Azoospermia

What is azoospermia?

It is the absence of sperm cells in the semen. This condition is detected in approximately 10% of patients who apply to a doctor due to male infertility.

What are the causes of azoospermia?

Azoospermia is generally divided into two groups. The first is azoospermia due to obstruction in any part of the semen-carrying ducts, and the second group is the causes of azoospermia without obstruction. In cases of azoospermia due to obstruction, sperm production in the testis is usually normal or close to normal, and a high percentage of sperm is obtained. In the group without obstruction, sperm production is impaired for any reason in the testis.

What should be done when the diagnosis of azoospermia is made?

When the diagnosis of azoospermia is first learned, it creates a serious pressure, anxiety and restlessness on couples, and most couples think “can’t we have children?” the question is settled. First of all, the situation should be explained to the couple in detail by an experienced doctor, and information should be given about the ways to be followed, treatments and chances of success. Since the treatment process will be long in some cases, it is important to be patient with the patient-doctor relationship and the treatment process. After taking a detailed medical history in patients, a series of investigations should be conducted to determine the cause of azoospermia. The main ones are genetic examination and hormonal examination. According to the results of these, the treatment schedule should be prepared and explained to the patient in detail.

How is azoospermia treated?

Except in cases of congenital hormonal failure, the main treatment of azoospermia is based on methods of obtaining sperm from the testis. These are PESA and TESA, where sperm cells are searched with the help of a needle from the testis, and MESA and microTESE, where the testis is opened and sperm cells are searched.

How many times can TESE be done?

In patients with sperm in the procedure, TESE can be repeated in repeated treatments. Although there are no definite criteria for how many times this procedure will be performed, in the evaluation made by the urology specialist; TESEs can be decided again according to criteria such as testicular size, hormonal values, quality and quantity of sperm cells found in previous procedures. In patients with no sperm found in previous TESE procedures, recurrent TESEs should be evaluated first, if there are treatable causes, they should be treated and then TESE should be planned.

Does TESE cause erectile dysfunction?

Erectile dysfunction and decreased sexual desire are very rare effects after this procedure. Testicular sizes, hormone levels and additional diseases of the patient before the procedure can be used to estimate these risks.

How long does the recovery process take after TESE?

TESE does not interrupt daily life too much. Depending on the size of the procedure, patients can return to their daily lives after a rest period, which usually lasts for 4-5 days. However, this period is closely related to the weight of the work done by the patient and the pain threshold of the person. Patients are usually discharged after being kept under observation in the hospital for 4-6 hours after the procedure.

How often can TESE be reapplied?

In cases where both testicles are treated, a new procedure is usually not performed before at least 6 months. These rules can be stretched by the doctor in some special cases, such as in patients who have a single testis procedure and only cells are taken with a needle.

At what stage of treatment should TESE be performed? Should women or men be treated first?

The application in patients who will undergo TESE is in two ways; While some patients are prepared together with men and women and the TESE procedure is planned on the day of the egg collection, for some patients, treatments for the male are planned first, the TESE procedure is performed, and if the sperm comes out, the treatment for the woman is started. It is necessary to decide which of these to do according to the patients. The processes, the ways to be followed in cases of sperm coming out and not coming out can be explained and the couples can get their ideas.

Should a piece be taken for pathology in every TESE procedure?

The general practice is to take samples for pathological diagnosis, especially if sperm cells are not found in the first TESE procedures. In cases where sperm do not come out, this will give us an idea about the treatments that can be done for the next treatments and the ways to be followed. In addition, although it is a very small possibility, it is important to take pathology for tumoral formations that may develop in the testis.

Although sperm cells are found in TESE, can sperm not be seen in pathology?

Yes, the pathological diagnosis is only the result of the piece of tissue removed. If sperm cells are not produced in every region of the testis, which is usually the case in patients who do not have an obstruction in the semen duct, although there is sperm, there may be no sperm as a result of pathology. The opposite is also possible, although rare. In other words, although sperm cells cannot be found, sperm can be seen and reported in the piece sent to pathology. In this case, it would be appropriate to perform TESE again on the patient.

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