Overview

Azoospermia is not a very common problem in men. In medical terms, it means there is no sperm present in the semen. Azoospermia in males is seen in around 1 out of 10 men who have fertility issues. In such cases, the associated reproductive technology can help the men to have genetic offspring. In case that is not possible then the doctor can suggest the options like embryo donor, sperm donor, or adoption.

What is sperm production?

To get a better understanding of azoospermia, it is important to know about sperm production. The sperm cells start their journey in the testicles and inside of the body temperature will not be able to be handled by the sperm. Initially, the sperm cells are tiny and round. When they get interacted with hormones like FSH and LH, they

mature and develop.

What are the types of azoospermia?

Azoospermia is divided into 3 categories which are:

Pre-testicular azoospermia

Pre-testicular azoospermia is one that is linked to hormonal issues and it is also referred to as secondary testicular failure.

Testicular azoospermia

Testicular azoospermia is the type when the problem is with the testes. It is possible that the testes are not producing the testosterone or the testes are responding to the hormones released by the endocrine glands. Sometimes, there is the issue of sperm development.

Post-testicular azoospermia

Post-testicular azoospermia is the type when there is ejaculation dysfunction or blockage.

It is important to understand whether this problem has resulted in blockage or not. This is the reason you need to consult the doctor and he can tell you better what is the issue with sperm development.

What are the signs and symptoms of azoospermia?

As we have mentioned earlier, it is a problem of the lack of sperm in the semen. Usually, it does not result in any specific symptoms. If a couple is not able to conceive, then the male partner may have this issue. With that said, some of the notable symptoms of azoospermia are mentioned below:

• Low ejaculate volume or “dry” orgasm (no or little semen)
• Small or undescended testicles
• Smaller than normal penis
• Delayed or abnormal puberty
• Cloudy urine after sex
• Painful urination
• Pelvic pain
• Swollen testicles
• Low sex drive
• Enlarged breasts
• Muscle loss
• Reduced male hair growth
• Difficulty with erections or ejaculation

What are the causes of azoospermia?

Obstructive azoospermia may be caused by:

• A congenital anomaly
• Previous trauma or injury (including surgical)
• Infection or inflammation of the reproductive tract.
• Retrograde ejaculation (There is no blockage involved in this situation).

Nonobstructive Azoospermia Causes

Nonobstructive azoospermia may be caused by the following reasons:

• A varicocele
• Hormonal imbalances
• A genetic or chromosomal anomaly
• Side effects of medications or hormonal supplements.
• Damage to the testes from radiation, chemotherapy, or other toxin exposure.

How is the problem diagnosed and tested?

Semen analysis is the preferred and best way to check the sperm count. In case, the results come as sperm count is nil, then the doctor might ask you to get another test after a few months. The problem of azoospermia is diagnosed after doing 2 semen analyses properly and making sure that there are no sperm in the semen.

After that, the doctor will check the reason and accordingly, a treatment plan is made for you. Some of the additional tests which might be done are:

• Testing the testicles through physical examinations
• Testicular biopsy, if needed
• Karyotype testing and genetic testing to check for inherited problems.
• Blood work is done to measure the hormones in the body like testosterone and FSH.
• Transrectal ultrasound (TRUS) to check the blockage or abnormality in the male reproductive tract
• Consulting you in detail about your past medical history which includes any type of STDs also.

What are the treatment options?

Your fertility treatment plan will be based on the type of azoospermia you have along with the reason. During the consultation, the doctor will talk in detail with you and determine what treatment plan is best suited for your health.

Treatment of address the Infections

At present, if there is an infection then the doctor will suggest getting it treated first. Sometimes, the infection might not result in any symptoms and it increases the chances of permanent damage to the male reproductive tract.

Surgical Repair

In cases like blockage, the doctor will suggest repairing it with treatment. Through the surgical approach, the varicocele is removed or treated along with retrograde ejaculation can be treated. In some cases, the problem is solved after undergoing the surgical procedure.

Medication or Hormonal Support

Some patients have suggested medication and it might help the couple to conceive. The hormonal drugs which are suggested to men include:

• Clomid
• FSH
• hCG injection
• Letrozole

Sperm Extraction From Post-Ejaculate Urine

In case retrograde ejaculation cannot be treated then the doctor will retrieve the sperm through post-ejaculation urine. If not, then the doctor will suggest you undergo IUI/IVF treatment.

Lifestyle Change or Discontinuation of Medications

In some cases, the men smoke, drink alcohol, or have excess weight. The doctor will suggest you make lifestyle changes as it might help to address the problem. In case a man undergoes a chemo session, then the sperm count might get affected. Although, it will return to normal once the chemo sessions are over.

Testicular Sperm Extraction With IVF and ICSI

The TESE procedure is used to extract the sperm cells from the testicles. The procedure is done under general anesthesia and by making a small incision the sperm cells are taken. Once that is extracted, the ICSI/IVF procedure is done. Although, there is the risk that you might pass the infertility issue to your child. You must consult the doctor about what option is best.

Final thought

As we have said, the problem is severe, but there are treatment options available that can help the patients dealing with this condition. If you are struggling to get the right information and do not know what to do, then you should book your initial consultation with our fertility expert.