later with the results. As I go through the couple both have issues but the more uncomfortable issue is that of the semen count. I decide to appraise the couple first on Rose’ s results and the scan and hormones are essentially normal but the HSG indicates that one tube is blocked. I reassure Rose that even with one tube the female partner should still be able to conceive.
We then move to the hard news and I report that the semen test done indicates that there are no sperms in that particular semen sample. Wycliffe is very perturbed and obviously in disbelief. I inform them that we need to repeat the test in a different lab to confirm the test and refer them to one. I suggest they repeat the test after 3 months. I also tell them that we actually expect a similar result but we hope to get a different result.
3 months later they come with the repeat semenalysis result and as expected the results are the same; azoospermia. Wycliffe is still very shaken. I proceed to tell them that they must check the hormones to establish whether or not this is due to a block or due to a problem with the testes so they are not producing sperm.
We do the tests and unfortunately the tests come back that the issue is at the level of the testes. I appraise them of the results. They ask what the options are and the easiest option is to get a donor. The couple opt to do an intra-uterine insemination with donor sperm and luckily Rose conceives on the third attempt. Rose proceeds to have a normal pregnancy and delivers a beautiful baby girl. Rose is very lucky as I am sure there are women who get more desperate than the wife in my soap opera.
Azoospermia is the most severe type of male infertility and is complete absence of sperm in a semen sample even after centrifugation. Until recently, with the advent of Assisted
Azoospermia is the most severe type of male infertility and is complete absence of sperm in a semen sample even after centrifugation. Until recently, with the advent of Assisted reproductive technology, we did not have an answer for this problem.
reproductive technology, we did not have an answer for this problem. There are two types of azoospermia: obstructive and non-obstructive.
As the name implies in obstructive azoospermia there is a physical block of the vas deferens( tube where sperm are transported from the testis to the penis). Factors that can lead to this include previous surgeries( including vasectomy), infections( epididymitis), trauma to the testicles, congenital abnormalities( like absence of the vas deferens), cystic fibrosis gene mutations, or inflammation in the epididymis or vas deferens.
Treatment for obstructive azoospermia can include surgery to return patency in the reproductive tract. In some cases surgery is not feasible and for such cases sperm may be retrieved directly from the testicles or epididymis by aspirating with a needle under pressure( Testicular sperm aspiration- TESA).
Unfortunately, sperm retrieved using either of these techniques cannot be placed directly into the female reproductive tract. This sperm can only be utilized during in-vitro fertilization in a process we call intracytoplasmic sperm injection. This requires a highly skilled embryologist to the insemination and involves injecting the sperm directly into the oocyte( egg) which has already been collected. The success rate for ICSI is about 35 %.
Non-obstructive azoospermia( NOA) occurs when there is no sperm present in the ejaculate due to a failure in sperm production within the testicles, not because of a blockage in the reproductive tract; common causes include genetic abnormalities like Klinefelter syndrome, Y chromosome deletions, hormonal imbalances, exposure to toxins like radiation or chemotherapy, testicular trauma, infections like mumps orchitis, varicoceles, certain medications and even lifestyle issues like excessive use of alcohol, smoking or recreational drugs that can affect sperm production.
For NOA depending on the cause treatment may include hormonal therapy, lifestyle modification i. e. cessation of smoking, alcohol or drugs and avoiding exposure to environmental toxins. In some cases, if sperm cannot be retrieved naturally, a TESA can be attempted and if this fails you can have a microsurgery where a small biopsy is taken from the testes and sperm retrieved from the tissue( Testicular sperm extraction- TESE). Sperm retrieved in this manner can similarly only be used for ICSI.
In both cases Obsutructive and non obstrurctive azoospermia if all the above treatments are not successful or feasible( the cost is prohibitive for a good number of people), like Wycliffe and Rose, the option for treatment includes using a sperm donor. Donor sperm can be utilized for intrauterine insemination( the processed sperm sample is placed directly in the uterus of the intended recipient) or IVF or ICSI.
Even with donor sperm the couple may fail to conceive and the final treatment option would be adoption for such couples.
Majority of people imagine that ART is 100 % successful and I hope we have demystified this misconception. The role of the fertility specialist like any other health professional is to support the couple in their journey and enable them to make prudent, well informed decisions. Fertility is a very humbling specialty and one recognizes that in the end it is the Almighty who decides when He shall breath life and conception will occur.
Have a blessed 2025!
Dr. Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi. You can commune with her on this or related matters via email at: Drmaureenowiti @ gmail. com.