Azoospermia-Male infertility causes
Still not pregnant? For some couples, azoospermia or a lack of sperm-cell in the ejaculate can stand in the way of conception.
When it comes to planning a family. You could take the sperm-cell end of the equation for granted. This makes good sense of course because the majority of the male has enough strong swimmers to fertilize female eggs. But for some couples, azoospermia or a lack of sperm-cell in the ejaculate, can stand in the way of conception.
“Many men with azoospermia have normal semen volumes but do not realize that there is no sperm in their fluid,” says Marc Goldstein, M.D., the chief surgeon in the department of men reproductive medicine at New York Presbyterian Hospital, Weill Cornell Medical Center in New York City.
Infertility affects about 15% of the male population in the USA. Of this group, 10- 15% suffer from azoospermia, that is approximately 1- 2%, or over 1 million and post-pubertal men. “The rest of this group have either oligospermia [low sperm count or concentration], asthenospermia [slow swimmers], both conditions together [oligoasthenospermia] or crytoozoospermia [rare or very few sperm],” Dr. Goldstein explains.
If you are trying to conceive, azoospermia is not the end of the world. “There’re many treatment options available for the male with this condition to become biologic fathers and so it certainly does not mean there is no hope,” notes Michael Eisenberg, M.D., director of men reproductive medicine and surgery, an assistant professor in the department of urology at Stanford University School of Medicine.
Here is what you should know about the causes, diagnosis, and treatment of azoospermia:
2 main types of azoospermia are defined as obstructive and nonobstructive. “If any man has the obstructive variety, it means that sperm-cell is being produced inside the testicle but it is somehow blocked, cannot get out,” Dr. Goldstein says. The issues for those with the nonobstructive type lies in the production department: sperm-cell just ain’t being made.
Most cases are idiopathic or having unknown causes, explains Michael Feinman, M.D., a reproductive endocrinologist, the medical director at HRC Fertility. That has centers in Southern California. For both kinds of azoospermia, there can be rare genetic causes that impair sperm-cell production or transit, Dr. Eisenberg says. “Some male is born without the duct leading from the testis to the penis, which is called the vas deferens,” Dr. Feinman adds. Without this channel, sperm cannot travel out the end of the penis. That condition, which is the most common type of obstruction, is known as congenital absence of the vas, or CAVD, many men with it also carry the gene for cystic fibrosis.
Nonobstructive causes of azoospermia include a chromosomal abnormality like as Klinefelter syndrome, pituitary dysfunction resulting in low hormone production, certain operations such as prostate removal or a bilateral hernia repair. “Medical conditions like diabetes can cause a reversal of the flow of semen or retrograde ejaculation,” Dr. Feinman says. Cancer patients who need to undergo radiation and chemotherapy may develop azoospermia as these two treatments destroy the sperm-producing cells. “Any type of scrotal injury sustained in sports can harm the testes or epididymis [where sperm matures], leading to production or transport issues,” Dr. Eisenberg adds. Lastly, excessive use of testosterone can result in a temporary, even permanent, case of azoospermia.
In general, there are not any obvious symptoms, such as pain, that might indicate a man has azoospermia. “The exception to this are those men who have low hormone levels,” Dr. Feinman notes. “Males with Klinefelter syndrome will have other physical features typical of the syndrome,” he says. These may include enlarged breast tissue, low energy levels, small genitals, and above average height. “In rare cases of azoospermia, men may have small testes or swollen structures within the testes, or symptoms of low testosterone,” Dr. Eisenberg adds.
“Azoospermia is most commonly diagnosed when a couple discovers they are unable to conceive,” Dr. Eisenberg says. An analysis of the semen is the only way to determine whether this condition is present. “If there’s zero sperm, a reproductive urologist will establish whether it is obstructive or nonobstructive,” Dr. Goldstein explains. A blood test for follicle stimulating hormone (FSH) and testosterone and genetic tests will confirm the diagnosis. If FSH is elevated and the testis is small and soft, then this is typically a case of nonobstructive azoospermia. If the FSH, testosterone, and testis are all normal and the ducts are missing or swollen with sperm that can’t get out, obstructive azoospermia is diagnosed.
Care for this condition usually depends on the cause. “The obstructive variety that is caused by complications for sexually transmitted infections, such as epididymitis, or because a hernia repair has injured the vas can be repaired successfully with microsurgery,” Dr. Goldstein says. Obstructive azoospermia due to congenital missing ducts is treated by microsurgically sucking sperm-cell out (sperm aspiration), using it to fertilize the partner’s eggs retrieved by in vitro fertilization (IVF).
“In the rare few males with hormonal deficiencies, azoospermia can be treated with gonadotropins, like as non-ovulating women. And for many with nonobstructive azoospermia, even Klinefelter small patches of sperm-cell may be found in the testes and can be used for IVF,” Dr. Feinman says. If the diagnosis is a reversal of semen flow, sperm-cell can be retrieved from the urine.
Avoiding any kind of sexually transmitted diseases, or at the very least getting early treatment of the genital infections and may lower the risk of the azoospermia. “For male receiving cancer treatments, freezing sperm-cell prior to treatment may preserve fertility even if future sperm-cell production is compromised,” Dr. Eisenberg says. There’re also prophylactic measures which can be taken to lessen testicular exposures in certain cases of radiation treatments for cancer.
For some hernias, microsurgically assisted inguinal repairs can prevent injury and, as a result, cases of azoospermia. It is also suggested that men avoid excess alcohol and drugs, as abuse of either may cause infertility and possibly azoospermia. Testosterone and anabolic steroids might also be avoided. “Testosterone is a contraceptive for male, so those who take it, or any anabolic steroid, often develop azoospermia,” Dr. Goldstein warns. If these drugs are used long enough, the condition may be irreversible.