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AZOOSPERMIA: DIAGNOSIS AND TREATMENT
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Azoospermia (The absence of sperm)
- 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.
Aspermia is an absence of any ejaculate (semen) and is
much rarer
Note : 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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