What Is Azoospermia: Treatment, Causes, Symptoms and More

1. 🩺 Azoospermia: types, causes, prevalence
2. 🤰 Symptoms, diagnosis and treatment of azoospermia
3. ⭐ Causes of azoospermia
4. 💊 Diagnostics
5. ✔ Treatment

Despite the fact that azoospermia is considered a severe form of male infertility in terms of health care, expectant parents can do without services of a sperm donor if the causes of azoospermia in a man can be eliminated by treatment. Let us consider in more detail the origins of the problem, methods of therapy and reproductive prospects for men with a similar disorder.

Azoospermia: types, causes, prevalence

To understand the essence of the problem, it is necessary to imagine what the norm looks like. The normal sperm production process consists of several steps:

1. Sperm are produced in small tubes called vas deferens located inside the testicle.
2. Under the influence of hormones (FGS, LH, testosterone), germ cells in the tubes mature, taking the form of a tadpole.
3. From the seminiferous tubules, mature spermatozoa move to the epididymis, where they continue to develop.
4. Next, the erm cells move into the vas deferens.
5. From the vas deferens, the spermatozoa enter the seminal vesicle (the seminal gland), where they mix with the fluid that makes up most of the semen.
6. The mixture obtained at the previous stage is sent from the seminal vesicle to the prostate gland, where it is supplemented with prostate fluid.

Further, the already prepared sperm during intercourse passes through the urethra during ejaculation. The urethra passes through the prostate from the bladder and also through the penis.

Now that we have an understanding of the process of sperm production, we can consider the causes of the pathology of this process.

Two approaches have been taken in the health care field to address the causes of azoospermia. The first is based on fixing the moment in the reproductive cycle when spermatogenesis is disturbed. In accordance with it, there are three types of azoospermia:

• Pretesticular;
• Testicular;
• Posttesticular.

In the first case, the problem begins at the stage of production of pituitary and hypothalamus hormones. That is, there is no hormonal support for spermatogenesis.

In the second case, we are talking about the pathology of the testicle or the spermatozoa themselves. Either the testicles do not produce testosterone and / or do not respond to endocrine hormones, or there is a problem at the level of cellular development of the spermatozoa themselves.

In the third variety, the problem occurs at the stage of ejaculation. There is a blockage/absence of the vas deferens or epididymis, or dysfunction of ejaculation (for example, semen flows back into the bladder).

In the process of examinations, doctors, in communicating with patients, often use the following classification to explain the causes of the pathology:

• Obstructive azoospermia;
• Non-obstructive azoospremia.

In the first case, we are talking about a violation of the ejaculation process or an anatomical defect (blockage of the vas deferens), in the second - about hormonal deficiency or violations of the cellular development of spermatozoa.

Causes of azoospermia

The main causes of obstructive azoospermia are:

• Birth defects;
• Infections or inflammatory processes of the reproductive organs;
• Trauma or injury resulting from surgery;
• Retrograde ejaculation (sperm entering the bladder).

For genetic reasons, men may have an obstructed epididymis or vas deferens from birth.

The main danger of infectious processes in the reproductive organs is the possibility of the formation of scar tissue, which forms a blockage of the vas deferens. In some cases, not only genital infections can lead to such a result: for example, childhood parotitis can give a complication in the form of orchitis - inflammation of the testicles, which can also lead to blockage. Therefore, it is very important to inform the reproductologist of a detailed history, starting from childhood.

Trauma and surgery can also cause adhesions in the testicles or ducts.

If a man resorted to a vasectomy for contraception, he could develop adhesions in the vas deferens.

Retrograde ejaculation does not suggest blockage, but is referred to as obstructive azoospermia. Depending on the severity, either a low amount of ejaculate is assumed (most of it goes to the bladder) or the absence of spermatozoa.

Causes of non-obstructive azoospermia include:

• Genetic or chromosomal defects;
• Damage to the body by radiation, chemotherapy, toxic damage;
• Hormonal disorders;
• Side effects of medications or dietary supplements;
• Varicocele.

With regard to genetic or chromosomal defects, azoospermia has been reliably associated with three:

1. Microdeletions of the Y chromosome.
2. Klinefelter syndrome.
3. Kallman syndrome.

All these pathologies can lead to impaired puberty and, as a result, to infertility.

Chemotherapy, radiation exposure, exposure to toxins, pesticides, and heavy metals can cause azoospermia.

Important: before starting chemotherapy, it is necessary to discuss sperm cryopreservation with your doctor. The fact is that after a course of chemotherapy, spermatogenesis may suffer. In some cases, it can take from two to ten years to restore it, but there have been cases of a complete cessation of the process for life.

Hormonal causes are associated with disruption of the pituitary-hypothalamus-testes ligament or any of its elements.

A number of medications aimed at treating oncology, gout, Hodgkin's disease, as well as immunosuppressants used after organ transplantation, can also provoke azoospermia.

Important: The most common cause of azoospermia while taking medication is the use of anabolic steroids.

A varicocele (an enlarged vein in the scrotum or testicle) causes blood to pool in the place of its localization. This leads to an increase in testicular temperature, which can cause swelling, shrinkage of the testicles, and discomfort.

Based on the causes of the pathology described above, it can be concluded that it is practically impossible to prevent azoospermia if it is caused genetically or anatomically. The only thing a man can do throughout his life is to exclude harmful effects and not take steroid hormones for aesthetic purposes.

Symptoms, diagnosis and treatment of azoospermia

In general, azoospermia is a rather rare phenomenon that occurs in 1% of men.

There are no specific symptoms that suggest azoospermia of any type in a man. A number of some indirect ones suggest the presence of a problem, these include:

• Small volume of ejaculate or its absence ("dry" orgasm);
• Cloudy urine after sex (possibly with retrograde ejaculation);
• Painful urination;
• Pain in the pelvis;
• Swollen testicles;
• Small or undescended testicles;
• The penis is smaller than average in size;
• Delayed or abnormal puberty (Kallman and Klinefelter syndromes);
• Difficulty with erection or ejaculation;
• Low libido;
• Decreased hair growth;
• Enlarged chest;
• Loss of muscle mass.

A man may not have all of the above symptoms, but azoospermia is diagnosed.

Diagnostics

A reliable way to establish the diagnosis is to carry out a spermogram. Two analyzes will be needed with an interval of several months. If both results show the absence of spermatozoa in the ejaculate, the diagnosis of azoospermia will be confirmed.

Further examinations will be aimed at establishing the causes of the pathology. Your doctor will need the following information:

• A detailed medical history, including childhood illnesses not related to the reproductive system, information about past STDs;
• Physical examination of the testicles;
• Blood test for hormones, including FSH, LH, testosterone, prolactin, estrogen.
• Karyotype analysis in addition to a genetic test to determine hereditary pathologies;
• Transrectal ultrasound (TRUS) to determine the localization of blockage or abnormal structure of the reproductive system;
• Biopsy of the testicles (according to indications).

If tests or TRUS reveal a cause, a testicular biopsy may not be needed.

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

Tactics depend on the type and causes of azoospermia, as well as on the fertility indicators of the female partner.

If an acute infection is detected, antibiotic therapy and concomitant drugs are prescribed. If the reason is the intake of certain drugs or toxic effects, the problem can be solved by canceling them or eliminating the damaging effect (change of work with harmful conditions, etc.)

In the treatment of some types of azoospermia (for example, retrograde ejaculation), hormonal drugs may be effective. A similar measure can also help the production of sperm if the reasons lie in the hormonal imbalance. As a result, a man will be able to conceive a child naturally. This method may be associated with the extraction of healthy sperm from the testicle through a biopsy. In some cases, during retrograde ejaculation, sperm can be removed from the urine.

If the previous methods are recognized by your doctor as ineffective in your case, microsurgical treatment is indicated. This approach aims to eliminate adhesions within the reproductive tract and is also indicated for varicocele. With a favorable outcome, a man will be able to conceive a child on his own.

If for some reason it is impossible to extract spermatozoa or there are no healthy ones among them according to the results of a genetic test, the use of donor sperm is shown to the couple.

All the cases described above involving the extraction of spermatozoa suggest the need for assisted reproductive technologies (IVF, ICSI) to conceive a child. If some problems are identified on the part of a female partner, surrogacy and/or egg donation services may also be recommended

Feskov Human Reproduction Group has the latest and most effective methods for the treatment of azoospermia, and also offers guaranteed surrogacy programs that will result in the birth of a healthy child.

On our Youtube channel, happy parents from all over the world confirm the reliability of our medicine and reliability of the Ukrainian legislation in the field of assisted reproductive services. Check it out - and trust us! You will become parents no matter what.

Authors, contributors:

Olena Somova
Embryologist

published: 26 February 2023
updated   : 02 March 2023

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