Azoospermia, After Vasectomy

Azoospermia (the absence of sperm in semen) can be divided into two main groups:

OBSTRUCTIVE AZOOSPERMIA
Where sperm is produced in the testicles but the seminal tubes are obstructed. The most common causes of this are the congenital absence of seminal tubes that go from the testicles to the penis, vasectomy and infections.
In all cases of obstructive azoospermia, sperm can be extracted from the testicles through a small procedure done under local anaesthetic and on an outpatient basis (TESE). The extracted sperm can be used for IVF-ICSI and some of the sperm can be frozen for later use.

AZOOSPERMIA DUE TO VASECTOMY
When the fertility problem is the result of a vasectomy, the best option for the most possibilities for pregnancy is in vitro fertilisation (IVF-ICSI). Surgery is an alternative that is being abandoned due to poor results, the aggressiveness of the technique (it is still a complex procedure) and waiting for months to check if the semen quality obtained from the procedure is sufficient for attaining a pregnancy. In these cases we opt for IVF-ICSI with extraction of sperm from the testicles (IVF-ICSI with TESE) or from epididymides. Artificial insemination (IA) is not possible with sperm extracted from the testicles due to its low motility.

SECRETORY AZOOSPERMIA (LACK OF SPERM PRODUCTION)
There are multiple causes: chromosomes, genetics, infections, hormones, etc. It may be that there is no sperm in the semen and little sperm production in the testicles (this occurs in 50% of cases). Therefore, attempting to extract sperm from the testicles (TESE) for IVF-ICSI is justified. If no sperm can be found when carrying out the TESE technique, donor sperm from the Sperm Bank can be used, should the couple decide to do so.