI
http://www.maleinfertility.org/clips.html
ICSI
"One of the largest series reporting results using IVF/ICSI was from
Van Steirteghem et al. at The Brussels Free University in Brussels,
Belgium. In their preliminary report on 150 couples who underwent 150
consecutive treatment cycles, 1409 oocytes were injected and 830 were
successfully fertilized for a fertilization rate of 59 percent. A
total clinical pregnancy rate of 35 percent was achieved. The
fertilization rate in this study was not influenced by the standard
semen characteristics of concentration, motility, and strict criteria
morphology. In another largest case serie on ICSI in the United
States, Palermo et al. at Cornell reported successful fertilization in
1,142/1,923 (59 %) metaphase II oocytes injected, and ongoing
pregnancies in 84/227 (37%) couples. Neither semen quality nor the
source of sperm (ejaculated, surgically retrieved or
electroejaculated) affected fertilization rates. They concluded that
IVF/ICSI offers fertilization and pregnancy rates comparable to that
achieved with normal sperm quality for couples who have failed to
achieve fertilization on repeated IVF cycles or have severe
impairments in semen quality. In addition, the success of IVF/ICSI was
independent of standard semen parameters (density, motility, and
morphology)."
http://www.cornellurology.com/uro/cornell/infertility/srt/icsi.shtml
>>>>>>INFERTILITY SPECIALISTS
How to select a infertility specialist:
"If there is a male factor problem, referral may be made to a
urologist who specializes in infertility, or to an andrologist (a
sub-specialty in urology). In either case, it is essential that there
be good communication among all doctors involved in your infertility
care. Don't assume that the doctors themselves will facilitate this.
Request that reports be sent to the other participating doctors and
that they communicate frequently."
http://www.resolve.org/main/national/trying/where/physician/physician3.jsp?name=trying&tag=where
ANDROLOGIST:
"A physician-scientist who performs laboratory evaluations of male
fertility. May hold a Ph.D. degree instead of an M.D. Usually
affiliated with a fertility treatment center working on in vitro
fertilization."
http://www.obgyn.net/displayarticle.asp?page=glossary_of_terms
Infertility Clinics Listed by State:
http://www.infertility.to/clinics.html
Andrology - Clinics and Practices:
http://www.healthcyclopedia.com/medicine/medical-specialties/andrology/clinics-and-practices.html
Male Infertility and Reproduction Doctors:
http://www.ihr.com/infertility/provider/malereproduction.html
Three of the best (but there are many):
Center for Reproductive Medicine and Infertility:
The University Hospitals of Columbia and Cornell
505 East 70th Street, Suite 340
New York, New York 10021
phone - 212.746.1762 or 888.703.3456
fax - 212.746.8208
ivf@nyp.org
http://www.ivf.org/
Cornell University
Weill Medical College
Cornell Institute for Reproductive Medicine
Center for Male Reproductive Medicine and Microsurgery
http://www.maleinfertility.org/
Treatment of Infertility at Mayo Clinic in Scottsdale
Mayo Clinic
13400 East Shea Blvd.
Scottsdale, AZ 85259
http://www.mayoclinic.org/infertility-sct/
>>>>>>FORUMS
Harvard - Sexual Health - Men Forum
Medical Questions -> Health Forums ->Sexual Health - Men
http://ehealthforum.com/health/subject52_351094_what.html
The Male Infertility Forum
http://www.askphysicians.com/cgi-local/forums.cgi?display=thread&forum=21&id=6461
APA Male Infertility
http://www.americanpregnancy.org/infertility/maleinfertility.html
>>>>>>ADDITIONAL LINKS OF INTEREST
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
Formerly The American Fertility Society
1209 MontgomeryHighway ? Birmingham, Alabama 35216-2809
TEL: (205) 978-5000
FAX: (205) 978-5005
E-MAIL: asrm@asrm.org
URL: www.asrm.org
PATIENT?S FACT SHEET:
Diagnostic Testing for Male Factor Infertility:
http://www.asrm.org/Patients/FactSheets/Testing_Male-Fact.pdf
Links:
http://directory.service.com/m/male.infertility.service.com.htm
>>>>>>
On behalf of all GA researchers, I'd like to wish you a relatively
easy journey through the maze of our medical system, with a successful
conclusion - I sincerely hope I've been able to clear that path a bit
for you. If you have any questions, please post a clarification
request before closing/rating my answer and I'll be happy to try and
assist you.
Wishing you well,
Sincerely,
hummer
Search Strategy:
MedLine Plus:
AZOOSPERMIA
Google:
Male Infertility
AZOOSPERMIA
azoospermia treatments
azoospermia tests
azoospermia procedures
azoospermia specialists
azoospermia vasogram
azoospermia x-rays
azoospermia ultrasound
etc |
Clarification of Answer by
hummer-ga
on
25 Jul 2004 13:06 PDT
Hi tuta,
Yes (ofcourse depending on the cause) the chances are very good
they'll be able to extract some sperm, and you shouldn't have to spend
millions - these procedures are readily available and aren't just for
the rich and famous. I would say that at this point it sounds as
though you are doing everything right and now it is a matter of
starting your next phase with the urologist. Between now and then, do
look at all of the websites that I provided - I think you will come
away feeling optimistic about your chances, I know I did.
This link that I gave you,
http://www.cornellurology.com/uro/cornell/infertility/srt/icsi.shtml
is a good one for ICSI. It includes Indications, Techniques, Results,
Factors Affecting Results, Risks, and this Summary:
Summary:
"Since the first U.S. report of a successful delivery from in vitro
fertilization in 1983 the advances in the field of assisted
reproduction and micromanipulation have been truly dramatic. Perhaps
the most exciting advances have been in the area of male factor
infertility. Couples who previously would have been offered donor
insemination or adoption are now achieving . pregnancies despite
severe impairments in semen quality, the presence of only single
numbers of sperm in the ejaculate or unreconstructable reproductive
tract obstruction. Techniques of micromanipulation that were
revolutionary less than five years ago are now obsolete, replaced by
even more successful methods. Even non-obstructive azoospermia due to
maturation arrest or other impairments in germ cell maturation have
been added to the list of treatable factors in male infertility since
sperm can frequently be extracted directly from testicular parenchyma
that is surgically biopsied. For patients without sperm in the
testicular parenchyma, round spermatid or secondary spermatocyte
injections are possible."
Scientific Article: Silber and Johnson review the data on round spermatids' value:
"Are round spermatid injections of any clinical value? ROSNI and ROSI revisited"
" The discovery that azoospermic men with germinal failure often have
minute foci of spermatogenesis, was observed in the early studies of
quantitative analysis of spermatogenesis (Steinberger and Tjioe, 1968;
Zuckerman et al., 1978; Silber and Rodriguez-Rigau, 1981). However,
the importance of this finding for helping azoospermic men with
testicular failure have their own genetic child, was not readily
apparent until the era of intracytoplasmic sperm injection (ICSI)
(Palermo et al., 1992; Van Steirteghem et al., 1993). In 60% of cases
of azoospermia caused by testicular failure e.g. maturation arrest,
Sertoli cell only, cryptorchid testicular atrophy, post-chemotherapy
azoospermia, or even Klinefelter's syndrome), a tiny number of
spermatozoa can often be extracted from an extensive testicle biopsy,
and these few retrieved spermatozoa, using ICSI, can result in a
normal pregnancy (Devroey et al., 1995; Silber et al., 1995a,b,c,
1996). We termed this procedure TESE (testicular sperm extraction).
However, 40% of azoospermic men with germinal failure have no sperm
recoverable during an extensive TESE-ICSI procedure. Recently the
possibility has been investigated of using 'round spermatids', or
'round cells', derived from testicular tissue (or even from the
ejaculate), that are presumably early spermatids, to inject for ICSI
for such cases when no elongated spermatozoa are recoverable. Many
infertility clinics have attempted ICSI with ROSNI (round spermatid
nucleus injection) or ROSI (round spermatid injection). The concept
behind this is to provide an option for those patients in whom mature
spermatozoa cannot be identified in the TESE-ICSI procedure.
Unfortunately there has been a great deel of ignorance and frank
deception unfurled on an innocent public regarding the treatment of
such couples."
**Conclusion
"One of the problems for lVF clinics using the TESE-ICSI procedure is
that the embryologist and clinician may possibly have little input
from either a urologist or an endocrinologist who is experienced with
spermatogenesis and testicular histology. Our discovery that small
numbers of spermatozoa sufficient for ICSI can be found in the testes
of azoospermic men, does not mean that the testicle is a matzoh ball
full of spermatozoa. and round cells just waiting for injection.
We conclude that the ability to use TESE-ICSI to achieve pregnancies
and babies in azoospermic men with deficient spermatogenesis is
related to the ability to find tiny foci of spermatozoa in a testicle
that otherwise is grossly deficient in spermatogenesis (such that not
enough spermatozoa are being produced to reach the ejaculate), and not
upon the ability to find less 'mature forms such as 'round spermatids'
in these patients."
http://www.infertile.com/inthenew/sci/rosniros.htm
Sincerely,
hummer
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