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Percutaneous epididymal sperm aspiration and testicular sperm aspiration / biopsy

The problem

An uncommon type of infertility (1-2%) occurs where the male partner has no sperm in the semen (azoospermia).

In half of all cases, sperm production by the testes is normal but there is a blockage, which prevents sperm entering the semen (obstructive azoospermia). This may be due to -

1. failure of the sperm tubes to develop (congenital absence of the vas deferens),

2. a blockage of the sperm tubes (epididymis or vas)

3. a previous vasectomy operation (male sterilisation).



Although surgery in an option in some cases, men with obstructive azoospermia often produce anti-sperm antibodies which can kill off or slow down their sperm and leave them infertile even if the testicular sperm aspiration has succeeded in opening in their tubes.

In the other 50% of cases there is failure of adequate sperm production by the testes. This may either be a congenital problem, or the result of previous disease or such as infection eg mumps. Even in these patients, sampling (biopsy) of the tissue of the testis reveals that many men (about 30 - 40%) have areas where there are normal sperms which do not pass into the semen despite there being no blockage.