Asthenospermia

Azoospermia

Azoospermia means the absence of sperm in a man’s ejaculate. Causes include obstruction of the reproductive tract, hormonal problems, ejaculation problems, and problems with testicular structure or function. Many causes are treatable and fertility can be restored. Live sperm may be collected for use in assisted reproductive technology for other reasons.

What is azoospermia? 

Azoospermia is the absence of measurable spermatozoa in a man’s ejaculate (semen). Azoospermia causes male infertility.

How common is azoospermia?

Approximately 1% of all men and 10-15% of infertile men suffer from azoospermia.

What are the parts of the male reproductive system? The male reproductive system consists of:

• The testes, or testes, produce sperm (male reproductive cells) in a process called spermatogenesis. 
• Seminiferous tubules are small tubes that make up most of the testicular tissue. 
• The epididymis is a structure at the back of each testicle where mature sperm are transported and stored. 
• The vas deferens are muscular tubes that extend from the epididymis into the pelvis, then bend and enter the seminal vesicles. 
• Seminal vesicles are tubular glands that produce and store most of the liquid component of semen.
• The bladder narrows and a straight tube called the vas deferens forms and connects to the vas deferens. 
• The ejaculatory duct is formed when the seminal vesicle fuses with the vas deferens. The ejaculatory duct enters the prostate and connects to the urethra. 
• The urethra is the tube through the penis that removes urine from the bladder and sperm from the vas deferens.

During ejaculation, sperm moves from the testicles and epididymis to the vas deferens. The constriction (contraction) of the vas deferens pushes the sperm forward. The secretions from the seminal vesicles are added and the semen continues to advance towards the urethra. Before reaching the urethra, semen passes through the prostate, where milky fluid is added to the sperm to form semen. Finally, the semen is ejaculated (released) through the penis and urethra. A normal sperm count is greater than 15 million/ml. A man with a low sperm count (oligospermia or oligozoospermia) has a sperm count less than 15 million/mL. If you have azoospermia, there are no measurable spermatozoa in the ejaculate.

Are there different types of azoospermia?

Mainly he has two types of azoospermia.

• Obstructive Azoospermia: This type of azoospermia means that there is a blockage or lack of connection in the epididymis, vas deferens, or elsewhere in the reproductive tract. Sperm are produced, but the semen does not contain measurable amounts because sperm ejection is blocked.
• Non-obstructive azoospermia: This type of azoospermia means poor or no sperm production due to defects in testicular structure or function, or for other reasons.

Symptoms and causes

What causes azoospermia? The causes of azoospermia are directly related to the type of azoospermia. In other words, the cause can be due to obstruction or non-obstruction.

Obstructions that cause azoospermia most commonly occur in the vas deferens, epididymis, or ejaculatory ducts. Problems that can cause blockages in these areas include:

• Trauma or damage to these areas. 
• Infection. 
• inflammation. 
• Previous surgery in the pelvic area.
• Development of cysts. 
• Vasectomy (a planned permanent contraceptive method that cuts or clamps the vas deferens to prevent the flow of sperm). 
• Genetic mutations in cystic fibrosis cause the vas deferens not to form or develop abnormally, causing a thick secretion to build up inside the vas deferens and block the semen.

Non-obstructive causes of non-obstructive azoospermia include:

Genetic cause. Certain genetic mutations can cause infertility, such as:

• Kallmann’s Syndrome: An inherited (hereditary) disorder on the X chromosome that can lead to infertility if left untreated. 
• Klinefelter’s Syndrome: Male has an extra of his X chromosome (the chromosomal configuration makes him XXY instead of XY). 
• Infertility, lack of sexual or physical maturity, and learning disabilities often result. 
• Y Chromosome Deletion: A key portion of the gene on the Y chromosome (male chromosome) involved in sperm production is missing, leading to infertility. 
• Hormonal/endocrine disorders, including hypogonadism hypogonadism. Hyperprolactinemia and androgen resistance. 
• Ejaculation problems, such as retrograde ejaculation, in which semen enters the bladder

Causes of testicles include:

• Absence of testicles. 
• The testicle does not descend into the scrotum. 
• Inability of the testes to produce viable sperm
• The testicles do not produce mature sperm. 
• Inflamed testicles caused by mumps in late puberty. 
• Testicular torsion. 
• Tumor. 
• Responses to certain drugs that affect sperm production. 
• Radiotherapy. 
• Diseases such as diabetes, cirrhosis, and renal failure. 
• Vein from the testicle dilates or dilates, preventing sperm production.

Diagnostics and Tests

How is Azoospermia Diagnosed?

Azoospermia is diagnosed when sperm is not observed twice in the sperm sample when examined under a high power microscope after centrifugation. A centrifuge is a laboratory device that spins a test sample at high speed to separate it into different parts. In the case of centrifuged semen, sperm, if present, are separated from the surrounding liquid and can be observed under a microscope.

As part of the diagnosis, your doctor will take your medical history and ask questions such as:

• Past fertility successes or failures (ability to bear children). 
• Pelvic injury or surgery (these can cause blockage of the ducts or reduced blood supply to the testicles). 
• Urinary tract or genital infections. 
• History of sexually transmitted infections. 
• Exposure to radiation or chemotherapy. 
• Medications currently and previously taken. 
• Abuse of alcohol, marijuana, and other drugs. 
• A recent fever or exposure to heat, such as frequent visits to saunas or steam rooms (heat kills sperm).
• A family history of birth defects, learning disabilities, reproductive disorders, or cystic fibrosis.

Your doctor will also do a physical examination to make sure that:

• Check for signs/lack of maturity throughout the body and reproductive organs. 
• Penis and presence of vas deferens, epididymal tenderness or swelling, size of testes, presence of varicocele, and possible blockage of the ejaculatory ducts (by examination from the rectum)
• Check the sac. Evidenced by enlarged seminal vesicles. 

Your doctor may also order the following tests:

• Measurement of testosterone and follicle-stimulating hormone (FSH) levels. 
• Genetic testing. 
• X-rays or ultrasonography of the genitals to check for problems with their shape or size, tumors, blockages, or inadequate blood supply. 
• Brain imaging to detect hypothalamic or pituitary disorders. 
• Testicular biopsy (tissue removal). 

A successful biopsy means there is likely a problem somewhere in the sperm transport system. 

Sperm found within the testes may be frozen for later analysis or used to support a pregnancy.

Management and treatment

How is azoospermia treated? 

Treatment for azoospermia depends on the cause. Genetic testing and counseling are often an important part of understanding and treating azoospermia. 

Treatment approaches include:

• If blockage is the cause of azoospermia, surgery can unblock the fallopian tubes or reconstruct and connect abnormal or underdeveloped fallopian tubes. 
• If low hormone production is the main cause, you may be on hormone therapy. Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrozole, and letrozole. 
• If varicocele is the cause of low sperm production, the problem vein can be surgically tied off, leaving the surrounding structures intact.
• In some men, an extensive biopsy can be used to obtain sperm directly from the testicles.
• If viable sperm are present, sperm may be taken from the testis, epididymis, or vas deferens for assisted pregnancy procedures such as in vitro fertilization or intracytoplasmic sperm injection (injection of sperm into the egg).
• If a doctor suspects that a cause of azoospermia may be passed on to the child, the doctor may recommend genetic testing of the sperm before considering assisted fertilization.
• Activated PRP injection into the testiscles might stimulate new testicular tissue growth and increase the blood supply leading to rejuvenation of the testis to sproduce sperms

Prevention

How can azoospermia be prevented? There is no known way to prevent the genetic problem that causes azoospermia. If azoospermia is not a genetic problem, the following measures may help reduce the risk of azoospermia:

• Avoid activities that can damage your reproductive organs. 
• Avoid exposure to radiation. 
• Understand the risks and benefits of drugs that may affect sperm production. 
• Do not expose the testicles to high temperatures for a long time. 

Outlook/Forecast

What is the long-term outlook for patients with azoospermia? Prognosis varies for each cause of azoospermia. Many causes of azoospermia can be treated. You and your health care team will work together to determine what causes azoospermia and how to treat it. Hormonal problems and obstructive causes of azoospermia are usually treatable and fertility may be restored. Even if the cause is testicular dysfunction, it is possible to obtain live sperm for use in assisted reproductive technology.