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No sperm? No problem!
Before 1995, men with low or no sperm counts had no prospect of having their own genetic baby. However, the development of ICSI (intra-cytoplasmic sperm injection - in which individual healthy sperm are micro-injected into eggs obtained during an IVF cycle) transformed the fertility prospects for thousands of couples with severe male-factor infertility.
Although many men may suffer from azoospermia (absence of sperm in the ejaculate), the majority will produce viable sperm in their testes. The challenge for the fertility clinician is to find the sperm so that the embryologist can perform ICSI. (Unfortunately, even ICSI can't overcome complete azoospermia and these couples still need to use donor sperm.)
New hope
Progress with surgical sperm retrieval began with long and complex operations requiring general anaesthesia such as MESA (micro-epididymal sperm aspiration) or open biopsy. Today, outpatient procedures - such as PESA (percutaneous epididymal sperm aspiration) and TESE (testicular sperm extraction) -- have simplified the sperm retrieval process.
A further advance pioneered in the UK, at Midland Fertility Services, was the discovery that sperm-containing tissue obtained at PESA or TESE could be frozen without loss of viability. This meant that the process of sperm retrieval could be separated from ovarian stimulation for IVF. You could start your IVF drugs secure in the knowledge that your partner's sperm could be defrosted and made available on the right day to fertilise the eggs.
What causes azoospermia?
Men may be azoospermic for many reasons. Sometimes the cause is obvious - a vasectomy that couldn't be reversed, for example. Sometimes the cause may be CBAVD (congenital bilateral absence of the vas deferens - a genetic problem that can be associated with cystic fibrosis).
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