Azoospermia: Treatment, Causes & Symptoms

One of the leading causes of male infertility is attributed to azoospermia. Azoospermia is a medical condition in which there are no sperms in the ejaculate. 

An average man has > 15 million sperms/ml in his semen, but when it is not present in measurable amounts, the man is said to suffer from azoospermia. This condition is found in 5-10% of males who are evaluated for infertility. This condition may be due to a congenital problem at birth or may develop later on in life.

Types of Azoospermia

There are two types of azoospermia:

• Obstructive azoospermia: This is caused by a blockage in the reproductive tract for both the testicles which prevents the sperm from entering the ejaculate. This means even though there is normal sperm production, no measurable sperm can get into the semen.
• Non-obstructive azoospermia: This is due to decreased/absent sperm production by the testis.

Azoospermia Symptoms

In recent years, the P-shot has gained popularity as a non-invasive and painless procedure, offering benefits for men seeking to improve their sexual wellness. Here are five benefits of the P-shot:

• Low libido or sexual drive due to hormonal imbalance
• Lump on your testicles from an infection
• Decreased facial or body hair due to chromosome or hormone abnormality

Azoospermia Causes

• Obstructive azoospermia is caused due to obstructions which most commonly occur in the:
  • Epididymis: It is the coiled tube placed at the back of each testicle where the sperm matures.
  • Vas deferens: It is the tube which transports sperms from the epididymis.
  • Ejaculatory duct: It is the tube from where the sperm exits into the urethra and mixes with fluid to form the semen.
  • Epididymis blockage- There are many conditions which can lead to a blockage in the epididymis such as:
    • nfections such as epididymitis
    • Scrotal injury/trauma
    • Inflammation
    • Rare genetic conditions such as cystic fibrosis in which there is thickened secretions which can lead to a buildup and semen getting stuck
  • Surgery on the Vas deferens- Vasectomy results in cutting or clamping of vas deferens, thereby stopping the flow of sperm. However, the same impact is caused by these conditions as well:
    • Trauma/injury
    • Past surgery, including hernia repair
    • Cystic fibrosis gene mutations, which can disrupt the normal connection to the urethra
  • Ejaculatory duct blockages- Some of these blockages are congenital (present at the time of birth) while others are acquired (developed later on in life) due to:
    • Infections
    • Trauma
    • Prior surgery
• Nonobstructive azoospermia is caused due to numerous reasons as mentioned below:
  • Genetics
  • Karyotype abnormality
  • Y Chromosome deletion
  • Medications
  • Radiations and toxins
  • Hormone imbalances
  • Varicocele
  • Some of the other causes include illegal drug use, smoking, and excessive drinking.
    • Genetics–This is one area which is not clearly understood yet when it comes to impaired sperm production. Genetic causes that are known can be diagnosed and treated and through genetic counselling, the risk of passing these genes to the next generation is also discussed.
    • Karyotype abnormality–Men have 46 chromosomes; 22 pairs of X and Y chromosomes. Up to 10% of nonobstructive azoospermia patients are known to have detectable abnormalities that can affect sperm production. For example, Klinefelter’s syndrome is due to an extra X-chromosome which results in poor testicular function and low sperm count as well as low testosterone levels.
    • Y Chromosome deletion–There are numerous genes on the Y chromosome that are essential for the development of sperm, but some men have missing crucial sections. Diagnosing a particular Y chromosome issue is important because some deletions (like AZFc) have a higher chance of producing sperm. All sons born to a father with Y chromosome deletions will inherit this defect.
    • Medications–Certain medications can harm sperm production so it is important to decide which ones to stop and which ones to continue. For instance, testosterone is required for normal sperm production but testosterone supplements can often cause azoospermia.
    • Radiations and toxins–Exposure to certain substances such as heavy metals, toxic chemicals which have possible links to pesticides, and undergoing chemotherapy and radiation therapy, can impair sperm production. If you need to undergo these procedures, it is advisable to freeze (cryopreserve) sperm beforehand.
    • Hormone imbalances–If azoospermia is caused due to hormonal imbalance, it can be treated.
    • Varicocele–At times, veins present in the scrotum become widened and enlarged. This results in formation of a varicocele that impedes normal sperm production.

Treatment of Azoospermia

• Obstructive azoospermia treatment: Surgery is, by far, the best way to fix blocked tubes in the reproductive tract or treat congenital defects by making connections that never formed. In case, surgical reconstruction is not possible, sperm can be extracted from the:
  • Testicles
  • Epididymis
  • Vas deferens

  The extracted sperm is then used to attempt pregnancy via in vitro fertilization (IVF). If surgery is possible, it is of two types: endoscopic surgery and microsurgery.

  • Endoscopic surgery: This is a minimally invasive surgery in which a smaller incision is made under anaesthesia using a special endoscope, fitted with a camera and light. The surgical spot is magnified and the image is projected onto a monitor for guidance. The scope delicately makes its way through the urethra and the blockage is repaired,
  • Microsurgery: This is a proven technique, during which your andrologist makes a small incision on your scrotum under anaesthesia. With the help of high-powered magnification and special instruments, the blockage is carefully fixed or the missing connection is restored. Finally, the incision is closed.
• Nonobstructive azoospermia treatment: These days, owing to advanced treatments, some men with nonobstructive azoospermia may experience the presence of sperm in their semen again. For others, the treatment may be as simple as a few lifestyle changes, including swapping out a medication or beginning to avoid certain toxins. Even if you have undergone chemotherapy or radiation therapy, the fairly resilient reproductive system just needs time to recover.
  • Hormone treatment: In many cases, some men with nonobstructive azoospermia may benefit from treatment with certain hormones, depending on their existing levels. Due to this, sperm can be seen to return to the semen or the likelihood of finding sperm during extraction is increased. Human chorionic gonadotropin (HCG) and recombinant-Follicle-stimulating hormone (FSH) are two commonly used hormones in the hormone treatment.
  • Varicocelectomy: This treatment is beneficial for men who are suffering from varicocele. During a microscopic varicocelectomy, an operating microscope is used to identify and tie off the enlarged and widened veins that impede sperm production. While doing so, care is taken to preserve the other nearby structures such as arteries, vas deferens, and lymphatic channels. This procedure has about 40% success rate and men who undergo this, see sperm return to their semen. For those men who do not benefit from this procedure, they can opt for sperm extraction.

Azoospermia is a condition which can be addressed in most cases, especially if it is caused due to hormonal problems or obstructive issues. Men can gain back their confidence after treatment and fertility can potentially be restored. Team up with your uro-andrologist to determine the cause of azoospermia and decide on the treatment options available for you.

AndroNeo @ NU Hospitals is dedicated to provide solutions to all your andrological problems. With its team of specialists and dedicated doctors, this premiere institute offers time-tested solutions to even the most complicated cases in andrology. If you or a loved one is suffering from azoospermia, you can take the expert advice of the andrologists at AndroNeo and overcome your problem.

References:

1. Azoospermia (Sperm production). HEALTH University of Utah. https://healthcare.utah.edu/fertility/conditions/sperm-production-azoospermia.
2. Azoospermia. JOHNS HOPKINS MEDICINE. https://www.hopkinsmedicine.org/health/conditions-and-diseases/azoospermia.
3. Azoospermia. Stanford Medicine. https://stanfordhealthcare.org/medical-conditions/mens-health/azoospermia.html.
4. Azoospermia. UNC School of Medicine. UROLOGY. https://www.med.unc.edu/urology/patientcare/adult-non-cancer/male-fertility/azoospermia/.