What is Azoospermia?

In a normal male, the volume of ejaculated semen is approximately 2-5 millilitres and should contain sperm. Under normal circumstances, the brain sends hormonal signals that stimulate sperm production in the testes. The sperm then undergo development in the epididymis, move into the vas deferens, and are eventually ejaculated along with the semen. Azoospermia refers to the condition where there is no sperm present in the ejaculated semen, making natural conception difficult.

Causes:

Various factors can cause azoospermia and can generally be classified as obstructive and non-obstructive causes:

Obstructive Azoospermia:
The ability of the testes to produce sperm is not impaired, but there is a blockage in the ducts that transport the sperm, preventing them from reaching the semen. This can be congenital (such as congenital absence of the vas deferens) or due to acquired infections (such as mumps or sexually transmitted diseases) that lead to ductal obstruction.

Non-obstructive Azoospermia:
Testicular failure: The male is unable to produce sperm normally due to testicular dysfunction. This can be caused by genetic disorders (such as Klinefelter syndrome or Y-chromosome microdeletions), chemotherapy, radiation therapy, or certain medications. Varicocele (enlarged veins within the scrotum) or undescended testicles can increase the testes' temperature and lead to azoospermia. In some cases, the cause of azoospermia cannot be identified even after a thorough examination.

Hypothalamic or pituitary problems: The brain fails to send hormonal signals to stimulate sperm production. This condition is less common and can be caused by factors such as brain tumours, a history of brain surgery or radiation therapy, or genetic defects.

Retrograde ejaculation: In some men, semen does not exit through the penis during ejaculation but instead enters the bladder in a "retrograde" manner. Causes include diabetes, history of prostate or bladder surgery, certain medications for blood pressure or emotional disorders, and spinal cord injuries.

Symptoms:

Many men with azoospermia are diagnosed with this condition due to difficulties in conceiving (infertility). It may also be discovered during premarital/preconception check-ups. The symptoms experienced depend on the underlying cause:

Men with obstructive azoospermia generally have normal libido and sexual function. Some men with testicular failure may experience decreased libido due to low male hormone levels or may have sexual dysfunction. Men with hypothalamic and pituitary problems may exhibit symptoms related to the underlying cause leading to azoospermia. In the case of retrograde ejaculation, men may have very little or no ejaculation during climax, but they may notice cloudy urine after climax (due to the presence of semen in the urine).

Diagnosis:

To diagnose azoospermia, doctors typically perform the following examinations and evaluations:

• Semen analysis: The doctor will request a semen sample from the male for laboratory testing to determine the presence of sperm. If no sperm is found in the semen sample, another semen analysis should be conducted after a certain period of time, as acute illnesses can also cause temporary sperm production issues. If retrograde ejaculation is suspected, the patient should submit the first urine sample after climax for examination of the presence of sperm.
• Blood tests: Blood tests can be conducted to evaluate pituitary hormone and male hormone levels, to rule out any endocrine problems.
• Chromosome analysis: This is done to assess for any Y-chromosome microdeletions that may be causing genetic testicular failure.
• Ultrasound examination: Consultation with a urologist for a physical examination can help determine if there are any obstructions or structural abnormalities in the testes and the vas deferens.

Treatment:

Even if diagnosed with azoospermia, there is still a chance of successful pregnancy. Depending on the underlying cause and individual circumstances, reproductive specialists and urologists will tailor treatment plans accordingly. Here are some common treatment options:

Obstructive Azoospermia: Depending on the specific cause, surgical reconstruction to clear the blockage may be considered, or surgical sperm retrieval can be performed for the female partner to undergo in vitro fertilisation (IVF) treatment. Since the ability of the testes to produce sperm is not impaired, surgical interventions can often successfully obtain sperm.

Non-obstructive Azoospermia (Testicular Failure): Sperm retrieval directly from the testes is usually necessary. The success rate depends on the specific cause.

Hypothalamic or Pituitary Problems: Stimulation of sperm production can be achieved through hormonal injections.

Retrograde Ejaculation: If possible, discontinuing the medications that may be causing the problem can help. Sperm can also be retrieved from the urine for use in assisted reproductive techniques such as IUI or IVF.

How to Increase Sperm Count and Quality?

Men should adopt a healthy lifestyle: avoid smoking, maintain a healthy weight, and exercise regularly. They should also avoid wearing tight clothing and exposure to high temperatures, such as hot springs or saunas, as heat can kill sperm and affect testicular function.

Azoospermia is one of the causes of male infertility, but it does not mean that pregnancy is impossible. With proper diagnosis and treatment, many patients still have a chance to become fathers. If you or your partner suspects azoospermia, it is important to consult a specialist in reproductive medicine as early as possible to receive appropriate advice and treatment plans.