According to the Indian Society of Assisted Reproduction Infertility affects 10-14% of Indian population. Among the causes of Infertility male factor contributes to about 40-50% .
Azoospermia is defined as complete absence of Sperms in the Semen even after Centrifugation. Azoospermia is found in approximately 1% of all men and 10-15% of Infertile males. Azoospermia may result from a lack of spermatozoa production in the testes called as Non Obstructive Azoospermia (NOA) or from an inability of the produced spermatozoa to reach the emitted Semen called as Obstructive Azoospermia (OA). The causes of obstructive azoospermia are congenital bilateral absence of vas deferens that which helps in transport of spermatozoa from Testis into the emitted Semen, blockage of Epididymal duct due to Epididymal Cyst, Prostatitis, Epididymitis, Tuberculosis, Vasectomy and Testicular trauma. The causes of Non Obstructive Azoospermia is mostly genetic in origin which leads to testicular failure with absence of Spermatogenesis. The few other causes of Non-Obstructive Azoospermia include Orchitis, Varicocele, Pituitary Tumor and Testicular Cancer post Radiation or Chemotherapy. With the advances in Cancer treatments and improved survival rates more patients are seen with azoospermia due to chemotherapy drugs.
Evaluation of azoospermia patients is done to determine the cause and assess the risk of genetic abnormalities in these males and to estimate the probability of recovering sperms in these males from the various sperm retrieval techniques that are available today.
Couples with azoospermia can have children of their own with the Assisted Reproductive technique Intracytoplasmic Sperm injection (ICSI). The sperms are retrieved for ICSI from various sperm retrieval techniques like PESA (per cutaneous Epididymal Sperm Aspiration), MESA (Microsurgical Epididymal Sperm Aspiration), open TESE (per cutaneous Testicular Sperm Extraction) or open seminiferous tubules extraction and the most recent advanced technique is microsurgical testicular sperm extraction (micro-TESE). Micro-TESE is done using a high magnification microscope which helps to identify the dilated seminiferous tubules that contain spermatozoa which is not possible with naked eye. The probability of sperm recovery from these techniques is good for obstructive azoospermia than the non-obstructive azoospermia as there is normal spermatogenesis in the obstructive azoospermia type. But with the advanced technique like Micro-TESE the rate of sperm recovery can be improved even in Non-Obstructive Azoospermia.