Azoospermia and male infertility – diagnosis and prospects

Sometimes there is a way, especially when there is azoospermia because of channel blockage. I had many patients who didn’t have any spermatozoid after semen collection however, after hormonal treatment or some small surgical operation, they started to produce sperm. As we couldn’t find any spermatozoid, we did the testicular surgery, and after several times, the patient tried to give a fresh sperm sample and finally, he started to produce sperm, but it’s not so easy. Such treatment takes a long time, and of course, there is this surgical part involved. 

It depends on country and regulation, so there are two kinds of donors anonymous and open donors. Some sperm banks are giving a possibility to see adult photos. In our sperm bank, we prefer to provide mostly child photos because there is limited regulation in our country. There are sperm banks that can also provide adult photos, the same as egg donor photos. 

Firstly, if there is an implantation failure or if there is a fertilization failure before, the patient can try several attempts, but again, there is no fertilization, or there is a very low blastocyst rate, cleavage arrest. When we see that sperm quality is very low, and in teratozoospermia cases or a very high sperm DNA fragmentation, we are using this activation. We use it in cases where we need to do testicular surgery, we obtain sperm, we are using activation. According to our statistic and results, when we can’t get any blastocysts or fertilization and use the activation, we get many blastocysts and very high fertilization rates.

There is a publication about this. For such cases, we are trying to use it differently. There are two kinds of ways to wash sperm. The first is a swim-up, and the second is a sperm gradient technique. When we get sperm from a patient with azoospermia, and after the testicular surgery, the only one that is possible is a gradient technique because, with the swim-up technique, it will be impossible to reduce antibodies and the second when we make a high density of gradient, of course, there is a chance of reduction, and of course, ICSI technique is the only way to increase the chance of pregnancy. 

We transport such samples quite often from Ukraine to other countries, and mostly we have a ready database where the patient can choose online from the database which sperm donor they like. There are two kinds of shipment. The first is a hand-carry shipment, of course, because of COVID-19 restrictions, sometimes it’s difficult, but still, a cargo shipment is also available. We are trying to do what a patient prefers, but it depends on patient treatment and the country. When patients choose the donor, our carrier companies try to prepare documentation quickly, and we are shipping quickly, so there is no waiting list or long waiting time.

Piezoelectric activation is a new technology, it’s a very low length wave of the electric. No article or publication is suggesting there is any side effect because we are doing it in a very early stage, a fertilization stage. If there were some mechanical side effects, we should see them during embryo development, but none are found. We already have babies born where this technique was used, and we didn’t see any anomalies on the ultrasound during pregnancy. Also, babies don’t have any abnormalities or health problems.

This is a technique that is used for 1 or 2 years, so we still need time to analyse it. Finally, there can be two sides. The first is the mechanical side, we can see some physiological effect, but there is none. From the genetic side, the embryo is already tested, and we are using piezoelectric activation, we are trying to do NGS sequencing in almost 90% of our cases before the transfer, and we didn’t see any anomaly or health problem till now.

This is a difficult question. We don’t have such a program, I don’t think anyone has, but because it’s a difficult issue. In our clinic, we can consider much more, but when we are shipping sperm somewhere, there are many issues such as quality of the lab, their techniques, kinds of treatment they have, but also, the egg quality is questionable. There are different views for everyone, that’s why for egg donation, we have a guarantee program, but for sperm donation, we don’t have such a program because even if you have donor sperm, you cannot avoid the chance of sperm DNA fragmentation for 100% because you cannot be sure which sperm you select for fertilization will have a 0% of DNA fragmentation, so that’s why it is difficult to guarantee such program.

For non-obstructive azoospermia, I would suggest performing a karyotype for sure. Karyotype should be performed in every patient considering IVF. Especially for non-obstructive azoospermia, the karyotype is mandatory. Second is Y chromosome micro dilation (YCM) because this is one of the main reason for obstructive azoospermia, and if you find out Y chromosome micro dilation, then the next step after the fertilization and creation of the embryo will be NGS, so we should check embryo with NGS to transfer healthy embryos because it can pass from generation to generation.

We don’t use it for all men, we need to see at least one failed cycle with fertilization failure, or let’s say blastocyst failure. If you have 100 million spermatozoids, and if you have teratozoospermia, that means only 1% of sperm are normal. There’s still much sperm, so still, a hundred thousand sperm are normal, so I have a chance to select high spermatozoid quality. However, when we have azoospermia, and after a testicular surgery, we find several spermatozoids, we are using piezoelectric activation, even in the first cycle. When it’s a regular teratozoospermia, normal semen condition, and of course, if we receive requests from patients, we are considering it, but we are not using it as a common technique.