The first analysis that should be conducted in infertility is spermiogram analysis.ıf there are no sperms in the repeated spermiogram analysis of a man, pre and post washings, then this situation is called “azoospermia”. Sometimes while no sperm can be found in the pre-washing evaluation, a few sperms can be found in the post-washing evaluation (cryptozoospermia); in these cases, a single sperm can be kept inside an empty egg membrane and used afterwards (sperm in zona).

Today, one of the most important subjects of infertility treatment is obtaining sperm from azoospermic men. After the examination, analysis and evaluations, if sperm production is considered to be present in a man, spermatozoa is tried to be obtained from the epididiymis or testis via open biopsy or aspiration. Accroding to the condition of the patient and the results of his analysis, the chance of obtaining spermatozoa during the process varies. If spermatozoa is present in the tissues obtained with these processes, then Micro-Injection treatment (ICSI) is started. Before passing to the test tube baby treatments, the type and reason of the Azoosperimia should be determined.

Only ICSI application can be performen in azoospermic patients. When ICSI application is conducted, the fertilization rate of the oocyte is between 45-75%. This value is lower than the rates obtained with semen. In couples having azoospermia, pregnancy rates are 30-40%, live birth rates are 25-30%. Insemination or conventional IVF application with the sperm obtained from the testis or epididiymis are not performed.

FSH and LH hormones produced in the brain by the pituitary gland reaches testis via blood circulation and control the production of sperm. Testis tissue consists of seminipherous tubules that produce sperm and the intersititium sections that produce hormones. Leydig cells found in the intersititium produce the masculinity hormone called testosterone. Testosterone hormone both stimulates the sperm production in testis and also has effect on remote tissues via blood circulation (For example: sexual desire in the brain, deepening of the voice due to its effect on vocal cords, beard and moustache development on the face, male type development in the muscles and bones etc.).

Sperm production is conducted in seminipherous tubules. Seminipherous tubules consist of germ cell layers and small channels called lumen in the middle. Germ cells coat these small channels. While round, immature sperm cells take place in the outer section, mature spermatozoas are found in the lumen. Lumens unite to provide sperm flow to epididymis. The effect of FSH hormone released from the pituitary gland on man is providing the production of sperm in the seminipherous tubules. LH hormone controls the testosterone production from Leydig cells, indirerctly influencing the sperm production and its maturation.

Germ cells complete certain division and maturation stages and develop from spermatogonium into spermatozoa stage. While the chromosome number is 46, XY in spermatozonium, it reduces to half at the spertamatozoa which forms at the latest stage after meiosis (23, X or 23, Y). This chain of events is called "Spermatogenesis".

In every stage of spermatogenesis, many substances like enzymes and proteins take place. Many factors, primarily genetics and hormonal factors affect spermatogenesis. In order for a sperm to fertilize an oocyte of a woman, it should have passed into the stage of spermatozoon which is the mature form.With the immature forms of sperm cells, ICSI can not be conducted and even if this is achieved, (ICSI with spermatide) pregnancy rates are very low.

Sperm cells produced in the seminipherous tubules pass into the sperm carrying channels. Respectively, they proceed through rete testis --› ductus eferens --› epididymis --› vas deferens --› ejaculatory ductus --› seminal vesicule. Sperm cells, stored in the seminal vesicule are discharged from the tip of the penis during ejaculation as semen. Apart from sperm cells, prostate and liquids produced in other glands mix into semen.

Sperm cells produced in the seminipherous tubules in the testis tissue advance first to the epididiymis and then the channel of vas deference. An obstruction in any place on this path leads to obstructive azoospermia. If semen’s not having sperms is due to the low production or lack of sperms in seminipherous tubules, then it is considered to be non-obstructive azoospermia.

The andrological examination of an azoospermic man should be thoroughly conducted. As a reslut of hormonal and genetic tests, the type and reason of azoospermia is trying to be understood.

In advances sperm deficiency or azoospermia, below mentioned blood tests are conducted.