Azoospermia and infertility
Dear Professor Winston

I suffer from azoospermia. My wife and I underwent a successful fertility ICSI cycle using sperm retrieved surgically, for which we are very grateful. I had this done twice, both times sperm being found, as the first cycle failed. No-one has ever sought to investigate the cause of my azoospermia. I had blood tests and a physical examination and they hoped they’d find sperm – which they did. We were sent straight to fertility treatment involving lots of drugs for my wife, daily injections, regular blood tests, egg and sperm retrieval, etc. I would simply like to know if azoospermia could be reversed by any form of surgery or procedure and how best to approach this. Doctor referral to urologist? We have one beautiful baby but cost and the sheer pressure of the process precludes another go. At no stage did our consultant seek to investigate why I had azoospermia. I am 37 and healthy. Assumptions were a blockage due to damage either from injury or resulting from undetected infection. Thanks for any light you can shed on this.
Thank you, M.

Dear M

Yes – I agree with your doubts. This is just what I have already complained about on this website. People who are infertile are treated as if this is the diagnosis, rather than if it was a symptom of something wrong. The net result is a referral to an IVF clinic where the infertile couple are offered IVF because this is what the clinic is set up to offer. With any other medical symptom one would hope that doctors behave like proper doctors and try to establish what is the underlying cause of the problem before offering a treatment. Incidentally, technically speaking, IVF is not a treatment for infertility but a way of helping somebody get pregnant without really treating the underlying cause of infertility.

There are a number of urologists, who specialise in causes of male infertility, who complain about this attitude and it may well be well worth getting a referral to one of them. Forgive me, but I do not feel that this website should give details of who to see because I feel we should demonstrate no vested interest in any particular clinic or practitioner. But there are a number of fairly simple hormonal and other tests which are not expensive and which would give you a clearer indication as to whether you have a possibly correctable cause for azoospermia. Occasionally, this may be due to a blockage in the tubing leading from the testicle as you suggest is the case, in which event treatment is not likely to be easy and can be expensive. But given the fact you are producing sperm which are capable of fertilisation it is worth being carefully examined and investigated by a specialist urologist. The correct person to discuss this with is your general practitioner who has a contractual duty to search out the best referral for you and to make certain you do not have an underlying medical condition which should be investigated.

Let me know if you need more information in due course.

Best wishes
Robert Winston

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