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Total absence of sperm can be due either to a blockage, absence of the vas deferens or to a failure of the testes to produce spermatozoa.  The degree of this failure can be variable.

In cases of a blockage, it is quite easy to recover sperm directly from either the testis itself or from the epididymis, which is like a small reservoir appended to the testis.  However, the sperm that is collected is not able to fertilise the egg in the natural way and ICSI is always necessary.

In cases of testicular failure, it is now possible in around 50% of cases to collect at least a few sperm by performing one or multiple testicular biopsies.  Provided some mobile sperm are recovered, the chance of fertilisation of the egg is extremely good.

In both circumstances, it might be possible to freeze some sperm at the time of this procedure so that it can be used during subsequent IVF/ICSI cycles, if the first one is unsuccessful.

PESA (Percutaneous Epididymal Sperm Aspiration)

• This technique is generally used where there is a blockage.
• Under local anaesthetic, sperm is aspirated directly from the epididymis (the tube containing the sperm) with a very fine needle which has been inserted through the scrotal skin.
• An embryologist will then check the sample for the presence of sperm, under a microscope.

TESE (Testicular Sperm Extraction)

• This technique is used in cases of non-obstructive azoospermia or if PESA has been unsuccessful.
• The technique involves the collection of sperm directly from the testis.
• A special needle, which allows the surgeon to recover several samples of testicular tissue from different locations, is used.
• A sample from the testicular biopsy will be sent for histological examination in order to obtain a tissue diagnosis and also to rule out the risk of testicular cancer, which is known to occur slightly more frequently (1%) in men with non-obstructive azoospermia.

Majority of your treatment including consultations, drug therapy
and monitoring will take place at Holly House Hospital but please be aware
that egg collection, mixing of sperm and eggs, embryo culturing and
embryo replacement are all carried out at CRM London.