Azoospermia

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Azoospermia may be due to poor production of sperm, a problem in transport of sperm, or a problem with the ejaculatory process. TESA (testicular sperm aspiration) and TESE (testicular sperm extraction) are indicated when normal motile spermatozoa cannot be produced in adequate numbers to fertilize all of the woman’s oocytes

There are different reasons for this condition. One of the most common is Acquired Obstructive Azoospermia. It results from vasectomy, or inflammatory infections. In Congenital Obstructive Azoospermia, the patient is born without the vas deferens. This condition, known as Congenital Absence of the Vas Deferens (CAVD) indicates the patient may be carrying genes responsible for cystic fibrosis. Because of this relationship, genetic testing and counseling may be required prior to attempting fertilization.

In Non-obstructive azoospermia, the capacity of the testes to produce spermatozoa is so low that virtually no sperm are present in the ejaculate. Under those circumstances, attempts are made to retrieve spermatozoa directly from the testis. Genetic counseling is advised in this group of patients since the genes responsible for the infertility problem in the patient may be passed on to the offspring. However, no other major congenital abnormalities have been demonstrated to occur more frequently than in the normal population..

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The choice of protocol for IVF is variable from one patient to the other. In Rahem Fertility center, we tailor the optimal stimulation protocol, according to age, ovarian reserve, BMI and previous response.

For patients who will take drugs that may affect their fertility ( eg. Chemotherapy for cancer) sperm freezing and oocyte vitrification can help them to preserve their fertility.

This is a trans-vaginal procedure, in which the telescope (attached to camera) is passed into uterus. This helps to evaluate uterine cavity. It is of special importance to deal with the following lesions using hysteroscopy

This is the best modality of embryo freezing. All studies report better survival and higher pregnancy rates with vitrification than standard slow freezing. By this procedure, couples who have ICSI or IVF can increase their chances of having a child and also decrease the cost they bear.

Intra-Uterine Insemination (IUI) and ovarian stimulation with exogenous hormones is the alternative with the highest probability of pregnancy. The form of AI will be influenced by the effective sperm count, ovarian stimulation and deposition of sperm in the female reproductive tract.

Cases with known chromosomal or genetic defects will benefit from PGD. Cases who have multiple previous failed ICSI trials or who experienced recurrent pregnancy losses due to chromosomal defects may have benefit from PGS with selection of the chromosomally normal embryo(s) for transfer

By  this procedure one cell of the embryo produced  after ICSI or IVF   is taken and examined for the type of sex chromosome ( either xx or xy) and this is beneficial to select the embryo the couples wish to have.

For couples who are candidate for ICSI the husband may not get a semen sample on the day of oocyte aspiration due to anxiety  or get a sample of very poor quality .