Male Factor Infertility

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What is the azoospermia?

Azoospermia is a clinical condition characterized by the complete absence of sperm in the ejaculate. This condition is identified with the semen analysis. Two consecutive semen analysis showing azoospermia are required before the clinician can diagnose azoospermia. Azoospermia can be either congenital or acquired (secondary to other conditions).

To help the clinician in the identification of the causes of azoospermia and in treatment planning, azoospermia can be divided in two categories: obstructive (OA) or non obstructive (NOA). 
Obstructive azoospermia is caused by an obstruction in the seminal tract (tube) that leads the sperm to the outside of the body. In these patients the production of sperm is normal. It is very important to identify with targeted specialistic investigations the exact location of the obstruction as frequently, the obstruction can be bypassed thanks to very sophisticated and specialistic surgical procedures. As the seminal tract is a small structure, surgical reconstruction needs to be performed under magnification with microsurgical techniques. If the reconstruction is successful, sperm will be again present in the ejaculate and the patient will be fertile again. 

When reconstruction is not possible, sperm can be surgically extracted from the testicle and used in combination with assisted reproduction techniques to obtain a pregnancy. In these patients, the success of surgical retrieval of sperm is close to 100%.

Non-obstructive azoospermia is instead due to the reduced or absent production of mature sperm in the testicle. In these patients there is no blockage in the seminal tract and therefore surgical reconstruction is not an option. It is important in this group of patients to perform targeted specialistic investigations to try to identify the cause of azoospermia and to give the patient a rough idea if the surgical sperm retrieval can be successful or not. Surgical sperm retrieval is the only way to try to find sperms suitable for assisted reproduction techniques. Overall, the success of sperm retrieval in patients with non-obstructive azoospermia is around 75-80% although in some subgroups the success can be much lower or even zero. If sperms are retrieved, they are stored in the fertility lab by an embryologist and until the couple is ready to undergo assisted reproduction (In vitro fertilization – IVF) with intracitoplasmatic sperm injection (ICSI) in a dedicated fertility centre.

Why Choose Giulio

Giulio is a veteran surgeon with 15 years of experience in the field of Andrology and Reconstruction. He is also one of the largest penile prosthesis implanters in Europe, as well as the surgeon who performs the largest number of procedures for the correction of complex cases of Peyronie's disease. He has been invited to lecture and perform surgery in 21 different countries, in 6 different continents.


Penile prosthesis implants last year


Complex Andrological procedures every year


Phalloplasties over his career