Azoospermia

Azoospermia is termed used for no sperm count. Men may ejaculate, but their semen does not contain sperm. It might not get noticed till the man tries to make his female partner pregnant but fails. It’s the leading cause of infertility. Many of its causes are treatable, so it should be carried out earliest as one is aware of this problem.

It is mainly caused due to a blockage along the reproductive tract, hormonal problems, ejaculation problems, or issues with testicular structure or function.

Types of Azoospermia

The types of azoospermia are as follows: –

Pre-testicular azoospermia

It is a condition in which testicles are normal, but due to low hormone levels, the manufacturing of sperm is not taking place. It may also happen due to the effect of chemotherapy.

Testicular azoospermia

It is a condition in which there is no production of sperm. It can be because of many reasons, such as damage or injury to the testicles, or it might be due to infection in the reproductive tract. Genetic conditions like Klinefelter’s syndrome, Groin injury, or cancer and its treatment can also cause testicular azoospermia.

Post-Testicular Azoospermia

It is caused due to certain obstructions in the reproductive tract that prevents sperms from getting out. One of its leading causes is Vasectomy. Retrograde ejaculation is another factor that contributes to this condition. In retrograde ejaculation, semen retrogrades into the bladder instead of getting ejaculated out of the penis. Approx 40% of men are affected by this retrograde ejaculation.

Causes of Azoospermia

The causes of azoospermia are due to obstructive or nonobstructive sources.

Obstructions resulting in azoospermia occur in the vas deferens, epididymis, or ejaculatory ducts. The reason for blockage in the area may include

  • Vasectomy
  • Infections
  • Inflammation
  • Trauma or Injury in these areas
  • Previous Surgeries in the Pelvic Area
  • Development of a Cyst
  • Cystic Fibrosis Gene Mutation

Nonobstructive Causes of Azoospermia include:

  • Genetic Causes: – Some genetic causes can result in infertility, such as: –
  • Kallmann syndrome– It’s a genetic disorder that causes infertility in men if left untreated.
  • Klinefelter’s syndrome– In this genetic disorder male carries an extra X chromosome making his chromosomal makeup XXY instead of XY. This can result in infertility, lack of sexual or physical maturity, and learning difficulties.
  • Y chromosome deletion: the male chromosome that is responsible for sperm production is missing, which results in infertility.
  • Hormone imbalances, including hypogonadotropic hypogonadism, hyperprolactinemia, and androgen resistance.
  • Ejaculation problems include retrograde ejaculation, where the semen goes into the bladder.
  • Testicular causes, such as:-
  • Diabetes
  • Prior surgery
  • Trauma
  • Varicocele: dilation of spermatic veins.
  • Cryptorchidism: the testicle fails to drop from the inguinal channel to the scrotum.
  • Orchitis: inflamed testis due to an infection caused by mumps in late puberty.
  • Testicular torsion.
  • Anorchia: absence of the testicles.
  • Reactions to certain medications that herms sperm production.
  • Sertoli cell-only syndrome: testicles fail to make living sperm cells
  • The spermatogenic arrest is when testicles fail to deliver fully mature sperm cells.

Symptoms of Azoospermia

One may not have any symptoms. One can know they have azoospermia only when they are unsuccessful in conceiving after one year of unprotected intercourse. Any other signs or symptoms one encounter may be more related to hormonal imbalances or chromosomal genetic conditions.

However, some signs and symptoms that may indicate that you are at risk for azoospermia may include the: –

  • Ejaculate volume is low or dry orgasm
  • Cloudy urine after sex
  • Low sex drive
  • Painful urination
  • Pelvic pain
  • Erectile Dysfunction
  • Swollen testicles
  • Small or undescended testicles
  • Smaller than normal penis
  • Delayed or abnormal puberty
  • Reduced male hair growth
  • Enlarged breasts
  • Muscle loss

How is Azoospermia Diagnosed?

Semen analysis is the primary way to diagnose azoospermia. If your first semen analysis comes with zero sperm, your doctor will tell you to repeat the test a few months later.

And once azoospermia is diagnosed, the next step is to identify its cause. So the doctor will perform the physical exam along with knowing your medical history, which may include the following: –

  • Your fertility success or failure in the past (whether or not you conceived a child in the past)
  • Childhood illness
  • Your family histories like cystic fibrosis or fertility issues
  • Injuries or different surgeries you had in the pelvic area or reproductive tract
  • Urinary tract infection (UTI) or sexually transmitted infections (STI)
  • Prior or current exposure to radiation or chemotherapy
  • Current or past medications
  • Any possible misuse of drugs or alcohol
  • Recent illness that involved a fever
  • Recent exposure to high heat

Your healthcare provider may also do the following tests: –

  • Blood tests check the hormone level or genetic conditions for specific inheritable diseases.
  • Measure testosterone and follicle-stimulating hormone (FSH) levels.
  • X-rays or transrectal ultrasound of the reproductive organs to see if there are any problems with the shape and size and to look for blockages or abnormalities of the male reproductive tract or an inadequate blood supply.
  • Imaging of the brain to determine disorders of the hypothalamus or pituitary gland.
  • Testicular biopsy

A proper evaluation will include only some of the above tests. Tests like a testicular biopsy shouldn’t be used if other tests have already diagnosed the cause. A female partner evaluation is equally important as this will help in deciding the best treatment path for the couple.

Azoospermia Treatment

The treatment of azoospermia depends on its causes. So, if the cause of azoospermia is the blockage, it can be treated by either reconnecting or reconstructing the tubes or ducts that do not allow sperm to flow. This means surgery can unblock, reconstruct or connect the abnormal or never develop tubes.

And suppose low hormone production is the cause of azoospermia. In that case, you may be given hormone treatment and medications. Hormones may include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrozole, and letrozole.

Or if a varicocele is the cause of low sperm production, then with the help of surgery, the problem veins can be tied off, keeping surrounding structures preserved.

If one has a living sperm, one can have a biological child by retrieving it from the testes, epididymis, for techniques like IVF or ICSI with an extensive biopsy in some men.

How can Azoospermia be Prevented?

Despite genetic problems, one can prevent azoospermia by doing the following: –

  • Avoid rough contact sports, which may harm your testes and reproductive organs.
  • Limit radiation exposure.
  • Ask your doctor about the benefits and risks of medications that may harm sperm production.
  • Avoid activities that expose your testes to hot temperatures, like steam baths.

Conclusion

Most of the cause of azoospermia is treatable. However, if it is not treatable and living sperm is present in the testicles, then one can still have a genetic child through assisted reproductive technologies like IVF. So don’t be scared if diagnosed with azoospermia. Please discuss with your healthcare provider and determine its cause and available treatment.

Frequently Asked Questions (FAQs)

Yes, varicocele can lead to male infertility. The severity of infertility can be mild to severe and cause sperm disorders or hormonal imbalances.

The price of treatment of azoospermia varies from place to place. In metropolitan cities, its treatment cost is relatively higher than in other cities of India. Its price range varies from Rs 45000 to Rs 60000. However, the cost of treatment also depends on the cause of azoospermia.

You should contact your healthcare provider if any of the following symptoms persist: –

  • Having a fever.
  • Feeling weak, chills, and achy.
  • Seeing changes in your body, such as increased body fat, body hair, or breast tissue.
  • Having pain in the groin area that does not go away.

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