AZOOSPERMIA
Every day we have at least one man reach out to us indicating that they have azoospermia and they need help. They are usually feeling completely defeated. Almost always they do not even understand what the condition is and what options they have in their desire to father children. Hopefully this blog will shed light on the matter and restore hope to the many men/couples here in Kenya who have azoospermia as the cause of their infertility.
What is azoospermia?
Azoospermia is the medical term used when there are no sperm in the ejaculate.
It can either be:
- “obstructive,” where there is a blockage preventing sperm from entering the ejaculate,
- “non-obstructive” when it is due to decreased sperm production by the testis.
Obstructive Azoospermia
Here, testicles make normal sperm, but something keeps them from getting out.
Obstructions mostly occur in the vas deferens, the epididymus or ejaculatory ducts.
Problems that can cause blockages in these areas include:
- Trauma or injury to these areas.
- An infection in your reproductive tract, such as epididymitis and urethritis
- Inflammation.
- Previous surgeries in the pelvic area.
- Development of a cyst.
- Vasectomy (planned permanent contraceptive procedure in which the vas deferens are cut or clamped to prevent the flow of sperm).
- Cystic fibrosis gene mutation, which causes either the vas deferens not to form or causes abnormal development such that semen gets blocked by a buildup of thick secretions in the vas deferens.
Non-obstructive Azoospermia
Here the testis are not producing sperm as they should be. Causes of these include:
- Genetic causes. Certain genetic mutations can result in infertility.
- Hormone imbalances/endocrine disorders, including hypogonadotropic hypogonadism. hyperprolactinemia and androgen resistance.
- Ejaculation problems such as retrograde ejaculation where the semen goes in to the bladder
- Testicular causes include:
- Anorchia (absence of the testicles).
- Cyptorchidism (testicles have not dropped into the scrotum).
- Sertoli cell-only syndrome (testicles fail to produce living sperm cells).
- Spermatogenic arrest (testicles fail to produce fully mature sperm cells).
- Mumps orchitis (inflamed testicles caused by mumps in late puberty).
- Testicular torsion.
- Tumors.
- Reactions to certain medications that harm sperm production.
- Radiation treatments.
- Diseases such as diabetes, cirrhosis, or kidney failure.
- Varicocele (veins coming from the testicle are dilated or widened impeding sperm production).
How will Azoospermia be treated?
Treatment will definitely depend on the cause, but for any given patient, the best treatment is a customized approach based on many factors, such as partner’s age and reproductive function, physical exam findings, blood test results, long- and short-term family goals and even finances. Depending on the suspected causes, many treatments may be available. If there is a blockage (or history of vasectomy), reconstruction might be the best treatment for some men. In others, removing offending agents such as medications or recreational drugs might be the first step. Sometimes there may be hormonal abnormalities that need to be addressed, and in some men, treatment could increase sperm production. In some men, surgery to fix anatomical abnormalities or varicoceles can be pursued, and in others the best option is to go directly into the testicle to attempt retrieval of sperm that could be used for ART(assisted reproductive technology).
I had a semen analysis showing azoospermia — what should I do?
- the first step would be to get a repeat semen analysis at a lab that has a lot of experience doing semen and sperm tests, because results can vary a lot from test to test and lab to lab. Also, having small numbers of sperm can change the management/treatment options drastically, so the first step should be getting proper confirmation of the finding.
- After confirmation of the diagnosis, step 2 should be seeing a fertility doctor specializing in male infertility.
Sources:
John Hopkins Medicine “The Evaluation of the Azoospermic Male: American Family Physician: “Epididymitis and Orchitis: An Overview.”
UCSF: “In Vitro Fertilization,” “Intracytoplasmic Sperm Injection.”
Reproduction, Fertility and Development: “Causes of azoospermia and their management.”
The Urology Clinics of North America: “Obstructive Azoospermia.”
Clinics: “Obstructive azoospermia: reconstructive techniques and results.”
Indian Journal of Urology: “Surgical Sperm Retrieval: Techniques and Their Indications.”