The condition of absence of spermatozoa in the semen; failure of spermatogenesis, is called Azoospermia and is separated into Obstructive azoospermia and Non-obstructive azoospermia.
Non Obstructive Azoospermia
Non obstructive azoospermia is the condition when the testicles do not produce any spermatozoa or produce a very small amount, which is unable to be detected in the spermiogram. The causes can be congenital or acquired (i.e. Chemotherapy or Radiation).
The treatment of Non Obstructive Azoospermia cannot improve the condition of the sperm, although it can cure the infertility of the couple, by artificially extracting sperm directly from the testicles. The treating method for these cases is called Biopsy. The most common methods are; the Fine Niddle Aspiration (FNA) and the conventional Biopsy of the testicles (TESE). The success rates of these procedures vary between 30-45%, while bearing a high risk for complications and damage to the testicles.
The disadvantages of these procedures have been resolved by the method of micro-Testicular biopsy (microTESE), which was first applied by Schlegel, in 1999, and is based on the concept that sperm can be produced in small focal sites inside the testicles, even in the most severe cases of non-obstructive azoospermia (Focal Spermatogenesis). The process of finding these sites can only be performed with the use of a surgical microscope during the entire operation.
With the detailed application of microTESE we are able to intervene throughout the entire testicle and find those testicular tubules that seem to contain sperm. As the embryologist examines the biopsy material, during the operation, we are able to define the moment when we have collected the necessary amount of spermatozoa for the procedure of ICSI.
Thus, a much smaller amount of testicular tissue is required (15-20 mg, compared to 400-500 mg of TESE), which increases the possibility of success up to 60-70%; meaning 25% higher than the classic testicular Biopsy (TESE). This method was initially introduced and performed in Greece in 2004, by Dr A.Karanikas, who continues to apply it, with over 65% successful cases.
Last but not least, the testicular tissue sample, must also be examined by a pathologist, in order to prevent even minor possibilities of carcinoma development.