Azoospermia is a condition in which there’s no sperm detected in a man’s ejaculate (semen) on at least two separate occasions. Azoospermia leads to male infertility.
Different types of Azoospermia
There are two main types of azoospermia:
Obstructive azoospermia:
This type of azoospermia means that there is a blockage or missing connection along your reproductive tract. You are producing sperm but it’s getting blocked from exit so there’s no measurable amount of sperm in your semen.
Nonobstructive azoospermia:
This type of azoospermia means you have poor or no sperm production due to defects in the structure or function of the testicles or other causes.
SYMPTOMS AND CAUSES
What are the causes of azoospermia?
The causes of azoospermia relate directly to the types of azoospermia. In other words, causes can be due to an obstruction or nonobstructive sources. Obstructions that result in azoospermia most commonly occur in the vas deferens, the epididymis or ejaculatory ducts. Problems that can cause blockages in these areas include:
- Trauma or injury to these areas
- Infections
- 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 causes of azoospermia include:
- Genetic causes. Certain genetic mutations can result in infertility, including:
- Kallmann syndrome: A genetic (inherited) disorder carried on the X chromosome and that if left untreated can result in infertility.
- Klinefelter’s syndrome: A male carries an extra X chromosome (making his chromosomal makeup XXY instead of XY). The result is often infertility, along with lack of sexual or physical maturity, and learning difficulties.
- Y chromosome deletion: Critical sections of genes on the Y chromosome (the male chromosome) that are responsible for sperm production are missing, resulting 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)
- Cryptorchidism (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
- Tumours and Radiation Treatments
- Reactions to certain medications that harm sperm production
- Diseases such as diabetes, cirrhosis, or kidney failure.
- Severe Varicocele (veins coming from the testicle are dilated or widened impeding sperm production).
How is azoospermia diagnosed?
Azoospermia is diagnosed when, on two separate occasions, your sperm sample reveals no sperm when examined under a high-powered microscope following a spin in a centrifuge. A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged seminal fluid, if sperm cells are present, they separate from the fluid around them and can be viewed under a microscope. As part of the diagnosis, your healthcare provider will take your medical history, including asking you about the following:
- Measurement of testosterone and other hormone levels.
- Genetic testing.
- Ultrasound of the reproductive organs to see if there are any problems with the shape and size, and to see if there are tumours, blockages or an inadequate blood supply.
How is azoospermia treated?
Treatment of azoospermia depends on the cause. Genetic testing and counselling are often an important part of understanding and treating azoospermia. Treatment approaches include:
- If a blockage is the cause of your azoospermia, surgery can unblock tubes or reconstruct tubes.
- Medical hormone treatments: Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrozole and letrozole.
- If severe varicocele is the cause of poor sperm production, the problem veins can be tied off in a surgical procedure, keeping surrounding structures preserved.
- In certain cases of infertility due to azoospermia, sperms can be retrieved directly from the testicle by a trained male fertility specialist.
If living sperm are present, they can be retrieved from the testes, epididymis or vas deferens for assisted pregnancy procedures such as intracytoplasmic sperm injection (the injection of one sperm into one egg). If the cause of azoospermia is thought to be something that could be passed on to children, your healthcare provider may recommend genetic analysis of your sperm before assisted fertilization procedures are considered.
How can azoospermia be prevented?
If your azoospermia is not a genetic problem, doing the following can help lessen the chance of azoospermia:
- Avoid activities that could injure the reproductive organs.
- Avoid exposure to radiation.
- Know the risks and benefits of medications that could harm sperm production.
- Avoid lengthy exposure of your testes to hot temperatures.
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