Azoospermia

Many couples around the world suffer from infertility. When discussing infertility, we often tend to forget men’s responsibility in conceiving a child. Nearly 40% to 50% of cases of infertility are due to male factor infertility. Further, 10% to 15% of infertile men suffer from azoospermia. 

The possibility of pregnancy without ART with a partner suffering from azoospermia is negligible. However, the treatment options given in this article will help you and your partner conceive. Let us walk you through and explain what azoospermia actually is. We will talk about its type, possible causes, and male infertility treatment.

How male reproductive system works?

• Sperms are produced in the testes. 
• The sperm are then mixed with the seminal fluid or semen in the seminal gland. 
• In the prostate gland fluids are added to the overall semen mix. 
• The semen then moves through the urethra which travels from bladder, through the prostate gland and then through the penis during ejaculation. 

What is azoospermia?

Azoospermia means the absence of sperm in the ejaculation of the semen. It is one of the reasons for infertility in men. It either happens due to no production of sperm in the testicles or an obstruction in the reproductive tract.

Can it happen to you?

Azoospermia affects 1 per cent of men around the world. 10 per cent to 15 per cent of infertility in men is due to azoospermia. Thus, the chances are very less for one to suffer from it. Nonetheless whenever someone faces the symptoms mentioned should immediately consult the doctor. 

What are the symptoms of azoospermia?

Generally, the symptoms of azoospermia can go unnoticed. A person finds out that they may have it when they are unable to conceive for one year after having unprotected sex. Other than infertility there are no prominent symptoms. However, some of the noticeable azoospermia symptoms include: –

• Low sex drive
• Erectile dysfunction
• Low ejaculation fluid or having a dry orgasm
• Swollen testicles
• Decreased hair on the face or body
• Small or undescended testicles
• Painful urination
• Cloudy urine after sex
• Pelvic pain
• Delayed or abnormal puberty
• Smaller penis 

These all are the symptoms of azoospermia. They are related to different types of azoospermia differently. Let’s find out how. 

What are the types of azoospermia?

Broadly there are two types of azoospermia obstructive and non-obstructive. Post-testicular azoospermia is a type of obstructive azoospermia. Under non-obstructive, there are further two types which are pre-testicular azoospermia and testicular azoospermia.

1. Obstructive Azoospermia

Out of all the azoospermia cases, 40 per cent of the cases are of the obstructive type. In this type, the sperms are produced but are obstructed to flow out due to blocked in the reproductive tract. Post-testicular azoospermia is an obstructive type.

2. Post-testicular azoospermia

It can be diagnosed if there is low serum follicle-stimulating hormone (FSH) present and low testosterone level. A semen analysis will give no sperm count. 

The treatment will depend on its causes and the fertility issue of the female partner. Surgery can remove the obstruction. The other option is sperm retrieval or testicular sperm extraction which will be used for IVF or IUI.

The conditions responsible for this type are the absence of vasa deferentia, vasal obstruction, epididymal obstruction, ejaculatory duct obstruction and disorders of ejaculation. 

3. Non-obstructive Azoospermia

The rest 60% of the azoospermia cases are of the non-obstructive type. There is an issue in sperm production itself. There are further two types – pre-testicular and testicular.

4. Pre-testicular azoospermia

In this, there is no issue with the testicles but it is unable to produce sperms. It is also called secondary testicular failure. 

It usually results from pathological endocrine conditions. The problem could be the result of a genetic problem, medications, exposure to radiation or toxic materials, infection and/or inflammation. 

Hormone balancing medicine could be used to restart the production of sperms. Then the sperms could be collected through sperm retrieval or testicular sperm extraction method. 

5. Testicular azoospermia

This typically happens when there is a sperm production disorder in the testicles themselves. The causes for they are of two types acquired and congenital. 

Infections like mumps orchitis and malaria, exposure to pesticides and chemicals, cancer and its treatment are acquired causes. Whereas the congenital causes are cryptorchidism, Klinefelter’s syndrome and genetic chromosomal abnormalities. 

For the couple to get pregnant after this testicular sperm extraction method can be used. The sperm extracted can be used in IVF or ICSI. 

Thus, these types affect the fertility of men. Ever wondered what can be its causes?

What are the causes of azoospermia?

Obstructive Azoospermia may occur due to the following reasons: – 

• Epididymis blockages- They can be caused by several conditions like epididymitis infection, inflammation, scrotal trauma or injury and/or rare genetic conditions. 
• Retrograde Ejaculation- It is a condition where the sperm goes to the bladder of the person instead of his penis and mixing with the semen. 
• Infections- Infection or inflammation in the reproductive tract due to childhood disease or sexual or non-sexually transmitted disease can cause azoospermia. 
• Enlarged varicocele- It obstructs the reproductive tract of men. 
• Ejaculatory duct blockages- It can be present from the time of birth or can happen due to infection, trauma or any prior surgery. 
• Surgery of the vas deferens- Vasectomy, injury or surgery like hernia repair causes cuts or clamps in the vas deferens which obstructs the flow of the sperm in the reproductive tract. 
• Development of a cyst
• Cystic fibrosis gene mutation- It causes no or abnormal development of the vas deferens. This leads to building of thick secretion in the vas deferens and the semen gets blocked. 
• Vasography performed with improper technique

Non- obstructive type can be for various reasons ranging from: – 

• Genetics- Genetic mutations like the Kallmann syndrome, Klinefelter’s syndrome, etc. can cause azoospermia.
• Y chromosome deletion- Y chromosome is essential for the formation of sperms. When it is missing an individual is unable to produce sperms. 
• Toxin and radiation exposure-Exposure to radiation, chemotherapy and toxins like heavy metal may be the cause.
• Medications- Certain medicines like Cyclophosphamide, Chlorambucil, Colchicine, etc. can cause side effects harming the fertility of the men. 
• Hormone imbalance- Disorders like hypogonadotropic hypogonadism, hyperprolactinemia, etc. can also be the reason. 
• Karyotype abnormality- In men there are 46 chromosomes 22 are in pairs, plus one X and one Y chromosome. Having an extra X chromosome causes Klinefelter syndrome resulting in low sperm count and testosterone levels. 

Here we can clearly see that different types of azoospermia have different causes. The treatment and diagnosis also greatly depend on the type of problem. 

How is it diagnosed?

• Medical History– The doctor will have to know about the patients’ medical history to find out the reason for the problem to determine its type. It includes medical and surgical history, history of childhood illness, history of infections like UTI or STIs, and/or prior or current exposure to things like radiation or chemotherapy.
• Physical examination– Blood tests will be done to establish follicle-stimulating hormone (FSH) and testosterone levels. Palpation of the testes and measurement of their size and estrogen and prolactin levels are also checked. 
• Endocrine evaluation – It helps in formulating specific diagnosis and treatments for a large population of infertile men. 
• Semen Analysis– It is the main part of the diagnosis. Semen sample is taken to the lab for testing. If sperms are absent in the semen means one has azoospermia. It can be either the testes are not producing sperm or the sperm is restrained in the reproductive tract. 
• Karyotype testing and genetic testing– It sees whether any inheritable genetic condition had led to congenital azoospermia. 
• Transrectal ultrasound– It aids in finding out any blockage in the reproductive tract.  
• Diagnostic testis biopsy- This is only an option if the other listed diagnosis does not work. 
• Post-ejaculatory urinalysis– This test looks for sperm in the urine after one has ejaculated. It can be a sign of obstructive azoospermia. 

This diagnosis will help in better understand the problem and help formulate strategies for its treatment.

What are the effects of azoospermia on fertility? 

Possibility of pregnancy with when the partner is having azoospermia is to an extent negligible. It does not matter whether the partner has the obstructive or the non-obstructive type. Assisted Reproductive Technology (ART) can help in this case. The most common method is IVF. Let’s see what are the other possible solutions for it. 

What are the treatments for azoospermia?

Azoospermia treatment hugely depends on the type of azoospermia. Along with that, the condition of female fertility is also taken into consideration. Some of the possible treatments could be: – 

• Surgical treatment- Cases of obstructive azoospermia can be treated by performing a microsurgical treatment. It will help remove the obstacle for the flow of the sperm. It can also treat a varicocele and retrograde ejaculation. 
• Sperm retrieval- Sperm in this process is retrieved from post- ejaculate urine. It is then used in assisted reproductive technique like intrauterine insemination (IUI) or in-vitro fertilisation (IVF). This is effective for the non-obstructive type.
• Hormone treatment- The hormone treatment involve medicine which balances the hormones. It can help to increase the sperm content in the ejaculation, stimulate sperm development in men with azoospermia or allow enough sperm which will aid in the sperm retrieval method. 
• Testicular Sperm Extraction- In this process the sperm cells are directly extracted from the testes. The sperm extracted via this method can only be used in IVF or Intracytoplasmic sperm injection (ICSI). 
• Vasectomy reversal- Some cases of azoospermia can be due to previous vasectomy. Vasectomy reversal can be performed if a patient wants to plan a pregnancy. This can restore sperm flow into the semen. 
• Varicocelectomy- Enlarged varicocele, also leads to azoospermia in men. To restore healthy sperm production a microscopic varicocelectomy can help. 

Conclusion

To summarise it all, azoospermia affects the fertility of men who have the problem. The causes vary from genetics to any infection in the reproductive parts. The types are based on its causes and effects. Diagnosis of the problem is an elaborative process. The treatment of azoospermia takes under its umbrella various assisted reproductive technique process. You do not have to worry if you are suffering from azoospermia. With the help of proper treatments, the couple can conceive an off-spring. 

Suggestions

Male factor infertility should never be ignored. Couples who are facing problems with infertility should make sure that both partners are examined. Fertility Zilla has the best available doctors to give you guidance in diagnosis and treatment. Every Assisted reproductive Technique are available here. It provides the best IVF treatment in India. If in any doubt or have any questions feel free to contact us at- contact@fertilityzilla.com or +91 8882067985. 

FAQs

What kind of treatment do you need for azoospermia?

Surgery could be a good option. Hormone balancing medicine is also helpful for those who opt-out of the surgery or have non-obstructive type. Other treatments can include vasectomy reversal and varicocelectomy. 

When does the doctor tell you that you have obstructive azoospermia?

Semen analysis is done to find out whether you have azoospermia. When the testes are producing sperm but due to some blockage or issue with ejaculation sperm cannot reach the penis. It is the obstructive type. It can be found out through diagnosis done by the doctor. 

What do you need to know about azoospermia?

One must know the causes and symptoms of azoospermia. The treatment will be based on the type of azoospermia. It must be detected and treated immediately as some infections causing it can even be fatal. 

What kind of problem is post-testicular azoospermia?

Post-testicular azoospermia is the obstructive type. The problem is a blockage in the epididymis or vas deferens tubes or ejaculation dysfunction. This can be treated through surgery. If surgery is successful conceiving through without ART would be possible. 

How do you find out if you have azoospermia?

When even after one year of unprotected sex the partner is unable to conceive without any fertility issue on her part. Other symptoms may include low sex drive, pain in the pelvic region and less body hair. 

What does it mean to have pre testicular azoospermia?

Pre-testicular azoospermia directly affects hormones that are responsible for sperm production. The reason for pre-testicular type includes exposure to radiation or chemotherapy, genetic condition, etc.  It could be rectified in some cases by using hormone-balancing medicine. If not, then taking the method of a sperm donor or embryo donor can help the couple in conceiving. 

Is it possible to have biological children with azoospermia?

It depends on the type of azoospermia. Where there is a possibility of retrieving the sperm then pregnancy can be through Assisted Reproductive Technique (ART). 

References

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5. https://my.clevelandclinic.org/health/diseases
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