Overview
Azoospermia is a leading cause of male infertility and is estimated to affect about 1% of all men and 10-15% of infertile males.
Some individuals are born with this condition, while others develop it later in life. In this blog, let us take a closer look at “what is Azoospermia”, its causes, symptoms, and available treatment options.
What is Azoospermia? (Azoospermia Meaning)
Azoospermia, in medical terms, refers to the complete absence of sperm cells in the semen. It is a significant medical condition where there are no measurable sperm cells present in the ejaculate of the affected man. Normally, sperm cells are produced in the testicles located inside the scrotum. These sperm cells are then mixed into semen, which is a thick, white fluid released during ejaculation.
In Azoospermia, sperm cells are absent from the semen; this absence can result from various causes. Based on the cause of Azoospermia, it can be categorised into two types.
- Obstructive azoospermia : In obstructive azoospermia, the production of sperm cells is normal, but there is some kind of blockage preventing the flow of sperm throughout the reproductive tract.
- Nonobstructive azoospermia : In this type of azoospermia, sperm production is halted for some reason. The body doesn’t produce enough sperm cells to be measured in the ejaculate. This typically suggests another disorder affecting the testicles' function or damage to the reproductive organs.
What are Azoospermia Symptoms?
Most men don’t really show any azoospermia symptoms, and thus most remain oblivious to this condition until they try to conceive with their partners. In other cases, underlying issues may manifest as symptoms.
Depending on the condition of each person, the following azoospermia symptoms may be observed:
- Low semen volume or watery ejaculate : In some cases, semen may appear thinner or less in quantity, indicating potential blockage issues
- Erectile/ejaculation issues : Some might have trouble getting an erection for intercourse, while others might have trouble ejaculating. Some men also experience a significant decrease in sex drive, caused by hormonal imbalances.
- Swollen testicles or discomfort in the testicle area : This may indicate an infection.
- Infertility despite regular unprotected sex : Most affected males find out about azoospermia after repeated failure to conceive.
What Causes Azoospermia?
Doctors have identified numerous factors that can lead to azoospermia, including genetic conditions, congenital disorders, traumatic events or injuries near the pelvic area, and lifestyle factors such as narcotic use. Depending on the cause, azoospermia can be primarily categorised into three groups.
- Obstructive causes : After sperm cells are produced inside the testicles, they travel through the reproductive system via delicate tubes until they mix with semen. Obstructive causes of azoospermia impede this flow of sperm from the testicles into the semen.
- Vasectomy : It is the most obvious obstructive azoospermia causes, in which the vas deferens is cut to prevent sperm from joining the ejaculate. In other cases, the vas deferens may be congenitally absent from the body. Inflammation or scrotal injury may also cause duct blockage, while in other cases, infections (such as epididymitis) may become the culprit.
- Non-Obstructive Causes : These causes involve a decrease or complete absence of sperm cell production. Several non-obstructive causes have been identified, including genetic disorders (such as Klinefelter syndrome) and hormonal imbalances. Sometimes, injury or disease can lead to testicular failure, resulting in halted sperm production.
- Lifestyle-related : Other azoospermia causes may include use of dangerous drugs, excessive alcohol intake, and smoking. Radiation exposure may also lead to a decrease in sperm count.
How is Azoospermia Diagnosed?
Undergoing an infertility diagnosis can be emotionally upsetting for the man involved. However, obtaining an accurate diagnosis of azoospermia is essential for planning effective treatment.
The process of diagnosing azoospermia may involve several tests to determine whether the condition of “no sperm” is caused by a blockage or an issue with sperm production. Typically, it begins with a detailed medical history evaluation and physical examination, followed by specialised tests to identify the underlying cause.
- Semen Analysis : It is the most primary test that confirms the absence of sperm in the ejaculate after microscopic examination.
- Hormone Testing (FSH, LH, Testosterone) : Blood samples are taken to measure hormone levels, especially the levels of testosterone and follicle-stimulating hormone (FSH)
- Testicular Ultrasound : An ultrasound imaging of the scrotal area is usually performed to identify any abnormalities in the structure of the testes and/or the reproductive tract.
- Genetic Testing : blood tests are used to check for potential genetic causation of azoospermia, such as Klinefelter’s syndrome.
Azoospermia Treatment Options
Once the diagnosis is made, the treatment approach for azoospermia is decided based on the cause. Let’s review some of the common options for treating azoospermia:
- Surgery for Duct Blockages : For obstructive azoospermia, a simple surgery can often fix the blockages in the reproductive tract, ensuring the normal flow of sperm cells.
- Hormone Therapy : In non-obstructive azoospermia, hormone therapy may help improve the likelihood of sperm in the ejaculate.
- Sperm Retrieval Techniques : In some cases, it is not possible to retrieve sperm from the semen. Thus, conceiving naturally is also not feasible. However, all hope is not lost. Doctors may still be able to extract some sperm cells from your testes by using advanced sperm retrieval techniques such as TESA (testicular sperm extraction), PESA, and micro-TESE.
- IVF/ICSI Using Retrieved Sperm : The retrieved sperm can be used to fertilise your partner's eggs with assisted reproductive techniques such as In Vitro Fertilisation (IVF) or Intracytoplasmic Sperm Injection (ICSI) to help achieve pregnancy.
Thus, helping the affected to achieve biological fatherhood.
How Are Azoospermia and Infertility Treated Through IVF?
Azoospermia refers to a complete lack of sperm cells in the semen of a man. Without the male gamete (sperm cells), it is impossible to conceive naturally. Azoospermia is also one of the major causes of male infertility.
However, with the help of assisted reproduction techniques such as IVF treatment, it becomes possible for someone affected by azoospermia to achieve biological parenthood.
- Role of surgical sperm retrieval
Typically, in fertility treatments like IVF, semen ejaculation is used to recover sperm cells from the male. However, for individuals affected by azoospermia, this method of sperm retrieval is not feasible. Therefore, surgical sperm retrieval methods become critically important.
Methods such as TESA, PESA, or Micro-TESE (Microscope-assisted testicular sperm extraction) are employed to retrieve sperm cells from small pockets in the testes that still produce sperm.
- Use of IVF + ICSI for fertilisation
IVF treatment combined with ICSI (Intracytoplasmic Sperm Injection) is probably the most effective solution to achieve pregnancy even with severe cases of azoospermia. In IVF treatment with ICSI, a single healthy sperm cell is directly injected into a mature egg, enabling fertilisation. This method becomes extremely crucial in the case of azoospermia, where there is a significant lack of the quantity and quality of sperm cells
- Success rates and factors affecting outcomes
IVF treatment combined with ICSI has a relatively high success rate of over 50%. Several factors can influence the outcomes, including sperm quality, the woman’s age, egg health, and the overall condition of the couple.
Conclusion
Being diagnosed with azoospermia can be quite overwhelming and emotionally distressing, but it is important to remember that hope is not lost. It is a treatable male infertility condition. With the right guidance and early diagnosis, you can overcome this challenge and begin your journey to parenthood.
Make sure to consult with a fertility specialist to receive all the necessary guidance on how to proceed with azoospermia.
Common Questions Asked
Can azoospermia be cured?
The cure of azoospermia is highly dependent on what caused it in the first place. For many causes, there is a way to cure or reverse azoospermia. However, some other causes do not have any viable cures
Is male infertility permanent?
It is highly dependent on the cause of male infertility. In many cases, male infertility due to azoospermia is curable and/or manageable.
What are the signs of low sperm count in a man?
A major sign of low sperm count is difficulty conceiving after years of trying. Other potential signs may include decreased sex drive or a problem sustaining a firm erection
How common is azoospermia in men?
It is estimated that azoospermia affects nearly 1% of all men and 10-15% of all infertile males
What is the cost of azoospermia treatment?
The cost of azoospermia treatment varies significantly depending on the specific procedure used to treat it and the underlying cause of the azoospermia. It can cost anywhere from a few thousand for initial diagnostic tests to lakhs for advanced fertility treatment.
What is the surgery for azoospermia?
Reconstructive surgery to fix blockages to treat obstructive azoospermia and sperm retrieval procedures are the common surgeries used for azoospermia.
Can oligospermia turn into azoospermia?
Yes, oligospermia can progress to azoospermia, especially if it is severe and left untreated.