Male fertility - it takes two to tango

Options for the azoospermic male

Some men produce no sperm in the ejaculate and yet are producing sperm in their testes. This can happen if a blockage has occurred due to infection or surgery. Some men are born with a congenital absence of the tiny tubes called the vas deferens, which carry the sperm from the testes to the outside world. A man who has suffered a premature andropause (the male equivalent of the premature menopause) may also be azoospermic, but still be producing tiny quantities of sperm.

A technique that can help here is PESA (percutaneous epididymal sperm aspiration) or TESE (testicular sperm extraction). These are minor surgical techniques that do not require a general anaesthetic and which can obtain sperm directly from the testis or epididymus for use in an ICSI cycle. Hormone tests on the man, especially measurement of the newly identified hormone called inhibin B will identify which azoospermic men are likely to be producing sperm and therefore likely to succeed with PESA/TESE. ICSI is the most successful of the fertility treatments available at present with success rates of 25–30% per cycle being reported at the better clinics.

If all else fails….

For couples with very severe male factor infertility where the cost of ICSI (typically £2000–3000 per cycle) is prohibitive or where the man is carrying a genetic problem which he doesn't wish to risk passing on, then the use of donor sperm is still an option.