Absence of sperm in the semen sample

If there are no sperm cells in the semen sample (azoospermia) made at either the local hospital or here at the clinic, this could indicate no production of sperm in the testicles or absence of sperm in the ejaculate.

Lack of production of sperm in the testicle can be a result of a congenital defect in the testicular tissue, whereas lack of sperm in the ejaculate could be explained by blockage of the sperm carrying ducts, for instance caused by a Chlamydia infection.

Whether or not there are live sperm in the testicular tissues is determined by taking a small tissue sample from the testicle (testis biopsy). If this biopsy reveals that in fact there are sperm, it is possible to perform the same procedure again when subjecting the female to IVF treatment, where by using micro-insemination (ICSI) the eggs are fertilized with the male’s sperm (see description in next section under TESA)

If there are no sperm in the testis biopsy, donor insemination can be performed.

Testis  biopsy
The procedure, which is completely painless, is performed here at the clinic and lasts approximately half an hour. The couple will be given the result immediately after the procedure. We place a local anaesthesia in the groin and the scrotum, and initiate antiseptic procedures while the local anaesthesia starts to work. You may be given analgesics (morphine) intravenously (in a vein) via a needle inserted in your hand. After approximately 5 minutes, the sample is aspirated from the testicle using a thin needle. Most men only experience slight discomfort in connection with the procedure. The retrieved material is analysed at the clinic laboratory for the presence of sperm.

After the procedure
You might feel a slight pain in the scrotum and the groin for a few days after the procedure, and we recommend that you take it easy during this period. You can go to work, if only you refrain from strenuous physical work. Painkillers such as Panodil can be taken as needed, but no more than 2 tablets (500 mg) x 4 daily.

If you experience strong pain, swelling, redness or fever, please contact Fertilitetsklink IVF-SYD or your own GP/emergency service doctor. However, this happens very rarely.

TESA
Men who have previously been sterilized or men, in which the above testis biopsy has shown sperm in the testicle, may have their sperm removed from the testicle by a procedure known as Testicular Sperm Aspiration (TESA) in connection with IV treatment. These sperm can be isolated and used for the fertilization of the female’s eggs after egg retrieval.

After sterilisation, it will normally be possible to find sperm, even though the sterilisation procedure was carried out many years ago.

Retrieval of sperm from testicles in connection with IVF treatment.
TESA  is performed on the same day and preferably the day before the female’s eggs are retrieved. TESA is performed in the exact same manner as under the testis  biopsy section above. Only a few sperm are retrieved in connection with a TESA as it is only necessary to retrieve the same number of sperm as number of eggs. Due to the small quantity of sperm, we always fertilize the female’s eggs via micro-insemination (Intra Cytoplasmatic Sperm Injection). During the ICSI procedure, the single sperm is injected under a microscope into the egg by means of a tiny glass needle.

In very few instances, we see that there are no live sperm in the retrieved material, even though previous samples have proven otherwise. Therefore, prior to sperm retrieval you should decide what should happen if this situation arises. Should the retrieved eggs be fertilized with donor sperm, should they be destroyed, or should they be frozen as non-fertilized eggs?.

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