What is azoospermia?
- Azoospermia means there is no sperm in the semen. It may be a major cause of male infertility and may present from birth or develop in later life.
- Normally the testicles in a man’s scrotum produce sperm. The sperm flows through the male reproductive tract (vas deferens) to mix with fluid (prostate and seminal vesicles gland’s discharge) to form semen. Semen is thick, white fluid released from the penis during ejaculation.
- Low Sperm Motility may occur because of an obstruction in the vas deferens (sperm duct) or inadequate/absence of sperm production in the testicles
- It is estimated that approximately 1 % of all men and 10-15 % of infertile men suffer from azoospermia.
Types of azoospermia
There are two types of azoospermia.
- Obstructive azoospermia:
In this case, the reproductive tract for both testicles is blocked. In this case, there is normal sperm production, but no measurable sperm can get into the semen.
- Nonobstructive azoospermia:
In this type, the production of sperm is very poor. Testicles do not produce enough sperms for a detectable amount to show up in semen.
Causes of azoospermia
Causes of obstructive azoospermia:
Obstructions occur most commonly in the
1. Epididymis
The coiled tube on the back of each testicle is where sperm matures.
- Epididymis blockage:
- Epididymitis (bacterial or viral infection).
- Scrotal trauma/injury.
- Rare genetic condition (blockage or abnormal development)
2. Vas deferens
The tube that transports sperm from the epididymis.
- Vas deferens blockage:
- Injury during surgery on the vas deferens.
- Trauma or injury.
- Previous surgery for hernia repair.
- Cystic fibrosis gene mutation.
3. Ejaculatory duct:
The tube from which the sperms exit into the urethra and mixes with fluid to form semen.
- Ejaculatory duct blockage:
- Congenital (ejaculatory duct blockage is present at birth)
- Infection or trauma.
- Prior surgery.
Causes of nonobstructive azoospermia:
- Genetics: Y chromosome deletions cause up to 10 % of azoospermia patients.
- Hormone imbalance: It can cause azoospermia.
- Medications: Testosterone is necessary for normal reproductive functions but Taking it as a supplemental form can often cause azoospermia.
- Radiation and toxins: Heavy metal sperm production.
- Orchitis: One or both testicles swell or are painful due to infection.
- Not having testicles: Aals, pesticides, chemotherapy and radiation.
- Varicocele: It also can impair sperm testicles.
- Undescended testicles: A testicle that hasn’t moved into the scrotum.
- Lifestyle: Misusing drugs or alcohol and spending lots of time in hot tubs.
Symptoms of azoospermia
- Usually, they don’t realize the condition of Low Sperm Motility, until trying to conceive a child without success.
- Some people have low libido due to hormone imbalance.
Diagnosis and tests
- Semen analysis: On two separate occasions, shows no sperm.
- Medical history:
- Healthcare providers take a medical history, asking questions about injuries or surgeries for the pelvic region.
- Previous fertility history and semen report.
- Infections like mumps, measles, any viral infection, urinary tract infection, or sexually transmitted diseases.
- Current and past medication(testosterone or anabolic steroids).
- Drugs, alcohol, or marijuana abuse.
- Family history of birth disorders.
- Physical examination: Palpation of the scrotum and its contents will reveal the presence, size, position, and shape of the testicles.
- Blood tests: To measure testosterone and FSH (follicle-stimulating hormone) levels.
- Ultrasound sonography: Scrotal sonography is used help to evaluate the size and Abnormality of testicles, epididymis, and scrotum, prostate/rectal ultrasound sonography may be performed to check the size and shape of the prostate, seminal vesicles, and vas deferens. It may be also used to look for varicocele.
- Management and treatment:
- If the blockage is the cause of azoospermia, surgery is an option.
- If low hormone production is the main cause, hormone treatment may be helpful.
- Will sperm come back after azoospermia?
- Yes, it can, but it depends on the types of azoospermia.