Azoospermia detected before remarriage.

Hanoi – Mr. Phi, 38 years old, was diagnosed with azoospermia (absence of sperm) during a pre-marriage examination. He underwent surgery to find and freeze sperm to preserve his chances of having children.

Mr. Phi already has a daughter with his first wife, and recently experienced a decline in vitality and libido. A urological examination revealed no sperm in his semen sample.

Advanced testing at the Tam Anh General Hospital’s In Vitro Fertilization Center (IVF Tam Anh) in Hanoi showed follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels of 33.5 mIU/mL and 19.6 mIU/mL, respectively, nearly three times higher than normal. This indicated impaired spermatogenesis and the body’s need to increase hormone production to stimulate testicular activity. Ultrasound showed that the volume of both testicles was approximately one-third of normal.

Dr. Nguyen Huy Hoang diagnosed the patient with non-obstructive azoospermia due to testicular atrophy following mumps three years prior. Dr. Hoang explained that the mumps virus causes inflammation, leading to irreversible damage to spermatogenic stem cells, resulting in a decrease in sperm count, morphology, and motility, as well as testicular fibrosis and atrophy.

Orchitis (inflammation of the testicles) occurs in approximately 20-25% of men who contract mumps after puberty. Patients may experience reduced fertility, decreased testosterone, decreased libido, or erectile dysfunction. However, in non-obstructive azoospermia, the damage is usually not uniform across the entire testicle. Some seminiferous tubules may remain functional and produce very few sperm, insufficient for semen to be present.

According to Dr. Hoang, micro-TESE (testicular tissue extraction for sperm retrieval) is the most effective treatment to help Mr. Phi have children. After about 3 hours of searching, the team discovered several potential seminiferous tubules in the right testicle, so they only harvested tissue from this location, preserving the left testicle to maximize its endocrine function for the patient.

The tissue sample was transferred to an ISO 5-standard ultra-clean laboratory. Embryologists separated the tissue into small pieces, observed them under an inverted microscope, then washed, filtered, and centrifuged them to remove tissue debris, dead cells, and inflammatory cells. After multiple microscopic examinations at magnifications exceeding 200x, the team found enough sperm to freeze three tubes.

The medical team is performing surgery to retrieve sperm for the patient. (Illustrative image: IVF Tam Anh)

This sperm was mixed with a cryopreservation medium and preserved using vitrification technology in liquid nitrogen at -196°C. This temporarily halts all biological activity of the cells, allowing the sperm to maintain a stable state for many years. When Mr. Phi wants to have children, the sample will be thawed so that specialists can inject sperm into the cytoplasm of his wife’s egg to create an embryo.

“We plan to have in-vitro fertilization (IVF) after getting married early next year,” Mr. Phi said.

Dr. Hoang noted that men who have had children before do not necessarily have normal fertility. Diseases such as mumps can impair sperm production, even leading to azoospermia. After age 40, sperm quality also tends to decline, affecting the ability to conceive. Men should have pre-marital health checkups or checkups when remarrying or planning to have more children to help detect abnormalities related to fertility early and treat them promptly.

Patients with non-obstructive azoospermia can generally be treated with the micro-TESE method, with a sperm retrieval rate of about 60%; in cases caused by mumps complications, the success rate is nearly 100%. This method uses very little tissue compared to traditional methods, reducing the risk of bleeding, infection, testicular tissue damage, and limiting post-operative hormonal decline. The quality of embryos produced from sperm obtained using micro-TESE during in-vitro fertilization is equivalent to that obtained from semen.

If a risk of decreased sperm production is detected, men should consider sperm cryopreservation to preserve their chances of having children.