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Causes, Diagnosis and Treatment of Azoospermia

  • 4.6 (6 Votes)
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Azoospermia is a condition in which there is no sperm in the male ejaculation and it is diagnosed with the semen analysis test. The lack of sperms is the result of dysfunctional hypothalamus or pituitary gland or blockage in the reproductive/ sperm ducts. Treatment for azoospermia involves surgery, sperm retrieval techniques such as TESA and FNA Mapping.

Azoospermia, as the name suggests, is related to sperms.  The literal meaning of Azoospermia is the absence of sperms in a man’s semen. Hence, Azoospermia is one of the major reasons behind male infertility. Reproductive glands in the male body generate sperm that combines with the seminal fluid generated by the accessory glands namely seminal vesicles, the prostate, and the bulbourethral glands which in a whole becomes the semen during ejaculation. The semen produced by an azoospermic seems normal in terms of its looks and consistency but lacks the most important part of a healthy semen i.e. sperms. Hence, if you get to hear by the specialists that your semen has no sperm in the ejaculation then it means you have Azoospermia.

Causes of Azoospermia

There are a number of reasons that cause azoospermia in men. However, different cases of this medical condition need different treatments.  Azoospermia is classified into two major categories - Obstructive Azoospermia (OA) and Non- Obstructive Azoospermia (NOA).

First of all, let’s get to know about these conditions and then we will discover the causes.

1. Obstructive Azoospermia (OA)

In this case, the sperm production transpires normally inside the man’s testicles but due to the blockage in the reproductive tubing the sperm get restrained from exiting the male’s body and entering the world outside. Usually, the men with Obstructive Azoospermia have less volume of semen while ejaculation.

obstructive azoospermia

Some of the common causes of Obstructive Azoospermia include:

  • Vasectomy: Vasectomy is a small surgery to block the male’s sperm carrying ducts. This is done intentionally to stop the sperm flow in the ejaculation. This is one of the most common birth control methods and it’s 100% effective. Previous vasectomy can also be the reason for obstructive azoospermia in men.
  • Infection: Another major cause of Obstructive Azoospermia is infection. Infections in testicles, prostate, reproductive tract or venereal diseases can lead to the suspension and blockage in the small tubules of the ejaculatory duct.
  • Surgical complications: Surgical complications can be another big reason behind the blockage of the ejaculatory duct, especially the surgery performed on the urogenital organs.
  • Congenital Conditions: Some males do not have a portion of vas deferens since birth, which could be due to the genetic situation. While in some cases prostate of a male contains cyst in it (they are either born with it or developed), that blocks the sperm flow from ejaculatory duct resulting in the absence of sperm in ejaculation.

2. Non- Obstructive Azoospermia (NOA)

In NOA, the reproductive duct is open, but there is either a ridiculously low level of sperm production or no sperm production at all. In most cases, there is a very low level of sperm generation, which hinders the sperm to make the way out from the testicles. NOA is caused due to the testicles abnormalities or peculiarities in reproductive hormones essential for controlling the sperm production.

non obstructive azoospermia

Some of the common causes of Non-Obstructive Azoospermia include:

  • Genetic conditions: The genetic causes of NOA are chromosomal malfunctions, which means there is a reduction in the number of chromosomes (this situation is called aneuploidy). Other chromosomal malfunctions include the breaking up of chromosomes and changes in the location of those broken parts of the chromosome (this situation is called translocation).
  • Varicocele: Another major and common cause that leads to Non Obstructive Azoospermia is the presence of varicose veins near or around the testicles. This condition can be treated easily.  Varicocele leads to the minor reduction of sperm count, however, in several cases, this condition can cause male infertility.
  • Hyper spermatogenesis: This is a common condition with men having azoospermia due to non-obstruction of ducts, where the production of sperms in testicles is lower than it should be.
  • Maturation Arrest: This is the condition where the production of sperm is interrupted during the maturation phase, which in turn leads the testicles to fill with precursor sperm only. This condition takes place at an early or late stage of the maturation process of sperm.
  • Sertoli-cell Only Syndrome (SCO) or Germ Cell Aplasia (GCA): This is the worst case in NOA. In this case, the germ cells that divide and become the sperms are missing within the testicles.

Treatment of Azoospermia

Azoospermia can be highly disturbing for the most men, but the good news is that it is fixable. Every individual is different having a different body-type with different health issues & requirements. Therefore, the treatment of Azoospermia in men differs from patient to patient.

Treatment of Obstructive Azoospermia

Men with Obstructive Azoospermia have blockage in the ejaculation ducts, which acts as an obstruction for the sperm flow. This obstruction results in low sperm count or no sperm in ejaculation. There are two primary methods with which we can provide treatment for Obstructive Azoospermia in men and restore the flowof the sperm-  

1- Surgical treatment ofObstructive Azoospermia

The surgical correction is done by a microsurgical reconstruction of the vas deferens and/or epididymis. However, in cases of ejaculatory duct obstruction, it is performed by transurethral resection of the ejaculatory ducts (TURED).

2- Utilization of Sperm Retrieval Techniques

Sperm retrieval technique is used to retrieve the sperm from the testes or epididymis of a man with obstructive azoospermia. Sperm retrieved from the male reproductive system is utilized in fertility treatment i.e. in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI)

Some of the Sperm Retrieval Techniques used in the cases of obstructive Azoospermia include

  • Microsurgical Epididymal Sperm Aspiration (MESA)
  • Percutaneous Epididymal Sperm Aspiration (PESA)
  • Testicular sperm extraction (TESE) and micro TESE
  • Testicular Epididymal Sperm Aspiration (TESA)

Treatment of Non Obstructive Azoospermia

For the Non-Obstructive Azoospermic patients, the treatment might not be easy and largely depends on the cause of the condition. While there are a few surgeries to retrieve the sperm, one of such methods that include sperm extraction for Non Obstructive Azoospermia affected males is called "FNA Mapping".

FNA Mapping - FNA Mapping is also known as testicular mapping or sperm mapping. It is also called as the "GPS of the testicles". This technique allows pointing the specific areas within the testicles with a higher level of sperms. The highest sperm level in the testicles increases the chances of successful extraction of the sperm. The sperm can then be extracted with the help of a surgery called "micro testicular sperm extraction" (mTESE). FNA combined with mTESE is a perfect and ideal way to treat NOA patients with minimum risk, pain and recovery time.

Additional Treatment for Azoospermia

  • Patients with lifestyle issues like hormonal imbalance can be treated in simpler ways such as changing medications and dietary supplements for addressing the hormonal problems.
  • Varicoceles can be fixed with a low-risk surgery called varicocelectomy.
  • For conditions like genetic mutations, sperm donation can be a great way for couples willing to conceive a baby.

Diagnosis of Azoospermia

Diagnosis of Azoospermia is done with the help of semen analysis test. If the test reports reveal sperm count to be NIL then the person suffers from azoospermia. The doctors go through the patient’s medical history as the part of Azoospermia diagnosis that usually includes:

  • Fertility success rate in the past
  • Childhood diseases
  • Injuries or surgeries in the reproductive area
  • Urinary or ejaculation tract infections
  • Exposure to chemotherapy or radiation in the past
  • Sexually transmitted diseases
  • Fever or heat exposure
  • Drug or alcohol abuse
  • Past or present medication consumption
  • Family history including birth defects

If a male has been diagnosed with azoospermia then the specialist may also refer some tests to know the root cause of azoospermia. Some of the common tests recommended to the patient once he is diagnosed with azoospermia include

  • Measurement of hormone levels such as testosterone and follicle-stimulating hormone (FSH)
  • Brain imaging to locate the hypothalamus and pituitary gland disorders
  • Genetic tests
  • X-rays or ultrasound to detect any tumor or blockage in the duct
  • Biopsy of the testes to find out the type of Azoospermia

Male infertility caused due to Azoospermia is nothing to be worried about as there are fertility treatments and Azoospermia treatment methods, which can resolve male infertility with the utmost proficiency allowing you to cherish the boon of fertility.

To know more about the Male Infertility and how you can recover from Azoospermia as per your respective health condition, reach us at +917899912611 and let us assist you to regain your fertility.

Dr. Srilatha Gorthi

About The Author

Laparoscopic Surgeon, Gynecologic Surgeon Dr. Srilatha Gorthi
Hyderabad

Dr. Srilatha Gorthi is an infertility specialist and laparoscopy surgeon located in Hyderabad. Her area of expertise lies in the field of Gynae diseases and conditions, and Assisted Reproductive Technology (ART). She provides a number of services that comprise of In vitro Fertilization (IVF), Intrauterine Insemination (IUI), ICSI, TESA, MESA, Gynae Hysteroscopy, Laparoscopy, treatment of Ovarian Cysts, Endometriosis, PCOS, Fibroids, Polyps and so on. Dr. Srilatha Gorthi practices at The Birthplace Hospital, Revive Multi Specialty Clinics and Fertility Centre, and The Birthplace Clinic and has a rich experience of more than 18 years. Dr. Gorthi has won 9 Gold Medals in MBBS.She is a reputed member of the Federation of Obstetrics and Gynaecological Societies of India (FOGSI), European society of Gynaecological Endoscopy and British Medical Association, UK, and British Fertility Society. You can get her information at www.elawoman.com

SOURCES AND REFERENCES:

  1. Male infertility and its causes and treatments absence of sperms, Elawoman - 2017
  2. Male infertility causes symptoms and treatment male infertility, Elawoman - 2017
  3. Physical factors to consider before donating sperm sperm, Elawoman - 2017
  4. Male ejaculation disorders and treatments ejaculation, Elawoman - 2018
  5. What is pesa (percutaneous epididymal sperm aspiration) treatment? no sperm in the ejaculation, Elawoman - 2018
  6. Types of birth control methods and its effectiveness birth control methods, Elawoman - 2017
  7. How to increase sperm count and improve fertility sperm count, Elawoman - 2017
  8. What is icsi (intracytoplasmic sperm injection) treatment? intracytoplasmic sperm injection, Elawoman - 2018
  9. What is in-vitro fertilization (ivf) and its needs IVF, Elawoman - 2017
  10. What is mesa (micro-epididymal sperm aspiration) treatment? MESA, Elawoman - 2018

6 Comments

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Parthiv Deshmukh

Azoospermia can happen to anyone so, having a healthy diet, regular exercise and not having any vasectomy surgery can avoid this infertility issue.

Oct. 1, 2018, 6:05 p.m. 4.5

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Rajeshwar Pradhan

My azoospermia is a genetic mutation condition, so I opt semen freezing. It might don't work in every condition but I got lucky.

Sept. 29, 2018, 3:14 p.m. 4.5

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Niranjan Veera

I want to have Mesa treatment, please suggest me with some good options to get it done.

Sept. 13, 2018, 11:54 p.m. 4.5

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Bharti Vaidhya

My husband had vasectomy surgery before our marriage and now he faces obstructive azoospermia. His MESA treatment was successful and we have conceived now. It's riskfree and easy going process.

Sept. 12, 2018, 6:52 p.m. 5.0

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Divyanka Ghai

Azoospermia seems to be very serious problem. Every man should get the semen analysis done to check if they have azoospermia or not. Thanks for sharing.

Aug. 25, 2018, 2:34 p.m. 4.5

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Soumil Purujit

Aug. 25, 2018, 1:49 p.m. 4.5

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