Fertility testing & diagnosis
Azoospermia: obstructive versus non-obstructive, TESA and micro-TESE
By Dr. Suresh Kattera · 18 min read · Published
What is Azoospermia?
Receiving a semen analysis report stating "Zero Sperm Seen" can feel devastating, but azoospermia does not automatically mean a man cannot father biological children. A formal diagnosis requires centrifuging the sample at 3000g for 15 minutes to confirm the absence of even a single sperm cell in the pellet.
Azoospermia falls into two fundamentally distinct clinical categories:
Surgical Sperm Retrieval Modalities
- PESA (Percutaneous Epididymal Sperm Aspiration): A fine insulin syringe gently collects fluid directly from the caput epididymis under local anesthesia. Quick, incision-free, and ideal for obstructive cases.
- TESA (Testicular Sperm Aspiration): A fine needle collects seminiferous tubules directly from the testis.
- Micro-TESE (Microsurgical Testicular Sperm Extraction): Performed under an operating microscope (20x magnification). An operating andrologist identifies and biopsies only the wider, opaquer tubules most likely to harbor active foci of spermatogenesis, minimizing parenchymal tissue damage.
Embryology Lab Processing
Surgically retrieved sperm cells are immotile or sluggish. In our Class-100 andrology suite, embryologists use pentoxifylline or laser-assisted viability tests to identify live sperm before performing ICSI.
Frequently asked questions
Yes. Over 90% of seminal fluid volume is produced by the prostate and seminal vesicles; sperm contributes only 1% to 2% of volume. Therefore, ejaculate volume and physical appearance are usually entirely normal in men with azoospermia.
In cases of hypogonadotropic hypogonadism (low FSH and low LH due to pituitary dysfunction), medical hormone therapy with gonadotropins can successfully induce spermatogenesis. For primary testicular failure with high FSH, surgical retrieval (Micro-TESE) is the primary option.