AZOOSPERMIA

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Andrology , Assisted Reproduction , Urology

ABOUT THE DISEASE

Azoospermia is a lack of measurable level of sperm in ejaculate/seminal fluid. In most of infertile couples (almost 40%), the male has a fertility problem.

Azoospermia can be of two types:

Obstructive azoospermia, which means that there is no problem in the production of sperm inside the testicle but the sperm fails to flow to the outside world because of obstruction in the reproductive tubing. This occurs due to genetic conditions, infections and trauma/surgeries

Non-obstructive azoospermia, on the other hand, means that there is no blockage in the tubes but there is a problem with adequate production of sperm, i.e., either very low level of sperm production or no sperm is produced at all. Since the level is too low, the sperm fail to come out of the testicle. Use of medicines, illegal drugs, smoking, drinking alcohol, genetic conditions, abnormal hormone levels, radiation, or retrograde ejaculation may cause non-obstructive azoospermia.

SYMPTOMS

• Infertility in men; Inability to get the partner pregnant.
• Increased body fat, breast tissue, and body hair.
• Clear, watery, or whitish discharge from the penis
• Existence of varicoceles or enlarged veins in scrotum
• Stress or emotional pressure
• Small, soft, testicles that cannot be felt

CAUSES

A variety of different diseases or conditions may cause Azoospermia.
  1. Hormonal problem in the pituitary gland, which stimulates the production of testosterone in testicles.
  2. Testicular injury or failure, either from birth (congenital) or due to radiation or toxic chemical exposure.
  3. Cancer treatment.
  4. Action of Antibodies that attack sperm, post vasectomy infection.
  5. Use of Drugs/Addiction.
  6. Structural problems: Varicocele, Srgical vasectomy, Birth defects - Absence of a vas deferens, Retrograde ejaculation.
  7. Genetic problems.

Its causes can be grouped into three categories: pre-testicular, testicular, and post-testicular.

Pre-testicular causes (non-obstructive):
The testicle produce less sperm due to poor release of sex hormones.

Testicular causes (non-obstructive):
Testicular defects/failure, can be congenital or due to injury and may be structural or functional.

Post-testicular causes (obstructive):
Ant blockage in the reproductive tract or problems with ejaculation can prevents sperm from getting into the seminal fluid. It is the usual cause in about 40% of men with azoospermia.

DIAGNOSIS

- Physical examination
- Blood tests to check levels of hormones such as testosterone and follicle-stimulating hormone (FSH)
- Genetic testing to look for abnormal genes
- Biopsy of testes
- MRI of the pituitary gland
- Scrotal ultrasound and X-ray
- Semen analysis
- Spermatic venography to check for varicoceles.
- Post-ejaculatory urinalysis to looks for sperm in the urine.

TREATMENT METHODS

The treatment will depend on the cause of azoospermia:
• If the root cause is low hormone production, Hormone therapy is given.
• If its an infection of the reproductive system, medicines may be prescribed.
• Varicocele may be treated with percutaneous embolization.
• Surgery may have to be performed for varicocele removal or to repair a blocked vas deferens.
• In case of blockage, reconstruction or reconnection of obstructed or disconnected ducts can be performed.
• Sperm extraction can be done to remove live sperm from the testes or epididymis and if required may be used for assisted fertilization.

Genetic testing and counseling are an important part of treating azoospermia and assisted reproduction.
Men with non-obstructive azoospermia should go for genetic analysis, before planning for any type of assisted fertilization, in order to rule out any genetic factor which may be passed to their children.