Azoospermia is the medical term used when there are no sperm in the man’s ejaculate (or semen). It is an unusual but severe form of male infertility, affecting just 1% of the whole population and 10% of men with fertility issues. The satisfactory direction of treatment for azoospermia is primarily based on the actual cause of the condition and female partner’s fertility.
Here we will be discussing azoospermia in detail and its possible treatment option available, as well as the ART techniques which could assist affected men have a genetic baby.
Types of Azoospermia
There are different types of azoospermia, and each one having its own causes or associated medical conditions.
Pre-testicular Azoospermia
It is a nonobstructive form of azoospermia that can be resulting from a few genetic disorders, i.e., Kallmann syndrome that affects the ability of the body to produce the gonadotropin releasing hormone, affecting sperm production.
Brain related issues – in particular, damage to the pituitary gland or hypothalamus – can also lead to this condition.
Testicular Azoospermia
This is a type of non-obstructive azoospermia. This type of infertility condition occur due to the problem present in the testicles. The testes may not respond to the hormones released by the brain for healthy sperm production.
Post-testicular azoospermia
This obstructive form of azoospermia takes place in about 40% of all cases. Obstruction can occur because of a lacking connection, i.e., in vas deferens or epididymis that stores and carries the sperm.
Causes of Azoospermia
Obstructive Azoospermia can also occur because of the subsequent reasons: –
- Epididymis blockages- They may be cause by several conditions like epididymitis infection, irritation, scrotal trauma or harm and/or uncommon genetic conditions. • Retrograde Ejaculation- It is a situation where the sperm is going to the bladder of the person instead of his penis and combining with the semen.
- Enlarged varicocele- It obstructs the reproductive tract of men.
- Ejaculatory duct blockages- It may be present from the time of delivery or can occur because of infection, trauma or any earlier surgical procedure.
- Surgery of the vas deferens- Vasectomy, injury or surgical procedure like hernia repair causes cuts or clamps inside the vas deferens which obstructs the flow of the sperm inside the reproductive tract.
- Development of a cyst
Non- obstructive kind may be for numerous reasons ranging from: –
- Genetics- Genetic mutations just like the Kallmann syndrome, Klinefelter’s syndrome, etc. can cause azoospermia.
- Y chromosome deletion- Y chromosome is essential for the formation of sperms. When it’s far lacking an individual is not able to produce sperms. • Toxin and radiation exposure-Exposure to radiation, chemotherapy and pollution like heavy metal can be the reason.
- Hormone imbalance- Disorders like hypogonadotropic hypogonadism, hyperprolactinemia, etc. also can be the reason.
- Karyotype abnormality- In men there are forty six chromosomes 22 are in pairs, plus one X and one Y chromosome. Having a further X
chromosome cause Klinefelter syndrome resulting in low sperm count and testosterone levels.
Diagnosis
- Medical History– The health practitioner will need to know about the patients’ medical records to find the cause for the problem to determine its type. It consists of medical and surgical records, history of childhood illness, history of infections like UTI or STIs, and/or prior or current exposure to such things as radiation or chemotherapy.
- Physical examination– Blood tests will done to estimate the follicle-stimulating hormone (FSH) and testosterone levels. Palpation of the testes and measurement and estrogen and prolactin levels are also checked.
- Endocrine evaluation – It allows in formulating specific diagnosis and treatments for a large population of infertile men.
- Semen Analysis– It is the primary a part of the diagnosis. Semen sample is taken to the lab for testing. If sperms are absent in semen means one has azoospermia. It may be both the testes aren’t producing sperm or the sperm is limited inside the reproductive tract.
- Karyotype testing and genetic testing– It checks whether any inheritable genetic condition had caused congenital azoospermia.
- Transrectal ultrasound– It aids to find out any blockage inside the reproductive tract.
This diagnosis will assist in better understanding the trouble and helps
to formulate techniques for its treatment.
Treatment
Fertility treatment could be based on the specific kind of azoospermia and the exact cause of the condition. The fertility potential of the female partner may also influence the choices of treatment.
Treatment of Any Existing Infections
If one or both the partners have an active infection, this become necessary to be treated earlier before starting any other treatment.
Although a lot of men will be experiencing signs of an infection, such as painful urination, some infected patients will not show any symptoms at all. However, even with not any clear signs, the infection may be impacting their fertility and causing severe harm to their reproductive tract.
Surgical Repair
Sometimes, microsurgical treatment can be performed to repair the blocked and severed connections in the case of obstructive azoospermia. Surgery can also be performed to treat or remove an enlarged vein (varicocele) or treat with retrograde ejaculation.
Men with obstructive azoospermia may be able to conceive naturally if their condition may be corrected by surgery. However, it’s essential to realize that surgical treatments will not resolve the issue overnight. A semen evaluation will be performed within three to six months after surgery.
Medication or Hormonal Support
Azoospermia can be sometimes treated with medication. For instance, retrograde ejaculation is often treated with drugs, that could make natural conception possible.
ART ASSISTANCE – TREATMENT FOR AZOOSPERMIA (IVF, ICSI)
Pre and post testicular azoospermia are usually treatable, testicular azoospermia is however everlasting. If Azoospermia is caused due to blockages then there can be surgical techniques to remove the blockages for the male partner to conceive naturally.
In recent development male with Azoospermia have been able to father children through the combination of IVF and ICSI ART processes. Here sperms are directly extracted from Testis or Vas deferns or epidydymis by using various male infertility treatment techniques like TESA, TESE, MESA and PESA.
