Azoospermia; Causes, Symptoms, Treatment and More



What is Azoospermia?


Azoospermia is a lack of sperm in seminal fluid. Couples should start to seriously worry if they have had unprotected intercourses for a full year without being able to get pregnant even once. As a matter of fact, the man, woman or even both may have a fertility problem around 40% of infertile couples, the man has fertility problems. 


What are the Causes of Azoospermia?


In general, genetics plays a key role in around 10% o 15% of men with low sperm count or no sperm production. Defects in chromosomes can have negative effects on the number, shape, and size of sperm. Such defects can take place at different spots on the Y chromosome (male). Moreover, in some cases, a part of the Y chromosome might be missing and leads to infertility. 


How Does a Man Know if He Has Azoospermia?


If a man has been trying to get his partner pregnant for a whole year without any luck, he must see a doctor check this condition. As a starter, the doctor will need some sample of the semen to examine them in a lab by a high-powered microscope. If the result shows that there is no sperm in at least two separate occasions in the semen, then the man has azoospermia. 

Then the doctor will try to find out what is the reason behind the problem. In fact, he or she will need to know the patient’s medical history as well as running some tests such as a complete physical exam and test blood in order to measure the hormone levels. 

If the hormone levels are normal, the doctor will need to run a scrotal or transrectal ultrasound to check for an obstruction. An MRI may confirm the diagnosis, sometimes, surgery is the only solution to figure out the interference. If there is no blockage, then genetic tests can detect if there is any problem with the genes. 


What are the Types of Azoospermia?


The male reproductive system consists of the following: 

  • Testes, or testicles that produce sperm in a process known as spermatogenesis
  • Seminiferous tubules are tiny tubes that produce most of the tissue of the testes
  • The epididymis is a tube where the mature sperm are moved and stored 
  • Vas deferens is a tube that goes through the epididymis into the body cavity, then loops in order to connect with the urethra. Tightening of the vas deferens makes the sperm move along, past the seminal vesicles and prostate gland and that add seminal fluid to the sperm to form semen.
  • The urethra is a tube that runs through the penis to phase out urine from the bladder and semen from the vas deferens


What are the Symptoms of Azoospermia? 


The most common symptom of Azoospermia is being unable to conceive a baby even with having unprotected regular intercourses for a whole year without any success. In fact, there might be no other obvious symptoms but some men have a major problem such as an inherited chromosomal abnormality, an imbalance in hormones, or a condition that blocks the way of sperm. The symptoms of low sperm might include the following:

  • Problems with sexual function such as a low sex drive or difficulty having or keeping an erection
  • Pain or swelling in the testicle area
  • A noticeable decrease in the facial or body hair
  • Other signs of a chromosome or hormone abnormality

Azoospermia can be classified into three main types:


1) Pre-testicular leads to poor production of sex hormones which prevents the testicle from producing sperm. It can be caused due to any of the following:

  • Kallmann syndrome: A genetic disorder carried on the X chromosome, known by low levels of gonadotropin-releasing hormone (GnRH) and a loss of smell. 
  • Disorders of the hypothalamus or pituitary gland, which can happen due to radiation treatments or certain medications.

2) Testicular causes which are defects in the foundation or functioning of the testicles. This can be caused due to any of the following: 

  • Anorchia which is an absence of the testicles
  • Cryptorchidism 
  • Sertoli cell-only syndrome 
  • Spermatogenic arrest 
  • Klinefelter’s Syndrome
  • Mumps orchitis 
  • Tumors
  • Side effects to certain medications
  • Radiation treatments
  • Certain diseases such as diabetes, cirrhosis, or kidney failure
  • Surgery
  • Varicocele 

3) Post-testicular causes: Ejaculation problems that can prevent sperm from being in the seminal fluid. This condition takes place in about 40% of men with azoospermia. It can be caused due to any of the following: 

  • A missing connection in the epididymis, vas deferens, or elsewhere in the reproductive system
  • Congenital bilateral absence of the vas deferens (CBAVD): A genetic defect in which the vasa deferentia are absent at birth. 
  • Infection
  • Growth of a cyst
  • Injury
  • Vasectomy

What are the Risk Factors?


There are so many risk factors that directly related to low sperm count, including: 

  • Smoking tobacco
  • Drinking alcohol
  • Overweight 
  • Being depressed or stressed
  • Having certain infections in the past or current time
  • Exposure to toxins
  • Exposure to radiation
  • Overheating around the testicles
  • Trauma to the testicles
  • Being born with a fertility disorder or having a blood relative, such as your brother or father, with a fertility disorder
  • Having tumors and chronic illnesses
  • Undergoing cancer treatments
  • Certain medications
  • Having major abdominal or pelvic surgery


What are the Treatments for Azoospermia?


There are some types of treatments that can help men who suffer from azoospermia and want to conceive a baby. If a man has the obstructive type, he will need surgery to remove the blockage. Sperm retrieval can be helpful for men with nonobstructive azoospermia or those who have a blockage but do not want to undergo surgery. One option to do this is by using a tiny needle in order to extract sperm from a testicle. Then, freezing the sample to use it later in In Vitro Fertilization (IVF). If a man has a testicular biopsy, the doctor can collect sperm at the same time, so undergoing a second surgery is not necessarily needed.


Is there a Way to Prevent Azoospermia?


In order to prevent Azoospermia, a man should follow these tips: 

  • Giving up smoking
  • Quitting or limiting alcohol
  • Avoiding heat
  • Having a healthy weight
  • Avoiding exposure to radiations and toxins


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