AZOOSPERMIA: Diagnosis and Treatment -The absence of sperm
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Azoospermia is the complete absence of sperm in the semen and as such means that a man will be completely infertile. The diagnosis of azoospermia is sometimes still made even though as many as 500,000 sperm per ml of semen may have been seen because it is extrremely unlikely that the man will be able to father a child naturally. In fact it is rare that a man has absolutely no sperm at all and as long as some sperm are produced it is possible nowadays to help couples through a procedure called ICSI.
So, if the doctor says you have azoospermia make sure you ask exactly what the semen analysis results were.
Azoospermia occurs in about 2% of men in the general population. So whilst not common there are plenty of infertile men around - in the UK alone we would expect to find at least 300,000 men with azoospermia and many of these would appear extremely healthy and have no indication that any problem might exist ! In addition around 10-20% of men attending infertility centers will probably have azoospermia as well.
This means that if you and your partner have been trying for a year or more to have a baby there is an increased risk that you may have a problem.
The finding of azoospermia often comes as a surprise for a couple since there often are no symptoms (there frequently is an ejaculate and a normal ejaculation process). Whilst this can be very distressing it is possible to offer treatment through a fertility specialist in many cases so it is importnat not to just give up and think there is no hope. If treatment does fail it is possible to help some couples by using the new ICSI procedures.
The most severe expression of male factor infertility is azoospermia, where no sperm are present in the ejaculate. Azoospermia is found in 15-20% of men evaluated for infertility. Causes of azoospermia include congenital and acquired reproductive tract obstruction as well as spermatogenic failure.
Azoospermia may have different etiologies previously described as pretesticular (i.e. abnormal Hypothalamo-Pituitary-Gonadal hormonal axis), testicular (i.e. secondary to abnormal testicular function) and posttesticular (i.e. obstruction or ejaculatory dysfunction). This classification, although physiologically correct, is not always practical for treatment decision making. The division of azoospermia into OBSTRUCTIVE and NON-OBSTRUCTIVE categories allows better determination of specific treatment options available to a particular patient. It is also critically important since patients with nonobstructive azoospermia have different genetic problems.
The approach to azoospermic patient has changed significantly with the introduction of sperm retrieval techniques and assisted reproduction , especially IFV/ ICSI. Nevertheless, specific treatment of azoospermia remains not only successful but also a cost-effective option.
Testicular biopsy remains the oldest and most informative diagnostic modality to differentiate between obstructive and nonobstructive azoospermia. Previous recommendations of not performing biopsy in patients with 2-3 times elevated serum FSH level are outdated. It was shown consistently that gonadotropins as a markers of spermatogenesis are imperfect. Normal FSH level may be observed in patients with testicular dysfunction while significantly elevated FSH does not indicate complete absence of the spermatogenesis. Presently, testicular biopsy may not only discriminate between the types of azoospermia, but have a predictive value for sperm presence in the testis in cases of nonobstructive azoospermia. As soon as the cryopreservation of the testicular tissue with subsequent use in the assisted reproduction becomes widely available, testicular biopsy will also be a valuable treatment procedure.
Causes of Azoospermia
About underlying conditions: With a diagnosis of Azoospermia, it is important to consider whether there is an underlying condition causing Azoospermia. These are other medical conditions that may possibly cause Azoospermia. For general information on this form of misdiagnosis, see Underlying Condition Misdiagnosis or Overview of Misdiagnosis
Underlying conditions list: The list of possible underlying conditions mentioned in various sources for Azoospermia includes:
  • High fever (see Fever) - causing temporary lack of sperm
  • Undescended testicle
  • Testicle conditions (type of Male sexual conditions)
  • Obstructions of seminal passages
  • Testicle infection
  • Certain hormonal disorders
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