Stem Cell Therapy for Non-Obstructive Azoospermia:

Mesenchymal stem cells, also referred to as mesenchymal stromal cells (MSC) have been widely studied in clinical settings for their therapeutic potential in a number of diseases as well as tissue and organ damage. Besides therapeutic applications via injection of isolated stem cells, they have been used in tissue and organ scaffolding in order to regenerate a tissue or a whole organ! While stem cell induced organoids and organs are still work under progress and will need some time before they come into commercial use. However, mesenchymal stem cells are in commercial use in dermatology and orthopedics.

Manual liposuction using a syringe-connected cannula is the wide-spread method of obtaining mesenchymal stem cells. Therefore, we use the patient’s own adipose tissue and isolate his own stem cells before injecting it back for therapeutic purposes. This avoids introducing any foreign cells into the patient’s system.

MSCs are multipotent progenitor cells which means they have the ability to differentiate into many other cell types such as chondrocytes, osteoblasts and adipocytes. Therefore, they have multiple uses in the clinical setting for therapeutic purposes. However, this is not all they do. Mesenchymal stem cells are also involved in the expression of several enzymes and secretion of various factors including growth factors and chemokines. Growth factors are substances which stimulate cellular growth, proliferation and cell differentiation. Chemokines are known for their pro-inflammatory and homeostatic activity. It is through these amazing properties that mesenchymal stem cells are able to exert a number of healing and therapeutic properties. These therapeutic and healing properties have been observed and confirmed in numerous scientific studies on animals as well as on humans in certain applications.

What is Azoospermia?

Azoospermia is a condition defined by total absence of sperm cells in the ejaculate. The seminal fluid consists of semen and other factors, but no live sperm cells. Azoospermia is categorized under to main classes:

  • Obstructive Azoospermia: A condition where sperm cells are blocked from reaching the ejaculate due to a physical obstruction in the tubular system. Patients suffering from obstructive azoospermia have active spermatogenesis (sperm production) and mature sperm cells are often found in the epididymis or the vas deferens, but these sperm cells cannot be transported to the ejaculate. In these cases, surgical sperm extraction methods such as PESA, TESA, TESE can be used to obtain liver sperm cells surgically to be used in an IVF cycle.
  • Non-Obstructive Azoospermia: Refers to no sperm production in the reproductive tract. The reproductive organs maybe intact and there may be no apparent/visible defects. However, sperm production/maturation may be affected due to a genetic condition, exposure to radiation, accident or a surgery. In this type of azoospermia, the germ lines cannot induce production and maturation of viable sperm cells. It is men with this type of azoospermia who are ideal candidates for stem cell therapy.

The patient’s adipose tissue is obtained through manual liposuction and is processed for a certain period of time so that the mesenchymal stem cells can be isolated and cultured. After a successful culture period, the stem cells become ready for injection into the area where cell lines need rejuvenation/regeneration. The injection is done once with a certain amount of stem cells and the patient is discharged after a few hours of resting.

Given that spermatogenesis (sperm production from germ cell lines) takes about 75 days until mature sperm cells reach the ejaculate, the first follow up is done about three months after injection. We order a semen analysis test three months after initial injection to see if there are any live sperm cells in the ejaculate. This is repeated again after a month to observe any changes. In cases where both obstructive and non-obstructive azoospermia are present, a surgical sperm retrieval method may be necessary after stem cell injection.

How Does Stem Cell Therapy for Non-Obstructive Azoospermia Work?

Stem cells are isolated from the adipose tissue to be obtained from abdominal liposuction. This is a small-scale surgery, which is performed by a surgeon, therefore, before undergoing surgery, a written consent is obtained from the patient.

Adipose tissue obtained via the liposuction process is then subjected to enzymal dissociation and several other procedures so that the stem cells can be successfully isolated. In the meanwhile, patient’s platelet rich plasma (PRP) is also isolated separately. After the stem cells are subjected to culture media and seeding and once all the procedures are carried out, the combination of PRP with stem cell population is injected into testes at four different locations.

Once the PRP and MSC combo has been injected, the patient is discharged and semen analysis testing is ordered in 3 months time to observe the effects of stem cell therapy.

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