Evaluating and Treating Zero Sperm in Males (Azoospermia)

Azoospermia describes a condition in men where there is no sperm in semen. It is a potential infertility concern and accounts for 10-15% of all infertile men. Your physician may suspect the condition when no pregnancy has occurred after a year of unprotected sex and after a semen analysis test has reported Azoospermia. About 1% of men may suffer from azoospermia or no sperm in their semen analysis.

The Diagnosis and Cause of Azoospermia

Diagnosing Azoospermia

Semen analysis is a test where the semen of a male is analysed for various factors such as sperm concentration, sperm motility and sperm morphology. There are cases when a man can produce semen, however, the same is absent of any sperm cells. A single semen analysis report mentioning Azoospermia cannot be the sole diagnosis and the patient is recommended to repeat the semen analysis at a standardised laboratory before confirming this condition of Azoospermia.

Semen analysis for azoospermia is a laboratory process called centrifugation that separates the constituents of seminal fluid by spinning. As the fluid rotates rapidly, denser particles move away from the center. Technicians inspect this sediment for sperms. According to the WHO laboratory manual for evaluating human semen, no sperm in the residue indicates an azoospermic sample.

Azoospermia and normal

A fructose test is done for patients who have azoospermia as the presence of fructose in the sample is an indication of sperm production.

What to Expect from a Doctor Consultation for Azoospermia

Consultation with a doctor is required to find the exact cause of azoospermia. Your physician may examine your medical history, perform a physical examination, request blood tests, and obtain semen samples to repeat the semen analysis test.
A physical assessment for azoospermia is the first step of diagnosis. Providing an accurate medical history helps your physician discover injuries or surgeries in your pelvic area, any record of childhood illnesses, medication use or chemotherapy exposure, infections of the urinary tract or reproductive duct, and familial diseases such as cystic fibrosis. In addition, he may require information on alcohol or drug intake and exposure to excessive heat.

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Your physician may use discretion to perform diagnostic tests for azoospermia such as measuring hormone levels, performing genetic testing, imaging the brain and reproductive organs, or collecting testicular tissue for a biopsy to discover the cause of male infertility.

Obstructive and Non-Obstructive Azoospermia

Physicians generally classify the basis of this condition by naming it obstructive azoospermia or non-obstructive azoospermia. In normal conditions, testicles produce sperms and a tube called epididymis stores them. Sperms then move into the vas deferens where they mix with semen produced from the prostate gland. Finally, semen moves out through the urethra and penis. In obstructive azoospermia, testicles produce sperm normally, but sperm cannot flow out due to blocked tubes. In non-obstructive azoospermia, the problem occurs with sperm production and leads to no sperms or low sperm count.
Obstructive azoospermia happens when:

  • A vasectomy blocks sperm ducts intentionally to stop semen from flowing
  • Infections of prostate, testicles, or epididymis block the male reproductive system
  • Males are born with prostate cysts or missing portions of their vas deferens
  • Surgical procedures executed to correct conditions such as a hernia produce scar tissue that obstructs the reproductive tract.

In most other cases, the cause of non-obstructive azoospermia is:

  • Abnormal function of the testicles or reproductive hormones
  • Genetic causes linked to an extra X chromosome, or missing genes on the Y-chromosome
  • Varicose veins forming around testicles (varicocele) that affect the count and quality of sperms
  • Lowered sperm production in the testicles (hypospermatogenesis) leading to zero sperm or azoospermia
  • Inadequate development or maturation of the sperm
  • Other factors including chemotherapy, diabetes, sickle-cell anemia, steroid intake, and exposure to toxins

Treatment Strategies for Azoospermia

To restore male sexual health, a physician may treat male infertility by counseling, hormone treatment, reconstruction of obstruction, or sperm retrieval and assisted reproductive techniques. Depending on the nature of your condition, a doctor may attempt to restore male sexual health using one of the following treatment approaches.

No Sperm
  • Counseling on a healthy lifestyle and avoiding medication and toxins as a holistic first-line of treatment
  • Performing endoscopic surgery, microsurgery or assisted reproductive techniques for obstructive azoospermia
  • Administering hormones to stimulate sperm production in the case of hormonal imbalance
  • Retrieving sperm from the testis to fertilize the eggs in a laboratory procedure

As a final thought, it is possible to prevent male infertility from azoospermia if you avoid exposure to radiation, hot temperatures, and medication that may harm production of sperm. Maintaining optimal male sexual health certainly helps lower the risk of zero sperm count.

2019-02-15T11:17:07+00:00