Diagnostic methods for men:
Spermogram
This is ideally done where there is adequately trained staff, preferably by an embryologist. A period of 3 days of abstinence is required, no more than 5 days, and the time of ejaculation should be recorded in relation to the submission of the sample.
Functional sperm testing
This shows how many motile sperm remain at the end, as we prepare the sperm in laboratory conditions similar to those in the female reproductive tract. It is particularly indicated where there are somewhat slower sperm, as it shows how many sperm reach the target after everything the sperm must go through in the female reproductive tract, i.e., after capacitation (activation in the cervix), passing through the uterine cavity, and reaching the fallopian tube.
Hormone testing
The development of sperm, known as spermatogenesis, occurs under the influence of hormones; if there is a disorder, hormone testing is indicated.
Ultrasound of the genital tract and urologist examination
If there is a problem in the spermogram, testing of the reproductive tract is indicated to diagnose and eliminate any potential diseases.
Genetic testing
In cases of certain sperm disorders as well as azoospermia (absence of sperm in the ejaculate), testing of the karyotype (all chromosomes) or specific genetic defects (AZF region, CF, thalassemia, etc.) is indicated.
TESE (testicular biopsy - testicular sperm extraction)
Testicular biopsy is performed in cases when:
- sperm analysis shows no sperm (azoospermia)
- sperm are found in insufficient numbers for IVF
- a sperm sample cannot be obtained through ejaculation
Testicular biopsy is performed under general short-term anesthesia, where the urologist takes a piece of testicular tissue and hands it over to the embryologist, who checks for the presence of sperm after processing it under a microscope. If sperm are present and in sufficient numbers, the embryologist freezes the processed material, which is then stored in liquid nitrogen until use. A piece of testicular tissue is sent for pathohistology to obtain further information.
The cause of azoospermia can be of various natures depending on whether the testes produce a normal number of sperm while the ducts from the testes are damaged, blocked, or completely absent (retrograde ejaculation, obstructive azoospermia). Another reason is insufficient sperm production in the testes (non-obstructive azoospermia), which may be due to hormonal or genetic factors, failure of the testes to descend into the scrotum in time, physical trauma, radioactive exposure, consequences of various health conditions and diseases…
With TESE, we have the highest chance of finding spermatozoa, in about 50% of cases. For those who do not succeed, and in the histopathological findings it is noted that there is maturation of spermatozoa, i.e., maturation to forms that can be used for fertilization, the last option remains microTESE.
Micro-TESE
For patients in whom spermatozoa are not found through TESE, and the findings of histopathology, ultrasound of the testis, and hormones indicate that there may be foci of spermatogenesis within the testis, microTESE is suggested. The procedure is performed under anesthesia, where the testis is slowly opened at the equatorial level and examined under a microscope to find tubules that, by their color and size, may be places where spermatozoa exist. The embryologist examines the obtained material and, in case spermatozoa are found, freezes the material for use in a future IVF-ICSI procedure.