Azoospermia
What is azoospermia?
Azoospermia (a-zoo-SPER-mee-ah) is a major cause of male infertility in which no measurable sperm is present in a man’s ejaculate (semen). Normally, the testicles in a man’s scrotum produce sperm that then flow through the male reproductive system to mix with fluid in the seminal ducts to form semen. Semen is the thick, white fluid released from the penis during ejaculation. Azoospermia is found in 5 to 10 percent of men evaluated for infertility. The condition may be present at birth or may develop later in life.
How is azoospermia diagnosed?
Azoospermia is usually detected during the course of investigating infertility. While there are several aspects to the diagnosis, azoospermia is established on the basis of an analysis of two semen samples given at separate occasions. Further analysis of pelleted semen samples should also be performed to rule out the presence of a few hidden sperm (cryptospermia). Other aspects of the diagnosis and evaluation may include:
- Detail medical history
- Physical examination
- Hormone testing
- Genetic screening
- Genital tract imaging
What causes azoospermia?
A lack of sperm in the ejaculate can be due to blockage of the male genital system (obstructive azoospermia) with completely normal sperm production or the result of poor sperm production (nonobstructive azoospermia), which interferes with the production of sperm.
Obstructive azoospermia can be caused by the following:
- Infections: An infection of the testicles, prostate, or other parts of the male reproductive system may lead to blockage and azoospermia (such as those that cause cystic fibrosis).
- Genetic: Certain genes, present at birth, may cause abnormal development and blockage of the male genital tract.
- Trauma or surgery or radiation: Injury to the male sex organs or previous injury to the pelvis, lower abdomen, or spine may affect sperm production and block the flow of sperm. Prior surgeries or radiation to the abdomen, pelvis (such as a hernia) can also lead to blockage of normal sperm flow.
Nonobstructive azoospermia can be caused by:
- Genetic: The presence of certain genes at birth can affect sperm production or the formation of the male sex organs.
- Drugs: Steroids, antibiotics, and other drugs may affect male fertility. Drinking alcohol, smoking, and certain illegal drugs may also cause problems with sperm production.
- Radiation: Radiation, such as that used to treat cancer, may affect sperm production including chemotherapy for prior cancer.
- Varicocele: Veins (blood vessels) in the scrotum may become enlarged and widened which can impair normal sperm production.
- Other factors: Pesticides, heavy metals, heat, genital injuries, and undescended testes also may affect sperm production.
How is azoospermia treated?
Treatment depends upon the cause of azoospermia and is tailored to the individual patient.
Obstructive Azoospermia (blockage of sperm transit through male genital tract)
Based on the evaluation, the level of obstruction and cause of obstruction is determined. Blockage often occurs at the level of the vas deferens, epididymis, or ejaculatory duct. Microsurgical genital tract reconstruction (such as for vasectomy reversal) or endoscopic repair can help restore sperm to the ejaculate. Another option that patients may choose is surgical sperm extraction either from the testicle, epididymis, or vas deferens in order to conceive using assisted reproductive techniques.
Nonobstructive azoospermia (sperm production problem)
Despite inadequate sperm production for transit through the male genital tract and exit in the ejaculate, many men do have limited sperm production in the testicles and enough to become fathers. During the evaluation, our physicians will help determine the etiology of the azoospermia and if there are reversible factors that can be eliminated or modified to improve a man’s own sperm production. Genetic testing will also impact prognosis and possible risks to the offspring.
Treatment often centers around surgical sperm extraction. The goal is to find the few pockets of normal sperm production inside a man’s testicles.A surgical microscope allows improved visualizing of individual sperm producing areas of the testis to help identify the areas of sperm production (microscopic assisted TEsticular Sperm Extraction – mTESE). In addition, such techniques also minimize any complications from the procedure. Utilizing state-of-the-art techniques, our experts can help such men become fathers.
Your physician will talk to you about your specific case and treatment recommendations.