Azoospermia. What to do if the partner does not have sperm in the ejaculate?

1. 🩺 Azoospermia: types, causes, symptoms
2. 🤰 Diagnostic tests and diagnosis of azoospermia
3. ⭐ Treatment

One of the rarest and most severe forms of male infertility is azoospermia, the absence of sperm in seminal fluid. Although the pathology occurs in only 1% of men in the population or in 1 out of 10 men with fertility problems, it will not be out of place to understand what to do and what to expect and whether  sperm donor is needed when making such a diagnosis. We will talk about this in the article.

Azoospermia: types, causes, symptoms

The normal process of spermatogenesis includes sever

• The formation of spermatozoa in the form of round cells in the seminiferous tubules inside the testicle;
• Maturation of round cells due to FGS, LH, testosterone, change in their shape (“tadpoles”);
• The movement of spermatozoa into the epididymis, their further development.
• Mature sperm enter the vas deferens;
• They move to the seminal gland and mix with the liquid, which mainly consists of sperm;
• The resulting mixture enters the prostate gland, mixes with prostate fluid;
• The sperm obtained in this way is ready to exit through the urethra in the process of ejaculation.

There are two classifications of types of azoospermia, both directly follow from the causes of the pathology. The most commonly used classification implies two types:

• Non-obstructive (secretory);
• Obstructive (excretory).

Non-obstructive is associated with impaired production of gonadotropic and steroid hormones, such as FGS, LH and testosterone. That lack of spermatozoa in semen is a consequence of insufficient production of hormones: by the pituitary and / or hypothalamus or testicles. Failures can occur due to the following reasons:

1. Genetic or chromosomal pathologies;
2. The damaging effects of radioactive radiation, chemotherapy, pesticides and toxic substances;
3. Endocrine disorders;
4. Side effects of drugs or dietary supplements;
5. Varicocele.

The three most common genetic pathologies associated with the development of azoospermia are Y-chromosome microdeletions, Klinefelter and Kallman syndromes. These developmental anomalies cause a violation of the puberty process, resulting in an increased risk of developing azoospermia.

Radioactive radiation (including during chemotherapy), prolonged exposure to toxic substances on the body can provoke a violation of hormonal regulation and, as a result, the absence of spermatozoa in seminal fluid.

Important: If you have been diagnosed with an oncological diagnosis and chemotherapy is prescribed, consult your doctor about sperm cryopreservation before starting the course. There is a risk of permanent loss of reproductive ability after the end of the course of treatment. However, in most cases, the ability to conceive is restored within 2-10 years.

Endocrine disorders that affect reproductive function occur at the level of the brain (pituitary, hypothalamus) and/or gonads (testicles).

Also, some drugs used for oncology, gout, Hodgkin's disease, maintenance therapy after organ transplantation can also lead to the development of azoospermia.

Important: Very often, the lack of sperm is associated with the use of anabolic steroids to build muscle. In most cases, their cancellation by a doctor leads to the restoration of reproductive function.

Varicocele (enlarged veins in the scrotum or testicle) form an accumulation of blood, and hence an increase in temperature in the testicles, which has a detrimental effect on the maturation of spermatozoa.

Obstructive azoospermia involves a blockage in the epididymis or vas deferens. Spermatozoa do not go through all stages of spermatogenesis and do not enter the ejaculate. Pathology can be caused by the following factors:

• Congenital anomalies in the structure of the organs of the reproductive system;
• Infections or inflammatory processes in the genitals;
• Trauma or injury during surgery;
• Retrograde ejaculation.

As a result of a violation of the formation of the organs of the reproductive system at the stage of intrauterine development, a man may develop blockages in the epididymis or vas deferens.

As a result of past infections of the reproductive organs, scar tissue can form, resulting in blockage of the vas deferens. Such a result can also be caused by infections not related to the sexual sphere: for example, in children - mumps, in adults - influenza or tuberculosis.

There is a risk of adhesion formation after trauma and surgery, including vasectomy.

Retrograde ejaculation (sperm entering the bladder) is not associated with blockages in the epididymis or vas deferens, but is also a form of obstructive azoospermia. With this form, spermatozoa are not always absent, and a low amount of sperm can be observed during ejaculation.

Diagnostic tests and diagnosis of azoospermia

In most cases, the diagnostic test of azoospermia is associated with a couple's referral to a reproductive specialist after long unsuccessful attempts to conceive a child. The pathology does not have specific symptoms, but during the life a man can observe the following symptoms:

• The absence of sperm or its negligible volume during ejaculation;
• Cloudy urine after intercourse;
• Painful urination;
• Pain in the pelvic region;
• Swelling of the testicles;
• Small or undescended testicles;
• Small penis;
• Delay or disruption of puberty;
• Erectile dysfunction or ejaculation;
• Low libido;
• Decreased hair growth;
• Gynecomastia;
• Decreased muscle mass.

These symptoms are not specific to azoospermia and may not be present.

The only way to reliably diagnose is a spermogram. A man must take a semen analysis twice within a few months. If both examinations fail to detect spermatozoa in seminal fluid, a diagnosis of azoospermia will be made.

Important: the diagnosis does not mean the unambiguous need for the services of a sperm donor. Further research will establish the cause of the pathology in the man and will allow the development of a treatment regimen. In some cases, a man will be able to conceive a child naturally. You should know that getting good quality sperm is possible even with a fifth of a testicle.

To determine the causes of azoospermia, a man will undergo the following examinations:

1. Collection of anamnesis, starting from childhood: detailed information about past diseases, past sexually transmitted infections, if any, information about taking certain medications or dietary supplements.
2. Examination of testicles.
3. Analysis of urine.
4. Blood tests to determine the level of hormones (FSH, LH, testosterone, prolactin, estrogen, estradiol, inhibin B).
5. Karyotype study + genetic test;
6. Transrectal ultrasound (TRUS);
7. Biopsy of the testicles (according to indications).

The results of the examination will determine the type of azoospermia (obstructive or non-obstructive), and in connection with this, develop a treatment regimen. A testicular biopsy is used when tests and a physical examination fail to determine the cause of the problem.

The choice of treatment regimen is also based on the results of the examination of the female partner. Depending on her fertility and the results of the genetic test, the required amount of reproductive services is specified: in case of low fertility, partners may be recommended surrogacy program, oocyte donation and other methods.

In parallel with the man, fertility research and genetic analysis will be carried out for the woman. This will allow you to choose the most effective treatment tactics for a couple planning to become parents.

Treatment

The main methods of treating azoospremia, depending on the causes and severity of the condition, are as follows:

1. Lifestyle change. In cases where the pathology is caused by the use of drugs or dietary supplements or the harmful effects of the environment (radiation, heavy metals, toxic substances).
2. Antibiotics for the treatment of acute infections.
3. Hormone therapy.
4. Surgical intervention.

Taking hormonal drugs can solve the problem, in particular, of retrograde ejaculation. A man may be able to conceive a child naturally. In other cases, it remains possible to extract healthy spermatozoa suitable for fertilization from the testicle or from the urine. Extraction of germ cells by biopsy or centrifugation of urine automatically means the use of IVF or ICSI methods to achieve pregnancy.

In the case of adhesions inside the organs of the reproductive system, the doctor may recommend surgical treatment. This measure is relevant, including with varicocele. In some cases, a man's ability to conceive is restored.

If the treatment is ineffective (it is impossible to obtain high-quality spermatozoa), partners are advised to resort to the services of a sperm donor.

Important: assisted reproductive services will also be recommended in case of genetic problems in partners or fertility problems in a female partner.

If assisted reproductive technologies are the most reliable path to parenthood in your case, it is important to choose a reliable clinic with extensive experience in the treatment of azoospermia and other severe forms of infertility. Feskov human Reproduction Group has more than twenty years of experience, including combined cases with azoospermia and female factor infertility. We not only treat - we provide 100% results thanks to guaranteed programs.

The guaranteed program involves payment for the result - the birth of a healthy child. No repeated payments in case of unsuccessful IVF or termination of pregnancy: in such cases, at our own expense, we carry out as many repeated cycles as it takes to give birth to your baby.

We will focus all efforts to overcome your fertility problems: our methods allow you to overcome azoospermia in the vast majority of cases. We recommend the use of donor sperm only in extreme cases, when your spermatozoa do not leave hope for the birth of a healthy child.

If your spouse is found to have fertility problems that prevent her from bearing a child - in our country surrogacy is legally allowed. Feskov Human Reproduction Group has a huge database of proven surrogate mothers who are ready to bear a child for you. Legal support included in the price of the package of services will allow you to quickly and easily draw up the necessary documents for its legalization.

If future parents want to protect their baby from possible hereditary diseases, in addition to standard IVF and ICSI procedures, we recommend using the “Human Genomics” service. With the help of in-depth genetic studies, we can guarantee that your future child is not predisposed to more than 500 hereditary diseases, including oncology, cystic fibrosis, hemophilia and others. If your couple's genetics include sex-linked diseases, we will ensure the birth of a boy or girl, protected from the manifestation of a genetic pathology. We also have a “Gender Selection” service for those who simply dream of having a son or daughter.

Learn more about our programs - request a free consultation from Feskov Human Reproduction Group. We will determine the most promising path for you to the desired child.

Authors, contributors:

Alena Siwash

published: 25 April 2023
updated   : 26 April 2023

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