A medical condition in which there is a complete absence of seminal fluid and as a result, infertility
. The main reason is the lack of seminal fluid is [retrograde ejaculation] , but there are also other reasons such as blockage of the genital tract, gonadal failure or medications.
A medical condition in which the sperm cells are unable to move and therefore, of course, are unable to reach the egg. Total asthenospermia is reported in 1 of 5,000 men. The causes of immobility may be metabolic deficiencies, structural defects in the tail of the sperm cell, or death of sperm cells (necrospermia). There are tests that make it possible to distinguish between living and dead cells. The assumption is that in immotile living cells fertilization ability is not compromised and they can be used in [micromanipulation]
. Moreover, even in cases of absolute asthenospermia, among the millions of immotile cells, by [a thorough search]
it is possible locate individual sperm cells which have maintained a certain degree of motility and therefore are certainly suitable for fertilization.
A medical condition characterized by absence of sperm from the ejaculate. It affects approximately 1% of men worldwide and accounts for about 20% of male-factor infertility
cases. Azoospermia is determined in the laboratory when no spermatozoa were found in three semen samples given at different times.
There are two main types of azoospermia:
– Obstructive, in which there might be a normal production of sperm, but mechanical interference prevents its passage from the testicle to the urethra, such as varicocele, severe genital tract infection or congenital absence of vas deferens. Handling cases of infertility
caused by obstructive azoospermia usually involves a minor surgical intervention, such as extracting testicular or epididymal sperm and using them for IVF.
– Non-obstructive, usually characterized by absence or extremely low testicular sperm production. In most cases, this is a congenital condition, which could be of either genetic origin ([chromosome Y]
microdeletions, [Klinefelter syndrome]
), physiological ([cryptorchidism
] , [retrograde ejaculation]
) or hormonal (dysfunction of the pituitary gland or the testicle itself). However, this can also be acquired as a result of trauma, chemotherapy, chronic inflammation, or steroid use.
For many years, the only options available to men suffering from non-obstructive azoospermia were usage of donor sperm or adoption. These are still the only solutions for men suffering from a complete lack of sperm. However, in many cases of non-obstructive azoospermia, there is still minimal production of testicular sperm cells. Using surgical methods such as [TESE
] and [micro-TESE
] , it is possible to extract spermatozoa and use them for fertilization.
Despite the widespread use of these techniques and their relative safety, this is still an operation which causes severe discomfort to the patient. Moreover, sometimes the operation itself is unnecessary, since a careful examination of the sperm sample may reveal isolated sperm cells in the ejaculate which are not detectable by a standard microscopic examination (this is called virtual azoospermia). To address this problem, the [rare spermatozoa search] method was developed. By this method it is possible to locate tens or even hundreds of motile sperm in the ejaculate and thus completely obviate the need for surgical intervention.
Cryptorchidism (undescended testicle):
Cryptorchidism is defined as the absence of one or both testicles in the scrotum. It is the most common congenital malformation in the male sex system and occurs in about 3% of term-born males and up to 30% of premature male births. In most cases, the testicles descend to the scrotum during the first year of life and the rest require surgical intervention. Testicular activity is optimal at a temperature lower than body temperature (that’s why the scrotum is external). Therefore, while inside the pelvic cavity, the testicular function is damaged, especially in adolescence, when it begins to secrete hormones and produce sperm cells. When only one testicle is involved, there might be a relatively moderate decline of fertility – about 10%, whereas bilateral cryptorchidism has a significant effect, especially if the correcting surgery was performed at a later stage. It is possible to overcome this by fertility treatments, ranging from [IUI]
, depending on the severity of damage to the sperm.
Extracting sperm from the testicle:
In the absence of sperm in the ejaculate, there are several surgical methods for extracting sperm directly from the testicle or the epididymis.
TESA / TFNA – Aspiration of semen from the testicle using a needle. Used in cases of [obstructive azoospermia]
, where there is a blockage of passage of sperm cells from the seminiferous tubes to the epididymis.
PESA – Aspiration of sperm from epididymis using a needle. Used in cases of [obstructive azoospermia]
, where there is a blockage of passage between the epididymis and the vas deferens.
TESE – An operation under general anesthesia, during which an incision is made in the scrotum and a biopsy is taken from several testicular areas. The biopsy is scanned to find sperm in the laboratory. Designed for cases of [non-obstructive azoospermia]
, where no sperm was found in the ejaculate.
Micro-TESE is a micro-surgical method of sperm extraction that is performed under general anesthesia. During the operation, the testicle tissue is examined under a microscope and microscopic samples are taken from areas where spermatozoa are most likely to be found. The method is considered to be more effective than the conventional TESE and also “more friendly” for testicular tissue, but its cost is significantly higher.
Stands for IntraCytoplasmatic Sperm Injection, also known as “micromanipulation”. As its name implies, during this process, a single spermatozoon is injected into the oocyte by a microscopic pipette in order to fertilize it. The chances of fertilization using micromanipulation are considered higher than conventional IVF, and while ICSI was originally implemented to address serious defects in sperm concentration and motility, over time it has become the most common method of in vitro fertilization.
According to the World Health Organization, infertility is defined as a disease of the reproductive system characterized by a failure to achieve pregnancy after 12 months of unprotected sex and in the absence of other possible causes, such as breastfeeding or menopause. About 15% of all couples worldwide are defined as infertile, with about 40% of infertility cases being dependent on the female factor, 40% on the male factor, and the remaining 20% on the combination of both.
Stands for In Vitro Fertilization. The process simulates the natural fertilization of an egg by a sperm cell – in the laboratory. After a period of hormonal stimulation, oocytes are surgically retrieved from the ovaries, sperm is given by the partner (or the donor) and they are introduced into a fluid similar in its components to the natural environment of the fallopian tube, where fertilization occurs. Sperm cells are given a chance to locate the egg and fertilize it without further intervention.
Klinefelter syndrome (XXY syndrome,
A genetic syndrome in which a man has two copies of the X chromosome in addition to the Y chromosome, as opposed to the normal condition in which there is only one X chromosome present in men. The syndrome affects approximately one in 500 male births and its expression varies from person to person. There are many characteristics of the syndrome, but the most prominent of these is infertility as a result of impaired development of the gonads caused by excess activity of the extra X chromosome. However, in many cases, due to random genetic changes during embryonic development, there is a minor testicular activity and therefore, it is possible by [micro-TESE]
to extract spermatozoa from the testicle and use them for fertilization. Due to the difference in the expression of symptoms of the syndrome between individuals, it is sometimes diagnosed in childhood and other cases, only at the age of fertility.
Stands for Intracytoplasmatic Morphologically selected Sperm Injection. Unlike ICSI, which selects a normal-looking sperm at x200 magnification, during IMSI the sperm is selected at a x6000 magnification, allowing a much better assessment of its morphology. Given the specialized equipment and specialized training of staff, the process of selecting sperm for IMSI is seldom performed in the IVF lab, but by external laboratories specializing in morphological selection of sperm . IMSI has been shown to be effective in cases where other methods of fertilization have failed and in couples in which the woman’s age is over 40.
Stands for IntraUterine Insemination. This is a relatively minor intervention in the process of natural fertilization, and therefore is usually the first infertility treatment suggested. During the process, the sperm is washed and concentrated in the laboratory and then injected by a gynecologist directly into the uterus, essentially “saving the sperm the trouble” of traveling through the vagina and the cervix. The success rate of the method is not particularly high and is therefore recommended mainly for young couples and in the absence of severe fertility issues.
Oligospermia is defined as a low sperm concentration in the ejaculate and as a result, poor fertility. There are several levels of severity of oligospermia, but generally is defined as a concentration of less than 15 million sperm cells per mL. Factors responsible for oligospermia are varied and may be either reversible, such as [varicocele] , obesity, drug and alcohol use and even overheating of the testicular region, or irreversible, such as age, chromosomal abnormalities or mumps during childhood, but about 30% of the cases remain unexplained.
In many cases of moderate oligospermia, especially when the partner is fertile, no significant intervention is required. There are also medicines that help overcome oligospermia with a hormonal background, surgeries that deal with obstructive cases and there is widespread use of [intrauterine insemination]
. However, in cases of severe oligospermia (less than one million sperm per ml), there is no other option than [IVF
] and [micromanipulation
] of gametes. Because in most cases of oligospermia there are elements of both [Teratospermia
] and [Asthenospermia
], there is a great importance of selecting the best sperm cell for fertilization.
Varicocele (varicose veins):
Blockage of the venous valves leading the blood from the testicle, which causes the accumulation of venous blood containing toxins produced in the testicle as a result of metabolic activity and hampers oxygen supply to the testicle. As a result, both the sperm cells and the process of their creation (spermatogenesis) are damaged and fertility is impaired. Varicocele is diagnosed in 20% of men, usually between 15-30 years of age and can be repaired (if necessary) by surgery, but not every case of varicocele justifies surgical intervention. Moreover, sometimes the diagnosis is established too late and the damage to sperm production is irreversible. In both cases, to compensate for the damage caused by varicocele and to increase the chance for pregnancy, the technique of [morphological sorting] of sperm is often used.
A condition in which the semen, instead of being ejaculated via the urethra, is redirected to the bladder. This occurs when the muscle that closes the entrance to the bladder is weakened (due to high blood pressure, certain medications, or benign enlargement of the prostate). Therefore, the sperm that is pushed forward by the activity of the vas deferens muscles finds less resistance passing through the weakened muscle than into the urethra. The result is either complete or partial [aspermia]
. The arising fertility issue can be addressed by giving a urine sample immediately after the ejaculation attempt and isolating the sperm cells from the urine. Then, depending on the concentration, motility and quality of the sperm, they can be used for [IUI]
A medical condition in which the sperm cells have abnormal morphology. The morphology of the sperm cell reflects the state of its nucleus and affects its ability to bind to and penetrate the egg. The morphology of sperm cells is influenced by external factors such as smoking, chemotherapy or exposure to toxic substances, as well as from a number of diseases, such as [varicocele]
or diabetes. The solution in these cases is [micromanipulation]
, whereas using [high magnification]
is of vital importance in choosing the most structurally normal cell.
One of the two sex chromosomes in mammals, together with the X chromosome. The Y chromosome carries the gene responsible for male sex determination in the embryo. It also has a great influence on the development of the male reproductive system and sperm production.The Y chromosome is involved in several syndromes that affect fertility, mostly [Klinefelter syndrome]
. In addition, deletions on the Y chromosome may severely impair testicular function and sperm production, to the point of [azoospermia]
and therefore, azoospermic men are often referred to genetic testing. Azoospermia with genetic background is untreatable, but occasionally, an [extended search]
or [surgery] can yield rare spermatozoa, which can then be [frozen]
for future use.