How is Sperm Normally Produced?
Sperm are produced in microscopic structures called seminiferous tubules. This network of tubes loop tightly throughout each testicle and consist of more than 200 compartments. The seminiferous tubules are crucial to the process of reproduction and in most males they produce more than 12 billion sperm per month. The seminiferous tubules send immature sperm to the male reproductive tract called the epididymis where they are stored as they continue to mature. Mature sperm travel to a narrow muscular tube called the vas deferens from the epididymis. Here the sperm are propelled forward into the ejaculatory ducts. Here the sperm mix with seminal fluid, moving on to pass through the prostate gland and becoming semen before being propelled out through the urethra during ejaculation.
What is Azoospermia?
Azoospermia is the condition where no sperm are present in the semen (ejaculatory fluid). It affects about 1 % of all men. For two main reasons sperm can be absent from the semen. The first is a condition called Obstructive Azoospermia (OA). OA is caused by a blockage. Characteristics of this condition involve normal sperm production inside the testicle, but for some reason the sperm are trapped in the epididymis or other portions of the reproductive tract and are blocked from making their way to the ejaculate. Some causes of this blockage can include a congenital birth defect, vasectomy, infection or injury to the reproductive tract.
Non-Obstructive Azoospermia (NOA) on the other hand, is the result of severely impaired or non-existent sperm production. However, in the case of NOA, most men with the condition DO in fact produce usable sperm in certain locations inside the testicle. The key is to locate that sperm, safely retrieve it and preserve it for use in making a baby. Doing so requires a highly trained male fertility specialist, application of the right type of sperm aspiration technique and reproduction technologies such as ICSI to establish a pregnancy.
NOA – Not an Absolute “Infertility” Sentence Today
Testicular Mapping is a procedure recommended and performed by very few male fertility doctors in the world today, because other procedures for men with NOA have proven more accurate, efficient and effective, in addition to less cumbersome and less expensive.
Men diagnosed with NOA do not have sperm in their ejaculatory fluid due to problems with sperm production inside the testicle. Sperm production inside the testicle must reach a certain threshold before any sperm are released into the ejaculate. However, this doesn’t mean there is zero sperm being produced inside the testicle. In fact, more modern reproductive research has shown that up to 70% of men with NOA do in fact have small amounts of sperm being produced inside the testicle. The key is to use precise, safe, effective and cost efficient procedures to locate the healthy sperm and correctly obtain it for use in an In-Vitro Fertilization (IVF) /Intra-Cytoplasmic Sperm Injection (ICSI) procedure in order to have a baby. Testicular mapping is NOT one of those procedures.
To a trained micro-surgical expert, the seminiferous tubules which produce sperm typically look different than the tubules that are not producing any sperm. Those that make sperm are usually wider and have a golden yellow appearance under a microscope whereas those that don’t make sperm appear collapsed, white and often scarred. With these key distinctions in mind, expert micro-surgeons can use an operating microscope to hone in on differences in seminiferous tubule appearance to help locate productive and healthy areas of sperm inside the testicle, even in the man who has been diagnosed with NOA. This gives patients the best chance and highest success rate for finding sperm.