I am 34 year Old male with a secondary infertility case i.e. I already have 6 years old daughter which we got via natural conception. I don't drink, don't smoke at all and IT engineer by profession with no exposure of any heat whatsoever. It's been over 10 months since we are trying for our second baby and we aren't getting result. We had a rigorous tests done for my wife and she is all fine as she was during 1st conception hence with repeated semen analysis it's discovered that I have Azoospermia God knows how come it got developed in me :(. I have absolute no surgery or something hitting my testis which could ever lead to this. Doctor has advised me to go for Testicular Biopsy some have advised IUI / IVF. I want to know do I really need IVF as I strongly believe that I must be having sperms but it's not just coming through ejaculation. Please advise.

Dr. Komal SinghGynaecologist11yrs exp

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Hi Yatin, you are having sperm and that is why your doctor is planning testicular biopsy to retrieve them directly as they are absent in your ejaculate. But to conceive you need to undergo Ivf. 

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Dr. Parag PatilGynaecologist26yrs exp

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Azoospermia means your semen doesnot contain sperms. It could be due to either lack of production or due to obstruction of the tube which delivers the sperms at sex. In patients of azoospermia, is the volume of the ejaculate (semen) is good and fructose test is positive, it could mean there is no production. If the fructose if absent it suggests ejaculatory duct obstruction. Usually hormones tests like FSH, LH, Inhibin B levels are advised and on their basis, some hormonal treatment can be offered. Normal volume, PH and fructose being present and presence of GPC (glyceryl phospho choline) means there is NO obstruction, But Normal Volume, PH and fructose positive but NO GPC means it is vas deference epididymis level obstruction. Low volume, PH and fructose negative and NO GPC means it is ejaculatory duct obstruction So het the hormone tests done, GPC levels tested, and meet a urologist or andrologist who can guide your treatment. In patients who have sperm production but tubal block, the sperms can be aspirated by TESA or MESA but these need to be sued for IVF only. If the hormone levels are low, and there is NO obstruction, there are injections which can help increase the production. In patient who have never had a child or are not affording the expensive testicular biopsy, TESA, MESA,IVF, gynecologists also can suggest a donor semen insemination as a attempt for those who want a pregnancy desperately. So decide for yourself and then meet an andrologist or urologist.  

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