Hello. I'm Mrs Uma Gordon, consultant, gynaecologist and specialist in reproductive medicine and surgery. I'm also the clinical director of the Bristol Fertility Clinic. One of the most difficult areas that we face is a couple presenting to you with a complete absence of sperm in the ejaculate or azoospermia.
Usually, the men are quite distressed with this diagnosis because they are quite healthy yet, the sperm is not present in their ejaculate. We usually repeat it quite quickly in about two weeks' time to confirm the diagnosis. We don't wait for months to confirm this diagnosis because appropriate counselling, evaluation and treatment information is quite important. And reassuring them that they can have their own genetic children despite the fact that there is no sperm in their ejaculate.
Now, the reasons can be a few. It could be that the hormones that are needed to drive sperm production are absent. These are produced by a gland in the pituitary. And so, it is known as hypogonadotropic hypogonadism or an absence of the hormones. And then, simple treatment is replacing them. And then, in several months, sperm production will start to take place.
It could be that there is an obstruction to the pathway due to one reason or the other. And it could be surgically treated, or we could go in and collect sperm directly from the collecting duct known as epididymides. And the technique here is known as PESA, percutaneous epididymal sperm aspiration. The terms will appear quite difficult for you, but we will be providing you with diagrammatic information that will help you.
Sometimes the testes itself is at fault. It's not the hormones, it's not the pathway obstruction, but the testes itself is defective in producing sperm. Sperm production and spermatogenesis are affected, and there could be reasons for that. It's really making a diagnosis as to why. And can we correct it? If not, how can we obtain sperm? And we use the technique of surgical sperm recovery to obtain sperm and use it with advanced IV of technique ICSI.
Be reassured, if you go to a specialist in male infertility, they will do the workup, the hormonal test, the examination. Make a diagnosis and provide you with the most appropriate management option in your particular situation.
