Low Sperm Count, Azoospermia and other Male Infertility treatments

In many cases, infertility problems such as low sperm count, azoospermia and sperm motility issues, may lie in the male. So it is important to get the full picture from your infertility specialist before beginning this journey.

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What is Low Sperm Count and other Male Infertility issues?

Male infertility accounts for nearly 40% of infertility cases today. Conditions like low sperm count and azoospermia (absence of sperm in semen) are on the rise due to factors such as:

  • Illnesses, fevers, or local infections
  • Stress, pollution, and unhealthy diets
  • Trauma or infections in the testis

What Causes Low Sperm Count and Azoospermia?

  1. Varicocele: Local dilatation of veins in the testis can increase temperature, reducing sperm production.
  2. Hormonal Issues: Stress or poor brain-hormone signals can impact sperm production.
  3. Blocked Outlet Ducts: Obstruction in the vas deferens (duct carrying sperm) may lead to azoospermia.
  4. Genetic Factors: Chromosomal anomalies or Y chromosome microdeletions can contribute to infertility.

Diagnosis: How to Identify Low Sperm Count and Azoospermia

  1. Medical History and Physical Examination: Identifying underlying health problems affecting fertility.
  2. Semen Analysis: Evaluating sperm count, movement, and shape to check for abnormalities.
  3. Blood Tests: Assessing hormone levels that control sperm production.
  4. Genetic Investigations: Testing for chromosomal issues or genetic deletions.

Understanding Surgical Sperm Retrieval (SSR) for Azoospermia

SSR is indicated in specific cases, such as:

  • Obstructive Azoospermia: Blockages in the vas deferens due to trauma, infection, or congenital issues.
  • Non-Obstructive Azoospermia: Testicular failure to produce sperm caused by hormonal deficiencies, genetic factors, or infections.

Did You Know?

There are nearly 40% cases of male infertility in the world.

SSR Techniques

Percutaneous Epididymal Sperm Aspiration (PESA)

A small needle is placed into the epidydimis, which is a reservoir of sperm that sits atop each testicle, using local / general anesthesia and sperms are aspirated.

Testicular Sperm Aspiration (TESA) /Testicular Sperm Extraction (TESE):

If PESA is unsuccessful, TESA or TESE may be offered. In this procedure, the sperm is obtained directly from the testicle either by a needle or a tissue biopsy.

MicroTESE

MicroTESE is done under the microscope where our urologist dissects out only microscopic tissue (tubule) from areas with dilated seminiferous tubule, identified as having active spermatogenesis. Sperm may be found in 50-60% of well-selected cases. Microscopic tissue removal ensures no harm is done to testis.

Azoospermia & Low Sperm Count and Motility Treatment

Life Style Changes

We ensure that the male partner loses weight, takes a good diet rich in antioxidants, exercises regularly and reduces stress. At the same time he quits smoking alcohol and any other addictions.

Hormone Replacement

If hormones are deficient and are required to boost sperm production we start the replacement therapy (hCG & FSH). This therapy takes at least 3 months to show results.

Surgical Interventions

In case of dilated veins in testis surgical clipping (Variocelectomy) is done. This brings down the raised local temperature of testis enhancing sperm production. In case outlet duct (vas deferens) is blocked and the condition is good enough to try and repair.

Why Surveen Ghumman Sindhu?

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Our Success Story

My pregnancy has been possible only because of Dr. Surveen Ghumman Sindhu, whose way of treating her patient is exceptional. She is so calm and kind with her patient’s right from the beginning till end.


For my infertility problem, I was very skeptical to go to a doctor who sees every patient as just another client. However, after meeting Dr. Surveen Ghumman Sindhu, a person with pleasant disposition, passionate about her work and compassionate towards her patients, all my fears vanished.

We traveled the world for a chance to conceive. For 5 years we visited multiple gynecologists.. We did surgery after surgery. Internet searches speak of India as having high rates of success in terms of in vitro fertilization.


Frequently Asked Questions

1. Sperm production problems: About two-thirds of infertile men have sperm production problems.
2. Blockage of sperm transport: This is the second most common cause of male infertility and affects about one in every five infertile men
3. Sperm antibodies: In some men, substances in the semen and/or blood called sperm antibodies can develop which can reduce sperm movement and block egg binding
4. Sexual problems: Difficulties with sexual intercourse, such as erection or ejaculation problems, can also stop couples from becoming pregnant.
5. Hormonal problems: Hormonal causes are uncommon, and affect less than one in 100 infertile men
6. In many men with a sperm production problem, the cause cannot be identified.

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. A reproductive endocrinologist may offer IUI or IVF to help overcome male factor infertility. In cases where there is azoospermia i.e no sperms in the ejaculate, retrieval of sperms can be done surgically by aspiration or surgical extraction using PESA- Percutaneous epididymal sperm aspiration, TESA – Testicular sperm aspiration & TESE – Testicular sperm extraction, testicular biopsy.

Percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) are procedures for overcoming extreme male infertility. Men having very low or zero sperm counts, and sperm that are largely dead or completely immotile, can have children by these methods. The sperm collected can be used for intracytoplasmic sperm injection (ICSI). Yes, Dr. Surveen’s team performs such treatments for couples that require it as she has access to state of the art facilities at Delhi’s renowned hospitals.

PESA surgery can be performed under local anaesthesia or a short-acting general anaesthetic (depending upon the choice of the patient). The epididymis is aspirated to find motile sperm cells. Sperm removed are either utilized for ICSI or they are frozen for later use. Generally, this operation is reserved for instances where the obstruction has occurred. The procedure is often combined with testis biopsy for TESA.

This procedure can be used for instances where sperm production is a problem (non-obstructive azoospermia) or where there is an obstruction to sperm flow.  TESA for non-obstructive azoospermia (low sperm production or maturation arrest) takes around an hour. Here both testicles are usually operated on, and multiple biopsies are taken. It is normally done under general anaesthesia. However, very often sperms can be successfully aspirated by fine-needle aspiration under local anaesthesia or without any cut or stitches.

The minute quantities of sperm obtained at retrieval are not enough to be useful for Intra-Uterine Insemination (IUI) or any procedure other than ICSI. PESA and TESE procedures are the most popular because the goal is the retrieval of sufficient sperm for freezing and use in future IVF cycles using ICSI.

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