The first step in managing a case of AZOOSPERMIA is to find out the cause. However, in majority of the cases, no cause can be found.
If no cause is found, and the man wants to become a biological father, the treatment is sperm collection from the testicles by TESA (Testicular Sperm Aspiration- inserting small needle inside the testicles) or TESE (Testicular Sperm Extraction- making a small cut inside the testicles). The sperms obtained in this way, can only be used for IVF-ICSI (In vitro fertilization and Intracytoplasmic Sperm Injection).
Thus the wife of the man with azoospermia has to undergo IVF. That means she needs injection to stimulate the ovaries, for 10-14 days and then under anaesthesia, eggs are collected from the ovaries (OPU- Ovum Pick up) by a small needle.
However, there is the possibility that no sperms can be obtained from the testicles, or even if sperms are obtained they are not at all of any good quality.
That's why, before proceeding for TESA/ TESE, it is extremely important to look into the possibility of obtaining good quality sperms from the testicles.
It can be predicted by examining the man (size of the testes), checking blood for hormones (FSH, LH, Testosterone etc), some ultrasound examination (of the testicles- "Scrotal Ultrasound" and of the prostate- "Trans-Rectal Ultrasound- TRUS"). In some cases, karyotyping and Y-choromosome Microdeletion needs to be checked in blood to find out if thee is any chromosomal problems. However, no single test can predict the possibility of getting sperms by TESA/ TESE.
If the tests suggest that there is high chance of getting good quality sperms from the testicles, we can proceed for TESA/ TESE.
Again, it is important to discuss with the husband and wife, what to do, if no good quality of sperms are obtained.
Until very recently, there were only 2 options if no good quality sperms were obtained by TESA/ TESE
1. Using Donor Sperms
If no sperms were obtained, all the eggs of the wife can be fertilized with donor sperms (100%). If very small amount of sperms were obtained, 50-50 principle was used (half of the wife's eggs were fertilized with the donor sperms and half were fertilized with husband's sperms). For that, the couple needed to be prepared mentally for donor sperms before undergoing TESA and ICSI
However, donor sperm can ONLY be used with written permission from both husband and wife.
2. Discarding all the eggs collected from the wife- If donor was NOT acceptable
In that case after the money spent for the whole IVF process were wasted. Also, the eggs became useless.
What's new in the new Policy?
From now, onward, apart from the above two options (donor sperms or discarding the eggs), there are other policies that can be used, to make the process more pocket-friendly.
1. Freezing all the eggs without fertilization
It will help the couples to take time to take decision later, whether they want to use donor sperms in future or not.
However, the frozen eggs always do not survive well after warming from the frozen condition, because egg freezing is a relatively new innovation.
2. Doing TESA/ TESE only, avoiding OPU
If during TESA or TESE no sperms are found, the couples do not need to proceed for OPU. Thus, they do not need to pay for OPU. They only need to pay for injections (used to stimulate the ovaries) and for TESA. If sperms are found, then only you need to pay for the whole IVF-ICSI Process.
However, if there are large number of eggs in the ovaries, to ensure the safety of the wife, we can puncture few follicles under anaesthesia. The cost of this process is minimal, compared to the OPU.
3. Trial TESA
Before the actual IVF process is started (before the wife is receiving the injections), we can attempt TESA from the husband. If sperms are found, then they can proceed for ICSI and TESA subsequently. If no sperms are obtained, they can take time to decide whether they want to proceed with donor sperms or not.
The problem is that, the husband needs to undergo TESA twice- first time as diagnostic process and second time as the actual treatment.
4. Using Donor Sperms (with Consent) and freezing all the embryos
As egg freezing is not always convenient, the couple can decide to fertilize all the eggs of the wife with donor sperms and the embryos can be frozen. Frozen embryos have good success rate of survival after warming and give even better pregnancy rates than fresh embryo transfer.