Dr. Arun Muthuvel – IVF Specialist Chennai

Dr Arun Muthuvel

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AZOOSPERMIA TREATMENT CHENNAI INDIA

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Top Azoospermia Specialist Doctor in Chennai, India.

Dr Arun Muthuvel has been rated as top Azoospermia and IVF Specialist Doctor in Chennai, Performed highest number of Azoospermia Treatment Cycles in Chennai. Presented numerous Infertility Papers in national and international conferences.

Education: MBBS, MS, MCh - Reproductive Medicine & Surgery

  • 1st few in India to have completed M.Ch (Reproductive Medicine and Surgery) degree which is the only recognised Super Speciality degree in Infertility by Medical Council of India.
  • India’s only Fertility Super Specialist with highest Azoospermia experience.
  • Ranked among Top Azoospermia Specialists in India.
  • The Only Doctor from India to have made Oral presentation in Americal Society of Reproductive Medicine Conference held at Salt Lake city, USA.
  • Received Radiocity Chennai city Icon award 2018.
  • Received Young Achievers Award at Times Health Awards 2018.

Azoospermia videos in Tamil

Azoospermia Videos in English

IVF - ICSI

IVF Failure Treatments

PGD

Azoospermia

TESA - Micro TESE

Miscarriages

Consult with Dr Arun Muthuvel MS, MCh who is a specialist in Azoospermia at Iswarya Fertility centers in Chennai, India.

International Trainings

  • Advanced IVF @ Boston IVF (Harvard University, USA)

  • Natural Cycle IVF at Michigan IVF, USA

  • Andrology, Micro TESE for Azoospermia at Univeristy of Miami, USA

  • PGD IVF & Embryo Biopsy from Cleveland Clinic, USA

IVF Success Stories

Azoospermia Treatments - TESA, TESE, Mirco TESE

micro-tese-procedure-chennai-india
Micro tese treatment best in india

AZOOSPERMIA SIMPLIFIED

INTRODUCTION

  • Azoospermia is the medical term used when there are no sperm in the ejaculate.
  • Rare (approximately 1% of all men [1]),
  • Approx 10%–15% of all infertile men.
References: Stephen EH, Chandra A. Declining estimates of infertility in the United States: 1982-2002. Fertil Steril 2006;86(3):516–23. VOL. 109 NO. 5 / MAY 2018 781 Fertility and Sterility, Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989;142(1):62–5. 3.

DIAGNOSIS OF AZOOSPERMIA

no sperm is identified in the centrifuged pellet of two separate semen samples.

AZOOSPERMIA CLASSIFICATION - ETIOLOGICAL

  • Pre Testicular – hormonal
  • Testicular – intrinsic failure
  • Post Testicular – obstruction

AZOOSPERMIA CLASSIFICATION - CLINICAL

  • Obstructive
  • Non Obstructive

PRE TESTICULAR (HORMONAL)

  • Genetic abnormality
  • Kallmann’s syndrome
  • Prader-Willi syndrome
  • Idiopathic HH
  • Isolated FSH / LH deficiency
  • Prolactin excess – micro / macro

TESTICULAR (INTRINSIC FAILURE)

  • Genetic abnormality –Klinefelter’s syndrome, XYY, 46 XX male syndrome, Yq AZF gene deletion
  • Varicocele
  • Bilateral anorchism, cryptorchidism
  • Sertoli cell only syndrome
  • Gonadotoxic therapy : drug, radiation, chemical
  • Orchitis – mumps / Infections

OBSTRUCTIVE AZOOSPERMIA

Normal sperm production + obstruction

Causes

  • Previous vasectomy
  • Obstructions in Epididymis, Vas or Ejaculatory duct
  • Infections
  • Iatrogenic injuries during Scrotal/inguinal surgeries
  • Congenital anomalies

NON OBSTRUCTIVE AZOOSPERMIA

Due to abnormal sperm production

Causes

  • Sertoli cell only syndrome
  • Maturation arrest
  • Hypospermatogenesis
  • Klinefelter’s syndrome
  • Kallmann syndrome
  • Y-Chromosome microdeletions
  • Post mumps – orchitis, Post CT / RT
  • Torsion – testis / Cryptorchidism

EVALUATION OF AZOOSPERMIA

  • Semen Analysis – Repeat – Repeat ?
  • Clinical History
  • Physical exam – General & Local (vas*)
  • Imaging (USG Scrotum / TRUS)
  • Hormonal – FSH, LH, Total / Free Testosterone, Prolactin, Estradiol. FSH – >7.6 mIU/ml
  • Genetic – Karyo, Ych micro

Diagnostic evaluation of the infertile male: Practice Committee of the American Society for Reproductive Medicine, 2014

NEXT STEPS IN AZOOSPERMIA EVALUATION

  • Differentiate first
  • Is it Obstructive or non Obstructive ?

How do we differentiate Obstructive vs Non Obstructive Azoospermia ?

Childhood and Developmental history
  • Cryptorchidism, testicular torsion
  • Mumps – orchitis
  • Herniorrhaphy
  • Onset of puberty
  • Secondary sexual development
  • Onset axillary, pubic hair, start of shaving
  • Onset of masturbation

How do we differentiate azoospermia by clinical history ?

Medical history
  • Systemic illness: hepatic, renal failure
  • Gonadotoxic therapy – CT, RT, Steroids, Smoking, thermal, etc
Surgical history
  • Herniorrhaphy, bladder neck, orchidectomy, retroperitoneal surgery

How do we differentiate (by Dr Arun Muthuvel MS, MCh - Azoospermia Treatment Chennai)

Physical examination
  • General appearance
  • Gynecomastia
  • Axillary, pubic hair
  • Testis volume, consistency
  • Epididymis induration
  • Varicocele
  • Digital rectal examination

Semen analysis in Azoospermia

  • Repeat – Repeat
  • At least 2 times
  • Inspect Pellet after centrifugation at 1,500-2,000 rpm for 10 min
  • If ejaculatory vol < 1 ml – Postejaculatory urine should be examined

OBSTRUCTIVE AZOOSPERMIA

Semen Analysis
  • Complete proper collection ?
  • Semen Volume
  • pH
  • Fructose
  • Post ejaculate urine analysis

Ultrasound scan in azoospermia diagnosis and treatments

Scrotal
  • Testis volume / Varicocele / Testis tumor
TRUS - Transrectal USG
  • r/o or to confirm level of obstruction
  • Low volume azoospermia without absence of testicular atrophy

How do we differentiate ?

  • Clinical history
  • ExaminationTestis – N / smallVas, Epi N.Testis – N size
  • Vas,Epi N/Absent.
  • Semen analysis
  • pH, Fructose, Volume normal.
  • pH acidic ? Fructose absent ? Volume – low
Hormones
  • Hyper-hypo / Hypo - hypo / normal

Histological patterns of spermatogenesis in Azoospermia testicular biopsy

  • Tubular sclerosis – Absence of seminiferous tubules
  • SCOS – No germ cells within the seminiferous tubules
  • Spermatogenic arrest – Incomplete spermatogenesis, not beyond the spermatocyte stage
  • Hypospermatogenesis – All germ cell stages present including spermatozoa with a decline in no of germ cells
  • Normal spermatogenesis
  • Mixed pattern – different stages of spermatogenesis

Sperm Retrieval rate in Non-obstructive Azoospermia

  • Hypospermatogenesis 70-85%
  • Maturation Arrest 35-47%
  • Sertoli Cell-only 10-24%

Hormones - Non Obstructive Azoospermia

Clinical status
  • Germ cell aplasia – FSH ↑, LH and Testosterone – Normal
  • Testicular failure – FSH ↑, LH ↑, Testosterone – Normal or Low
  • Hypogonadotropic Hypogonadism – FSH, LH, Testosterone all are low

Treatment options in Azoospermia

  • Obstructive vs Non obstructive
  • Testicular biopsy
Diagnostic
  • Diagnose Obstruction vs Non Obstruction
  • Identification of mature sperm for ICSI
  • Identification of malignancy
Therapeutic
  • Harvesting of sperm for ICSI

Medical Treatment of Azoospermia

Hypogonadotropic hypogonadism
  • HCG / HMG / FSH
  • Combination / Step wise
  • Sperm count increase observed in 3-24 months

Varicocelectomy for Azoospermia

  • Only in clinically palpable cases
  • Severe hypospermatogenesis
  • ICSI vs varicocelectomy

Methods to Extract sperms in Azoospermia

  • PESA / MESE
  • TESA
  • TESE
  • Micro TESE

Conclusion

  • Azoospermia – common in Fertility Setup
  • Differentiate Obstruction vs Non obstruction Azoospermia
  • Medical vs Surgical
  • Right Surgical route

Consult with Dr Arun Muthuvel MS, MCh who is a specialist in Azoospermia in Chennai, India.