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Cryptospermia or cryptozoospermia is not a very common condition, which is one of the reasons this diagnosis is often missed. The word crypto means hidden, and as the word suggests, patients with cryptospermia have occasional sperm in the semen, but because their numbers are so few, they are very difficult to find and easy to miss. This is quite a common problem when the semen analysis is done in a general medical laboratory, where the laboratory technicians are not experienced and don't know how to do the semen analysis properly. A lot of technicians will do the microscopic analysis of the semen sample quite casually - and will report it is as having a zero sperm count or azoospermia, if they cannot see sperm in the first quick glance.
This can be very misleading, and lead both the doctor and the patient on a wild goose chase. Many of these patients end up with unnecessary surgery, such as a testis biopsy and even a VEA ( vaso epididymal anastomosis), because the diagnosis was not made correctly.
This is why it's extremely important that before labeling the sample as being azoospermia, the laboratory technician should centrifuge the sperm sample and look at the pellet very carefully for the presence of sperm.
Not only is it important for technicians to be aware of this condition, but it's also equally important for patients to be vigilant. Thus, if your semen analysis is reported as showing azoospermia, these are the two things you need to do.
The reason this makes such a big difference is that if there are a few sperm in your semen sample, then your best treatment option would be ICSI; and there is no need to waste time and money on medical treatment or ineffective surgical therapy.