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Azoospermia

Dr. Rajalakshmi VK (AIIMS)MBBS

September 17, 2020

September 17, 2020

Azoospermia
Azoospermia

About 15% of all couples around the world are infertile. This means they are unable to conceive a child naturally, irrespective of how often or how much they engage in sexual intercourse. A high percentage of these couples are unable to conceive due to infertility in men. 

There can be several reasons for this: male infertility is primarily due to low sperm count. Irregularity or dysfunction in the sperms or certain blockages that may be hindering the production and delivery of sperm in the body are some other potential reasons for male infertility. A very small percentage of infertile men have a condition known as azoospermia, where there is no sperm in their semen.

Read more: What is semen

According to various estimates, about 1% of all men in the world have azoospermia while 10-15% of men who are infertile are also said to have this condition, making it an extremely rare condition.

An average male has a sperm count of 15 million to over 200 million per millilitre of semen—the condition of azoospermia is extremely unusual. Read on to know the types, symptoms, causes and management of azoospermia.

Types of azoospermia

There are two chief kinds of azoospermia:

  • Obstructive azoospermia, where the man's testicles are able to produce sperm but there is an obstruction in the passages that deliver sperm to the semen. It is also known as post-testicular azoospermia.
  • Non-obstructive azoospermia, in which the man may have a disorder that results in the production of abnormal sperm, or low production or no production of sperm. This condition is also known as pre-testicular or testicular azoospermia. Non-obstructive azoospermia is often associated with a problem with the testes (testicular impairment) or hormonal imbalance (inadequate gonadotropin production).

Azoospermia symptoms

The symptoms of azoospermia may go unnoticed until a couple tries to conceive a child—if regular efforts to conceive are not working, the factor of male infertility comes into the equation, which may reveal the presence of this condition.

That said, there are some other signs that could help a doctor diagnose azoospermia:

Keep in mind that azoospermia is rare. If you have any of these signs, don't panic. Go to a doctor—a sexologist or fertility specialist—who can do a thorough checkup to confirm or rule out this condition.

Azoospermia causes

Both obstructive and non-obstructive factors could be behind the development of azoospermia in a man. Here are some of the primary causes:

  • Vasectomy: A vasectomy is a birth control measure designed to stop the flow of sperm from the testicles. Someone who has had a vasectomy would have azoospermia—that is, semen without sperm.
  • Cystic fibrosis (CF): Cystic fibrosis (CF) affects the respiratory and digestive systems. But it is also associated with obstructions in the vas deferens (ducts that carry sperm to the semen) and epididymis on either side of the testicles. As many as 95% of all men with cystic fibrosis do not have fully developed ducts (vas deferens), a condition known as the congenital bilateral absence of vas deferens (CBAVD).
  • Obstruction in the ejaculatory ducts: The tube that carries the sperm to the urethra and mixes it with fluids to form semen may be blocked in conditions such as congenital cysts (cysts present since birth) and some sexually transmitted diseases (STDs).
  • Phimosis: A condition where the foreskin is too tight and prevents the glans or the head of the penis from releasing urine and semen, phimosis may also be a factor behind azoospermia.
  • Surgery: Surgeries performed to treat hernia or other procedures could lead to cutting off of or blocking of the vas deferens, affecting the flow of sperm into semen.
  • The absence of testes: Anorchia or the congenital absence of testes is a rare condition that a child may be born with. The testes are responsible for the production of sperm.
  • Undescended testicle: Different from the absence of testes, undescended testicles is a condition where one or both of a child's testicles have not dropped into the scrotum before birth. It is also known as cryptorchidism.
  • Cancer: Certain types of cancer, and cancer treatments that include radiation and/or chemotherapy, are also known factors behind azoospermia.
  • Injury: External injuries to the groin area that have affected the testicles can also lead to azoospermia.
  • Genetic causes: Certain genetic conditions may also interfere with a man's sperm production. One such condition is Klinefelter's syndrome, where a person is born without the conventional combination of chromosomes (XXY instead of XY sex chromosomes).

Diagnosis of azoospermia

A doctor will ask for the person's medical history along with performing a physical exam to check for any external symptoms that may provide any answers.

semen analysis test is usually done to rule out or confirm male infertility—this test can help to diagnose accurately if the man has any infertility issues, including azoospermia.

The doctor may also ask about any surgeries, treatment or conditions that the patient may have had that can explain the difficulty in conceiving or infertility. Childhood illnesses are also associated with conditions such as azoospermia—detailed information about these, too, may tell the doctor more about the person's current condition.

Other tests may include checking for the man's hormone levels as well as genetics, besides imaging tests to analyse the genital area and the reproductive tract. (Read more: Male menopause)

Azoospermia treatment

Some obstructive forms of azoospermia are treatable. In conditions where the reproductive tract is causing issues, reconnecting or reconstructing the tubes and passages that take the sperm to form semen can be performed to treat azoospermia. Hormone therapy and medications may help when the condition is caused by low production of hormones.

Non-obstructive reasons for azoospermia, however, may not be reversible or treatable.

People with azoospermia who want to father a child can opt for procedures such as in-vitro fertilization (IVF) or other assisted reproductive technologies. Talk to your doctor about your options.



References

  1. Stanford Health Care [Internet]. Stanford Medicine, Stanford University; Azoospermia.
  2. Utah Center for Reproductive Medicine: University of Utah [Internet]. Salt Lake City, UT, USA. Azoospermia (Sperm Production)
  3. Sun F et al. Abnormal progression through meiosis in men with nonobstructive azoospermia. Male Factor. 2007 Mar; 87(3): 565-571.
  4. Aston KI and Carrell DT. Genome-Wide Study of Single-Nucleotide Polymorphisms Associated With Azoospermia and Severe Oligozoospermia. Journal of Andrology. 2009 Dec; 30(6): 711-725.
  5. Gershoni M et al. A familial study of azoospermic men identifies three novel causative mutations in three new human azoospermia genes. Genetics in Medicine. 2017 Feb; 19: 998-1006.

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