Azoospermia and male infertility – diagnosis and prospects

Birol Aydin, Embryologist
Head of Embryology Lab, Clinical Embryologist at IVMED, IVMED

Male Factor

From this video you will find out:
  • What’s azoospermia?
  • How is azoospermia classified?
  • How do you investigate azoospermia?
  • Can azoospermia be genetic?
  • What is a YCMD test?
  • Which is the best sperm retrieval technique for obstructive and non-obstructive azoospermia?
  • How successful is Micro TESE in men with non-obstructive azoospermia?
  • What is Round Spermatid Injection (ROSI), and when is it indicated?

Azoospermia and male infertility – diagnosis and prospects

How can I get pregnant with azoospermia?

In this webinar, Birol Aydin, Clinical Embryologist, Head of Embryology Lab at IVMED, explained what azoospermia is, how it is diagnosed and what treatment options are available for men who suffer from it.

How can I get pregnant with azoospermia? - Questions and Answers

Can azoospermia be prevented in any way?

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. 

Do you have adult photos of the sperm donors or only baby photos?

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. 

In which cases do you use activation medium (piezoelectric stimulation)?

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.

With sufficient antibodies in sperm, is ICSI able to wash the sperm well and increase the chance of getting pregnant? Are there any other options to reduce the antibodies?

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. 

How quickly can sperm donor samples be shipped to another country if one can’t make it to Ukraine?

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.

What can you say about long-term health for the babies in which piezoelectric activation was used?

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.

Do you have a guarantee program with the donor sperm if the eggs are also good?

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.

What genetic screening would you suggest for a patient with non-obstructive azoospermia?

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.

Do you use piezoelectric activation in all men with teratozoospermia, for the first IVF cycle, or after a failed cycle?

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. 

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Birol Aydin, Embryologist

Birol Aydin, Embryologist

Birol Aydin is a biologist, leading clinical embryologist and head of the embryology laboratory at IVMED. Certified member of ESHRE Birol graduated from Mustafa Kemal University of Science from the Biology department. He has 12 years of working experience in embryology and andrology, practising in 12 different countries in the embryology field: Australia, Sweden, Finland, Turkey, Serbia, Macedonia, Estonia, Georgia, Cyprus, Albania and others. His everyday work results in numbers of IVF cycles: Practice in IVF centre by fresh and frozen ICSI/ET more than 30,000 cycles | Practice in IVF centre by PGS&PGD more than 5,000 cycles | Practice in IVF centre by egg donation: more than 3,000 cycles.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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