What is azoospermia?

You probably think that it is something uncommon, right? Using the parallelism of hopkinsmedicine.org if you were at a stadium with 50,000 men attending a game — around 5,000 to 7,500 of those men will be infertile, and 500 of those men will be azoospermic! That number shows that around 10% of infertile men struggle with azoospermia, and 1% of the general male population does too. 

So, when we talk about azoospermia, we mean the condition where there is no sperm in the ejaculate. Its causes include a blockage along the reproductive tract, hormonal problems, ejaculation problems or issues with testicular structure or function. 

Types of it:

  1. Obstructive azoospermia. It means that there is a blockage or missing connection in the epididymis, vas deferens, or elsewhere along your reproductive tract. You are producing sperm but it’s getting blocked from exit so there’s no measurable amount of sperm in your semen.
  2. Non-obstructive azoospermia. It is when you have poor or no sperm production due to defects in the structure or function of the testicles or other causes.

Causes of azoospermia:

  • Trauma or injury to these areas.
  • Infections.
  • Inflammation.
  • Previous surgeries in the pelvic area.
  • Development of a cyst.
  • Vasectomy (planned permanent contraceptive procedure in which the vas deferens are cut or clamped to prevent the flow of sperm).
  • Cystic fibrosis gene mutation, which causes either the vas deferens not to form or causes abnormal development such that semen gets blocked by a buildup of thick secretions in the vas deferens.
  • Genetic causes such as Kallmann syndrome (a genetic (inherited) disorder carried on the X chromosome), Klinefelter’s syndrome (when a male carries an extra X chromosome), Y chromosome deletion (when critical sections of genes on the Y chromosome that are responsible for sperm production are missing, resulting in infertility.).
  • Hormone imbalances/endocrine disorders, including hypogonadotropic hypogonadism. hyperprolactinemia and androgen resistance.
  • Ejaculation problems such as retrograde ejaculation where the semen goes into the bladder.
  • Anorchia
  • Cryptorchidism
  • Tumors
  • Radiation treatments
  • Diabetes
  • Kidney failure
  • Varicocele (when veins coming from the testicle are dilated or widened impeding sperm production)

How can you diagnose azoospermia?

Obviously, when trying to conceive for months with no success, you and your partner shall visit a fertility specialist in order to find the cause of infertility. So there is a chance of this condition to be the core of your infertility struggles. Part of the specialist’s diagnosis will include asking the male partner about the above: 

  • Fertility success or failure in the past.
  • Childhood illnesses.
  • Injuries or surgeries in the pelvic area.
  • Urinary or reproductive tract infections.
  • History of sexually transmitted diseases.
  • Exposure to radiation or chemotherapy.
  • Current and past medications.
  • Any abuse of alcohol, marijuana or other drugs.
  • Recent fevers or exposure to heat, including frequent saunas or steam baths (heat kills sperm cells).
  • Family history of birth defects, learning disabilities, reproductive failure or cystic fibrosis.

After taking the medical history he/she will proceed with a physical examination and check your entire body in terms of signs of/lack of maturation of it. Reproductive organs will also be checked for tenderness or swelling of your epididymis, size of the testicles, the presence or absence of a varicocele, and any blockage of the ejaculatory duct (via exam through the rectum) as evidenced by enlarged seminal vesicles.

How can it be treated?

Always according to the cause. Treatment approaches include:

  • If a blockage is the cause of azoospermia, surgery can unblock tubes or reconstruct and connect abnormal or never developed tubes.
  • If low hormone production is the main cause, you may be given hormone treatments. Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrazole and letrozole.
  • If a varicocele is the cause of poor sperm production, the problem veins can be tied off in a surgical procedure, keeping surrounding structures preserved.
  • Sperm can be retrieved directly from the testicle with an extensive biopsy in some men.

If living sperm are present, they can be retrieved from the testes, epididymis or vas deferens for ART procedures such as IVF and ICSI. 

Is it preventable?

Currently there is no known way to prevent the genetic problems that cause it. If the condition is not a genetic problem, doing the following may help lessen the chance of it:

  • Avoid activities that could injure the reproductive organs.
  • Avoid exposure to radiation.
  • Know the risks and benefits of medications that could harm sperm production.
  • Avoid lengthy exposure of your testes to hot temperatures.

Extra common questions about azoospermia:

Q: Is it definite that when you have the condition you produce no sperm at all? 

A: Not necessarily. The testis can be making sperm, but it might not be enough to have any noticeable amount come out in the ejaculate.

Q: Should you undergo a diagnostic testis biopsy?

A: In the past, yes.  In modern practice though, biopsy is rarely performed alone. In most cases, doctors can predict with high accuracy whether or not a man has an obstructive cause of azoospermia.

Q: Can a man have normal testosterone and be azoospermic?

A: Sperm come from “germ cells” in small tubules within the testis. Testosterone comes from “Leydig” or “interstitial” cells in between the tubules. Since Leydig cells are more resilient than germ cells, they will often function partially or fully, even in a damaged or poorly formed testicle.

For any other inquiries please consult with the right specialist. If at any point you decide to proceed with a fertility treatment, contact us for more information. 

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