Azoospermia is a medical condition in which a man’s semen contains no sperms. It is an important cause of infertility in males. Azoospermia is a condition in which a man has no sperm in his semen. It affects about 1% of males and may be seen in up to 15% of men with infertility.
TYPES OF AZOOSPERMIA
There are Two Main Types of Azoospermia:
Obstructive Azoospermia: This type of Azoospermia means that there is a blockage in the epididymis, vas deferens, or elsewhere along the reproductive tract. You are producing sperm but it’s not getting released so there is no sperm in your semen.
Nonobstructive Azoospermia: This type of Azoospermia means there is a defect in the structure or function of the testicles or other causes. As a result, there is poor or no sperm production..
CAUSES OF AZOOSPERMIA
The causes of Azoospermia relate directly to the types of Azoospermia. In other words, causes can be due to an obstruction or nonobstructive sources.
Obstructions that cause Azoospermia most commonly occur in the vas deferens, epididymis, or ejaculatory ducts. Conditions that can cause blockages at these sites include:
- Trauma or injury to these sites
- Inflammation.
- Infections.
- Any surgery in the pelvic area in the past.
- Any cyst.
- Vasectomy is a procedure for preventing pregnancy in men by sealing off the vas deferens, which carries sperm from the testes.
- There is a mutation in the cystic fibrosis gene that can lead to either problems with the vas deferens formation or an abnormal development of the vas deferens which results in blocked semen.
Nonobstructive Causes of Azoospermia Include:
- Genetic causes. Certain genetic conditions can cause infertility, including:
- Kallmann syndrome: A genetic disease carried via the X chromosome and that if left untreated can cause infertility.
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- Klinefelter’s Syndrome: A male carries an extra X chromosome (which makes his chromosomal makeup XXY instead of XY). The result is often infertility. There is also a lack of sexual or physical maturity and learning difficulties.
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- Y chromosome Deletion: Important sections of genes on the Y chromosome (the male chromosome) that are responsible for sperm production are missing, resulting in infertility.
- Hormonal imbalances/endocrine disorders, such as hypogonadotropic hypogonadism. hyperprolactinemia and androgen resistance.
- Ejaculation problems such as retrograde ejaculation where the semen goes backwards into the urinary bladder
- Testicular causes include:
- Anorchia (absent development of the testes).
- Cyptorchidism (testes have not descended into the scrotum).
- Sertoli cell-only syndrome (testes fail to produce live sperm cells).
- Spermatogenic arrest (testes fail to produce fully mature sperm cells).
- Mumps orchitis (inflamed testes caused by mumps infection in late puberty).
- Tumours
- Testicular torsion.
- Reactions to certain medications like chemotherapy that harm sperm production.
- Radiation exposure
- Diseases such as diabetes, cirrhosis, or kidney failure.
- Varicocoele is a condition in which veins from the testes are dilated, or widened, impeding sperm production.
DIAGNOSING AZOOSPERMIA
A male is said to have Azoospermia when your sperm sample reveals no sperm, on two separate occasions. A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged semen, if sperm cells are present, they separate from the seminal fluid and can be seen under a microscope.
The cause of azoospermia is diagnosed through a detailed medical history, examination, and special tests.
As part of the diagnosis, Your Fertility Specialist Will Take Your Detailed Medical History, including asking you about the following:
- Fertility success or failure in the past (your ability to have children).
- Childhood illnesses.
- Injuries or surgeries in the pelvic area
- Urinary or reproductive tract infections.
- History of sexually transmitted diseases
- Your current and past medications
- Exposure to radiation or chemotherapy
- Any abuse of alcohol, marijuana or other drugs.
- Recent fever or exposure to heat, including frequent saunas or steam baths
- Family history of birth defects, reproductive failure, cystic fibrosis or mental retardation.
Your Fertility Specialist Will Also Conduct a Detailed Physical Examination and Will Check:
- Your entire body for signs of/lack of maturation of your body and reproductive organs.
- Your penis and scrotum, checking for the presence of your vas deferens, tenderness or swelling of your epididymis, size of the testes, the presence or absence of any varicocele, and any blockage of the ejaculatory duct (via examination through the rectum) as evidenced by enlarged seminal vesicles.
In Addition To The Tests Above, Your Fertility Specialist Might Recommend the Following:
- Measurement of testosterone and follicle-stimulating hormone (FSH) levels.
- Genetic tests for any inherited abnormalities
- Ultrasound of the reproductive organs to see if there are any problems with the shape and size of testes and their appendages, and to see if there are blockages, tumors, or an inadequate blood supply.
- Imaging of the brain to identify disorders of the central nervous system for example hypothalamus or pituitary gland.
- Biopsy of the Testes. A normal biopsy would mean a blockage is probable at some point in the sperm transport system. Sperm that has been collected is frozen and can be used in assisted pregnancy, for example in IVF.
TREATMENT OF AZOOSPERMIA
Treatment of Azoospermia depends on the underlying cause. Genetic testing and genetic counseling by trained experts are often important parts of treating Azoospermia. Treatment approaches include:
- You may be prescribed hormone treatments if your symptoms are caused by a hormonal imbalance. These therapies might help you regonstitute your hormone levels and alleviate your symptoms. Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, and letrozole.
- If a blockage in the reproductive tract is the underlying cause of your Azoospermia, surgery can unblock tubes or reconstruct and connect abnormal or undeveloped tubes.
- If a varicocele is the cause of poor sperm production, it can be treated by tying off the blood vessels. The treatment preserves the surrounding structures so that they can still function normally.
- Some men’s fertility doctors may recommend genetic testing of their sperm before undergoing assisted fertilization procedures since some men have Azoospermia.
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