Azoospermia (“No Sperm Count”) – Causes and Treatment - If you and your partner are finding it difficult to get pregnant, it may be a good idea to visit your local fertility clinic for a physical workup. Here, your reproductive endocrinologist will analyze both male and female factors in order to find out exactly what is going on with your fertility. Sometimes, male factor infertility can play a large role in pregnancy difficulties. Azoospermia can cause serious problems with sperm production and transfer, preventing a man’s sperm from entering his ejaculate. This can make pregnancy very difficult, if not impossible. However, new techniques are now being performed to help men with azoospermia father biological children.
What is Azoospermia?
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There are actually two types of Azoospermia
Obstructive Azoospermia: Obstructive Azoospermia - The result of obstruction in either the upper or lower male reproductive tract (epididymis, vas deferens, seminal vesicles or ejaculatory ducts). Sperm production may be normal (which may be verified through testicular biopsy or aspiration), but the obstruction is preventing the sperm from being ejaculated. Some causes of obstructive azoospermia are vasectomy, congenital absence of vas deferens, scarring from past infections, and hernia operations, or some genetic conditions such as Cystic Fibrosis. Some sperm may be found and extracted directly from the testicles.
Non-obstructive Azoospermia: Severely impaired or non-existent sperm production in the testicle. The function of the testicle is twofold. One is production of male hormones, and the other is production of sperm. Insufficiency of one or the other is frequently congenital, but in some situations can be acquired during one’s life. If the system of the testicle which produces hormones is impaired, the hormones could be substituted by numerous preparations readily available. Unfortunately, if the system producing sperm is impaired or missing, the only substitute is donor/surrogate semen. Many couples in similar situations prefer using semen form a properly screened donor under a physician’s supervision, compared to adoption. Sometimes the genetic and biological information about the adopted child are not available; sometimes care of the child after birth has been deficient and improper, leading to the acquisition of various diseases, for example HIV/AIDS and many others.
How Common is Azoospermia?
Azoospermia affects only about 2% of the general male population; however, it does account for a large percentage of those men actively seeking fertility treatments. It is thought that between 10% and 20% of men undergoing fertility treatments suffer from azoospermia. Most of these men have little or no sperm present in their ejaculate.
Symptoms of Azoospermia
Unfortunately, it is very difficult to recognize azoospermia without undergoing fertility testing. This is because there are no symptoms that occur along with the condition. You will likely have semen of a normal color and texture, and will encounter few difficulties with ejaculation. Only a sperm count can diagnose the condition.
Causes of Azoospermia
The are typically two main causes of azoospermia: a problem with sperm production or a problem with sperm transport. There are a variety of factors that may contribute to either of these causes.
Sperm Production Problems
Sometimes, azoospermia is the result of a dysfunction within the testes themselves, making it impossible for your body to produce enough viable sperm. In order to produce sperm, the proper cells need to be present in the testes and the proper hormones need to trigger sperm production. Failed sperm production is often the result of:
Hormonal Abnormalities
Sometimes your body may not produce enough of certain hormones involved in the sperm-making process, causing azoospermia. Hormonal imbalances caused by anabolic steroid use or particular disorders, like Cushing’s Syndrome, can contribute to azoospermia.
Cryptorchidism
Cryptorchidism, or undescended testicles, is a condition in which your testes have not descended properly. It is generally corrected in childhood, however, if it isn’t corrected, your testicles will be unable to produce sperm properly.
Vascular Trauma
Trauma to the testes or to the blood vessels within the testes can also prevent your body from producing sperm. Varicocele causes veins in the testes to enlarge and become swollen. As a result, blood pools in the testes, impairing sperm production.
Sperm Transport Problems
In order for sperm to leave your body, it must be transported from your testes to your urethra. Sperm travels through a series of ducts inside of your reproductive system, until it eventually mixes with your ejaculate and exits your body. Sometimes, blockages can occur inside of these ducts preventing sperm from mixing with your ejaculate. Sperm transport problems are often caused by:
Vasectomy: The vasectomy procedure introduces a cut or blockage into your vas deferens, preventing sperm from mixing with your ejaculate.
Congenital Absence of Vans Deferens: Some men are born without the vas deferens, which are tiny tubes that carry sperm to the urethra for ejaculation.
Infection: Certain infections, including STDS, can cause blockages in the epididymis or vas deferens, preventing sperm from mixing with your semen.
Causes of Obstructive Azoospermia
Genetic
You may have been born with genes that may cause infertility. A gene is a piece of DNA that tells your body what to do or what to make. Genes may affect sperm transport, such as in congenital bilateral absence of the vas deferens.
Infections
Infections of the male reproductive system, such as in the testicles or prostate, may affect male fertility.
Trauma
Previous injury or surgery to the spine, pelvis, lower abdomen (stomach), or male sex organs may cause damage to the male reproductive system. This may include surgery on an inguinal (groin) hernia. Trauma may affect sperm production or cause an obstruction in the flow or transport of sperm.
Varicocele
A varicocele is a condition where the veins (blood vessels) in the scrotum are enlarged and dilated (widened). Ask your caregiver for information about varicocele.
Vasectomy
A vasectomy is a surgical procedure that is done on males as a method of birth control. The vas deferens (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, or burned. The semen that is ejaculated no longer contains sperm.
Nonobstructive Azoospermia
Drugs
Certain drugs, such as steroids, antibiotics, and drugs to treat inflammation or cancer may affect male fertility. Smoking, drinking alcohol, and using illegal drugs may also cause problems with sperm production.
You may have been born with genes that may affect sperm production, such as Klinefelter's syndrome. These genes may also affect the formation of your reproductive (sex) organs, such as Kallmann's syndrome.
Hormones
Disorders of the testicles may produce abnormal levels of hormones that may affect the production of sperm.
Radiation
Radiation, such as that used to treat cancer, may affect sperm production.
Retrograde Ejaculation
Retrograde ejaculation is when semen travels into the bladder instead of outside the body. It is usually caused by a problem with the neck of the bladder and may be due to spinal cord injuries, medicines, or diabetes.
Other Factors
Pesticides, heavy metals, heat, and undescended testes (testicles that did move from the abdomen into the scrotum) may affect sperm production.
What are the signs and symptoms of Azoospermia?
You may have any of the following:
- Inability to get your partner pregnant.
- Increased body fat, body hair, and breast tissue.
- Clear, watery, or whitish discharge from the penis.
- Presence of a mass or swelling on the scrotum that feels like a bag of worms (varicocele).
- Stress or emotional pressure from not being able to conceive a child.
- Testicles that are small, soft, or non-palpable (cannot be felt).
- Veins that are enlarged, twisted, and may be seen in the scrotum (varicocele).
How is Azoospermia diagnosed?
Your caregiver will take a complete medical, reproductive, and sexual health history from you. He may need to know how long you have been trying to have a baby. The timing and frequency of your sexual activities, and problems with sexual urges and functions are also important. You will also be asked about your lifestyle, including alcohol intake and smoking, medications taken, and past diseases. You may need any of the following:
Physical Examination
Your caregiver will look for signs of any imbalance in your hormones, such as increased body fat, body hair, and breast tissue. The size and shape of your testicles will also be examined. Your caregiver may also do a digital rectal exam (DRE) to check your prostate and other parts of your reproductive system.
Biopsy
A sample of your testicle is taken by a needle or through a small incision (cut) in the scrotum. The sample is sent to a lab for tests. This will help determine the ability of the testicles to produce normal sperm.
Blood Tests
You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
Genetic Screening
Genetic testing may be done to look for abnormal genes. Abnormal genes may cause problems with sperm production, sperm transport, or formation of the male reproductive organs.
Imaging Tests
Dye may be used in certain tests to make pictures show up better. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. Imaging tests may include the following:
Magnetic Resonance Imaging Scan
This test is also called an MRI. An MRI uses magnetic waves to take pictures of your pituitary gland to check for other causes of your infertility. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
Spermatic Venography
This test will examine and show the position of the veins in the scrotum. It may be used to check for a varicocele.
Ultrasonography
A scrotal or transrectal ultrasound uses sound waves to find lumps and other changes in your testicles and scrotum. These tests may be used to check for a varicocele or any missing parts of the reproductive system.
Semen Analysis
A semen analysis is a test to check a man's fertility. It is done by taking a semen sample. You may need to talk with your caregiver about the method of sample collection.
Urinalysis
Post-ejaculatory urinalysis is a test that is done on your urine after you have ejaculated. This test looks for the presence of sperm in the urine, which may suggest an obstruction or problems with ejaculation.
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