Treatment of Azoospermia: Microsurgery

Herzliya Medical Center utilize the most modern methods of diagnosis and treatment of male infertility. One of the leading specialists in the area of the Center of male infertility is Dr. Shai Shefi - he is the only urologist in Israel, who has passed specialization in microsurgical treatment of azoospermia. There are techniques at HMC that allow for sperm retrieval in order for a couple to conceive.


The Main Causes of Male Infertility: Azoospermia

1% of the male population and 15% of patients seeking treatment of male infertility are diagnosed with the absence of sperm in the semen - azoospermia. The diagnosis of azoospermia is based on the results of at least two microscopic of seminal fluid from the patient. If a patient is diagnosed with azoospermia, sperm retrieval is only possible with the help of surgery.


Nonobstructive azoospermia

Nonobstructive azoospermia is the abnormality in sperm production, which results in no sperm in the semen. The causes of this condition may be congenital (including hereditary) disorders, as well as previous infection, chemotherapy or radiotherapy. Despite the fact that in azoospermia no spermatozoa is in the semen, in many cases, there is the possibility of a surgical recovery procedure, followed by in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Classical surgical techniques have several disadvantages, one of which is the inability to determine in advance which areas of testicular parenchyma there are still functioning foci that produce healthy cells.

Advantages of Microsurgical Surgery in Nonobstructive Azoospermia

The microsurgical procedure to obtain sperm (microdissection testicular sperm extraction – micro-TESE) was first described by US experts in 1999. The main advantage of microsurgical intervention is the possibility of an extensive study of testicular tissue with minimal risk of further damage. The effectiveness of this method has gained wide popularity among professionals and urologists around the world and marked the beginning of a new branch in urology.

During a micro-TESE, the outer lining of the testes is incised and a thorough investigation of its tissues is conducted, with the use of a highly sensitive surgical microscope, which among other things has important diagnostic value. The indisputable advantage of micro-TESE are:

  • Study larger testicular parenchyma without compromising its integrity, since the cut of the outer lining does not injure the underlying tissue. The disadvantage of classical surgeries in azoospermia are deep cuts, and it is not always crowned with success, especially in cases of rare and small-sized pockets of stored spermatogenesis.
  • Microscopic examination can detect stored ducts with a high probability of sperm. The micro-TESE technique allows the removal of minimal testicular tissue compared to conventional surgical procedures. Despite considerable research, the area of total tissue removed during a micro-TESE is significantly less than conventional surgery.
  • The minimal and usually reversible testicular damage during the micro-TESE allows to repeat the procedure, if needed


Dr. Shai Shefi - leading urologist and andrologist at Herzliya Medical Center. Dr. Shefi specializes in the treatment of male infertility. During two years, he underwent his fellowship in the field of advanced methods of diagnosis and treatment of male infertility at the University of San Francisco (UCSF), USA. Returning to Israel, he became a pioneer in the field of microsurgical treatment of male infertility.


Obstructive azoospermia

Obstructive azoospermia the sperm is produced normally in the testicular parenchyma, however, duct blockage prevents sperm entry into the seminal fluid. This condition may be congenital (patients with cystic fibrosis, for example) or develop as a complication of inflammatory disorder. Treatment of obstructive azoospermia includes an aspiration (microsurgical epididymal sperm aspiration - MESA). This procedure, as opposed to the traditional needle aspiration allows retrieval of a large amount of sperm for subsequent cryopreservation and application by repeated cycles of IVF/ ICSI.

Implementation of micro-TESE and MESA requires special skills and specialized equipment available only in the leading urology centers in the world. Patients of Dr. Shefi at Herzliya Medical Center will have a unique opportunity to undergo the most advanced treatment of azoospermia, which guarantees a high success rate with minimal risk of complications.

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