Azoospermia: Causes, Diagnosis and Treatments

Graphic depicting azoospermia.

Azoosepermia is a condition where men have no measurable amount of sperm in their semen. About 1% of men are affected, which accounts for approximately 10-15% of men who are infertile.

Azoospermia doesn’t have any outward signs or symptoms, but if you’ve been trying to conceive unsuccessfully, it could potentially be the cause.

What Causes Azoospermia?

It is possible that there could be a problem with your testicles that prevents them from producing sperm, a blockage in the reproductive tract, hormone problems, complications with ejaculating. Azoospermia falls into two primary categories, obstructive and non-obstructive.

Non-Obstructive Azoospermia

There are two types of non-obstructive azoospermia. These include:

Pre-testicular azoospermia: In this condition, your body is unable to trigger sperm production from your testicles, even though they may otherwise function normally. Although this type of azoospermia is rare, it can be caused by hormone imbalances or endocrine disorders, or following chemotherapy/radiation treatments.

Testicular azoospermia: This is when sperm production is hampered by damage or trauma to the testicles, or other factors directly affecting testicular function. Some causes of this condition include:

  • Infection involving the reproductive system, including epididymitis or urethritis.
  • A condition during adolescence such as mumps, or viral orchitis which causes swelling of the testicles.
  • Injury or trauma to the groin area.
  • Previous surgery involving the pelvic area.
  • Chemotherapy/radiation treatments
  • Genetic conditions, such as cystic fibrosis and Klinefelter’s syndrome.
  • Inflammation.
  • Formation of a cyst or tumor.
  • Varicocele (a condition where the veins leaving the testicles are enlarged).
  • Diabetes
  • An adverse reaction to some medications.
  • Anorchia (the absence of testicles)
  • Cryptorchidism (when the testicles that haven’t descended)
  • Sertoli cell-only syndrome (the testicles do not produce sperm)
  • Spermatogenic arrest (the testicles are unable to produce mature sperm)

Obstructive Azoospermia

Also called post-testicular azoospermia, obstructive azoospermia affects approximately 40% of men diagnosed with azoospermia. This occurs when the testicles produce sperm normally, but something prevents them from getting into the semen.

Some causes include:

  • Blockage of the tubes that transport sperm from the testicles into the semen. These include the epididymis, vas deferens and the ejaculatory duct.
  • Retrograde ejaculation (when semen goes into the bladder and rather than through the penis during ejaculation.
  • Having had a vasectomy.

Diagnosis

Your doctor may want to perform fertility testing if you have been unsuccessful in getting your partner pregnant.

You will first need to provide semen samples which will be analyzed by a lab using a powerful microscope. If two separate semen analysis tests show that no sperm are present your semen, you will most likely be diagnosed as having azoospermia.

Your doctor will then attempt to pinpoint the cause. He or she will probably want to conduct a complete physical examination, review your medical history, and have bloodwork done to determine your hormone levels.

If hormone levels are determined not to be the problem, your doctor may also want to conduct a scrotal or transrectal ultrasound to check for any physical obstructions. An MRI might be used to verify the diagnosis. However, in some cases, the only way to identify the obstruction is through surgery.

Additionally, in situations where there are no blockages, genetic testing can be used to determine if the problem has to do with your genes.

Treatments

Certain treatments are available to help those men diagnosed with azoospermia who want to father children.

Surgery can be performed to remove an obstructive blockage. The more recently the blockage has formed, the greater the likelihood of the surgery being successful.

Sperm retrieval is an option for men who have nonobstructive azoospermia. It can also help those with a blockage who don’t want to have surgery.

In this method, sperm is removed from one of the testicles using a very small needle. The sample can then be frozen for later use in IVF treatments (In vitro Fertilization).

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