Azoospermia: Symptoms, Causes, Diagnosis and Treatment

It is not uncommon to meet couples who have been married for several years but do not have any children. The level of acceptance of childless couples is growing among social circles. Neighbours do not look upon it as something unusual. Some couples do not have children because they are too focused on their work and feel that having a baby will hinder their career growth. This has led to family planning taking a back seat. However, not every childless working couple has planned a delayed parenthood. Many couples are not able to conceive naturally and have children. Over the last couple of decades we have seen a sharp rise in infertility. It is not just a female issue, In some cases both partners suffer from some degree of infertility.

Difference between Normospermia(Normal Sperm Count) and Azoospermia (Low Sperm Count)
Difference between Normospermia (Normal Sperm Count) and Azoospermia (Low Sperm Count)

There are many reasons for male infertility. These problems of male infertility prevent the couple from being able to get pregnant naturally. Almost 50% of the infertility cases pertain to the male partner or both partners. One of the possible causes of male infertility is nil sperm count.

What is Azoospermia?

Azoospermia is the absence of sperm in the ejaculate. Little prior to ejaculation the semen is mixed with sperm. The sperm is the male contribution for conception and is crucial for fertility. When a male ejaculates in the vaginal passage the sperms travel to the fallopian tubes in search of the female egg. Once the female egg has been located, one healthy and robust sperm then enters the egg and fertilises it to form an embryo.


The azoospermia definition can be summed up as a zero sperm count. It is a condition which makes a male infertile. The male partner needs to have a certain minimum sperm count which deems him fertile. Without the required sperm count present in the semen a man is not able to impregnate his female partner naturally. A male should have a minimum sperm count of at least 20 million per millilitre of semen.

Symptoms of Azoospermia

How does a man get to know that he has a zero-sperm count? It is not a sickness or a disease. It is a condition which does not allow a certain function of the body. This is due to the malfunction of an organ or could also be due to the blockage of ducts. In this case it is the production of healthy sperm which is impaired.

There are no specific external symptoms which can characterise Azoospermia. So a male will not suffer any external or noticeable symptoms with this condition and may appear absolutely healthy and robust. The symptoms are not visible and hence usually a male is not even aware that he has a fertility issue.

CASE STUDY

Seema and Nikhil started trying for a baby when they turned 30. After 6 months Seema found that her periods were regular and she was not conceiving. She decided to visit a gynaecologist to see if everything was fine with her. After several tests it was found that she has no medical problems which would hinder her from getting pregnant. After another 8 months passed she was still not pregnant. Seema happened to meet a friend who had just delivered a baby after IVF treatment at Medicover Fertility. She was all praises for the service and suggested that Seema and Nikhil at least meet the fertility consultant at Medicover Fertility.

They booked an appointment and met Dr. Sweta Gupta . After several tests it was found that Nikhil has azoospermia due to a genetic condition. The doctor apprised them that azoospermia was not uncommon among men and there was a good possibility of getting pregnant with IVF treatment. The azoospermia treatment success rate in India is quite high. The couple took a week to think it over and finally signed up for IVF treatment at Medicover Fertility, one of the best IVF clinics in India.

Azoospermia Diagnosis and Tests

Infertility diagnosis in male can be quite disturbing. But treatment starts when the cause is determined. Normally, sperm is produced in the scrotum’s testicles (testes) which flows through the reproductive tract to mix with fluid present in the seminal ducts, which then forms semen. Up to 2% of the World’s men lack measurable sperm in their ejaculate or semen and azoospermia represents about 10% of those male infertility cases.

Diagnosing azoospermia starts mostly with examining 2 semen samples, they should be collected at different times to get the accurate result. The sample should be tested within an hour of receiving the sample. The container in which the semen is brought should remain at body temperature. The first step involves a semen analysis. If no sperm is found, then the samples are centrifuged (spun at high speed) to get a concentrated pellet (the residue left after centrifugation) and examined further to find any hidden sperm. Hidden sperms are also called cryptozoospermia.

Other diagnostic procedures for azoospermia may include

  • A detailed medical history including reviews of any earlier medical records defining male infertility of the patient.
  • Physical examination
  • Hormone testing
  • Genetic screening
  • Genetic tract imaging using ultrasound, MRI (magnetic resonance imaging) or CT (computed tomography) scan.
  • Testicular Biopsy – An important tool in diagnosing male infertility.

Causes of Azoospermia

In a man who has Azoospermia, before initiating a treatment, it is important to know the cause for lack of sperm in the ejaculate, whether it is from an obstructive or non-obstructive process.

Azoospermia can be divided into two broad categories.

  • Obstructive Azoospermia – It means that sperms are being produced normally inside the testicle, but there is a blockage or obstruction in the reproductive tubing, that is not allowing the sperm to come out in the ejaculate.
  • Non-Obstructive Azoospermia – It means that the tubes are open, but there is a sperm production problem, that is either no sperm are produced at all or there is a very low level of sperm production. The level of sperm is so low that it cannot come out of the testicles and can only be found inside the testicle.

Causes of Obstructive Azoospermia

Obstructive Azoospermia can be genetic, congenital or acquired.

  • Vasectomy – The most common cause of obstructive azoospermia is Vasectomy. Vasectomy interrupts the sperm ducts to stop the flow of the sperm. Hence no sperms are found in the semen.
  • Infection – Obstructive Azoospermia can also be caused by infections of the testicles, prostate or reproductive tract such as epididymitis, prostatitis and other venereal diseases. These can cause a blockage in the small tubules of the epididymis or the ejaculatory duct.
  • Congenital conditions – Some conditions are genetic. Some men are born with a missing portion of the vas deferens. Others may be born with a cyst in the prostate that blocks the ejaculatory ducts.
  • Surgical complications – Some surgical procedures performed on the urogenital organs or hernia surgery can result in scarring that leads to a blockage. Mostly children are at a risk because their reproductive tract is very small, and a surgery can cause complication.

Causes of Non-Obstructive Azoospermia

Non-Obstructive azoospermia can be caused by abnormalities within the testicles or hormonal causes. The causes can be genetic, congenital or acquired.

  • Genetic cause – These include chromosomal abnormalities. The most common chromosomal problem causing azoospermia in men is a situation where there is an extra X chromosome, and the syndrome is called Klinefelter’s syndrome. Another genetic cause of azoospermia is a deletion of some of the genes on the Y chromosome. These genetic causes of azoospermia are not reversible but still most men with genetic issues can produce small amounts of sperm within the testicles that can be used to father a child.
  • Varicoceles – They are characterised by the presence of varicose veins around the testicles. This condition is reversible and are the most common cause of male infertility.
  • Hypospermatogenesis – This means that there is sperm production in testicles, but lower than the normal sperm count, which may not be enough to impregnate a female.
  • Maturation arrest – Some men suffer from a problem in which the sperms produced in their testes do not mature. A few sperms may mature but majority of the sperms remain in the precursor stage. For pregnancy, mature sperms are required.
  • Sertoli cell only syndrome or Germ Cell Aplasia – With Sertoli cell only syndrome or germ cell aplasia, the germ cells that divide and become sperm are missing from the testicles. But still 15-20% of men will have some low level of sperm production somewhere in the testicles.
  • Testicular cancer – At times the first sign of testicular cancer is azoospermia or a very low sperm count. So, men with abnormal sperm count must be examined thoroughly.
  • Medical treatment – Chemotherapy and radiation therapy used to treat cancer patients can cause temporary azoospermia. This is an acquired cause. Once treatment stops, the sperm production resumes may be within 2 years.
  • Prescription drugs – Another cause of Non-obstructive azoospermia are the use of testosterone and steroids. These can cause sterilisation and are very common. This is also an acquired cause and are reversible.

How common is Azoospermia?

This is not very a very common condition. It affects only about 1% of the entire male population. The absence of sperm prohibits natural conception. For a male to have sperm in his semen is imperative to be able to father a child.

Male infertility is quite common today especially in urban areas. When a couple is not able to conceive there is a high probability that one of the causes is male infertility. Among the couples that seek treatment for infertility we find that about 20% of them suffer from zero sperm count.

SUCCESS RATE

As soon as we got married we decided to start a family. My husband worked with his father in the family business and there was no need for me to work. We wanted a large family and planned to have many children. After a year of marriage I was still not pregnant though we were having very regular sex. I would keep track of my ovulation days and we ensured that we didn’t miss any opportunity during my fertile period. Finally after almost a year and a half we decided to visit a doctor to find out what was wrong and why I was not getting pregnant. I underwent many tests, all of which turned out to be clear and my doctor declared that I was fertile and fine. Now it was my husband’s turn to have some tests. He was not happy at the prospect. However, when his semen analysis test results came the doctor diagnosed that he had non-obstructive azoospermia. We were not prepared for this and didn’t know how to deal with it. A friend referred us to Medicover for fertility treatment and the rest is history. Today we are proud parents of 3 lovely children and we owe a big thanks to the team at Medicover Fertility for helping us though the most difficult time of our lives. – Ritika, 27 years

DOCTOR’S SUGGESTIONS

Fertility consultant at Medicover Fertility Clinic: The patient had a Non Obstructive Azoospermia condition which made him unable to impregnate his wife. When the couple first came to me I prescribed certain preliminary tests for both of them to ascertain what was preventing conception. Ritika’s test results were fine and she was healthy and fertile. The Semen analysis test of her husband raised some concern. After more tests we found that he suffered from sperm maturation arrest. This is a condition in which the required quantity of sperms is produced by the testes, but these sperms do not mature as they are naturally supposed to. To help this couple get pregnant we suggested testicular sperm extraction in which we hoped to find a few mature sperms. In most cases of maturation arrest there are still few sperms found which do mature. Fortunately we were able to find a small percentage of mature sperms which could be used for Ritika’s IVF procedure. We used the ICSI fertilisation technique which was successful.

Many men are not even aware that there is no sperm in their semen. It is only when they are not able to make their wives pregnant that they realise that something is not right. Fortunately with the use of latest technology there is hope for men suffering from azoospermia at Medicover Fertility.

Oligospermia and azoospermia–the difference?

Azoospermia is the absence of sperm in the semen. Oligospermia is a condition when a male has less than 15 million of sperm in a millilitre of semen. Oligospermia and azoospermia are both condition in which natural conception is not possible. A male suffering from either of these conditions will need medical help to father a child. IVF with ICSI is the best fertility treatment recommended for azoospermia as well as severe oligospermia.

Treatment for Azoospermia

The type of treatment for the absence of sperm depends on the cause of the condition. For some conditions there may be an azoospermia cure, but in most of the situations the patient may have to undergo alternative treatment to assist with fertility.

Blockage – Absence of sperm due to a blockage in the duct can be rectified by microsurgery. Obstruction in the vas deferens or the tubes can be removed or a bypass created to allow the sperm to travel freely.

Hormonal causes – The lack of sperm production due to hormonal imbalance can be rectified by administering the required hormones to instigate the proper production of sperms.

In some cases of non-obstructive azoospermia surgery does not help. In various other conditions the doctor may prescribe medicine for azoospermia. This medication will help to improve the sperm production and in turn increase the sperm count.

The absence of sperm in the semen only becomes a concern when a male wants to have a child. Usually a man will not have his sperm count or have a fertility check as part of a regular health check-up.

Men who have been diagnosed with zero sperm count will have to undergo fertility treatment to become a parent. Medicover has been able to help numerous men with Azoospermia to have children through In vitro fertilisation technique. There are several types of sperm retrieval procedures which can be used depending on the infertility diagnosis.

  • MESA (Microscopic Epididymal Sperm Aspiration) – This is a sperm retrieval technique which Is performed using microsurgery. A small incision is made in the testes and the sperm is taken out from the epididymis, where it is stored after production.
  • TESE (Testicular Sperm Extraction) – In the TESE procedure, a small tissue sample is lacerated from the testes. This microsurgical procedure involves making a small incision in the testes through which the required tissue is removed. This tissue is then taken to the lab and the sperm is removed from it.
  • MicroTESE is a procedure used when there is a low sperm concentration in the tissue that is extracted from the testes. With the help of powerful magnification the few available sperms in the tissue are extracted.
  • PESA (Percutaneous Epididymal Sperm Aspiration) is a simple procedure whereby the sperms are extracted directly from the epididymis with the help of a syringe.
  • Testicular Biopsy – may be used to retrieve sperm for use in IVF. It is done when sperms are being made in the testicles but are not present in the semen. They are of 2 types
    • PTBX (Percutaneous Testicular Biopsy) – In this procedure a hollow needle is used to extract small cores of testes tissue. The sperm found in this tissue is then aspirated.
    • Open Biopsy – Also called surgical biopsy. A cut is made in the skin as well as in the testicle. Then a small tissue sample is taken out from the opening.

Azoospermia Treatment Cost
The azoospermia treatment cost depends on the type of treatment that the patient needs to undergo. A simple surgical procedure will cost very little. Treatment like sperm extraction is combined either with preservation of the sperm though freezing or with IVF treatment and this would include the cost of the accompanying treatment as well.

Becoming a father with Azoospermia

Medicover Fertility is a renowned international brand. We have a team of highly skilled and experience doctors who are able to successfully help men with various types of azoospermia. Medicover Fertility has a very high fertility success rate as we use the latest technology fertility treatments.

Medicover Fertility has many azoospermia success stories to share. Couples who had lost all hope saw their hearts desire become a reality at Medicover. Medicover Fertility is one of the leading fertility clinics and has a very high success ratio for helping patients with azoospermia to successfully conceive. We also help with fertility preservation for couples who want to plan for more children. We are proud to have some of the best fertility experts in the country working at Medicover Fertility.

Related Questions

Q: Is azoospermia treatable?

A: Some types of this condition can be treated directly. Other cases are able to become fathers with the help of IVF fertility treatment.

Q: What causes azoospermia?

A: There are several causes such as scaring from surgery, infection of the urinary tract, missing vas deference, blockage of ducts used for transporting the sperm etc. Some men suffer from birth defects which results in the lack of sperm production. Genetics can also lead to azoospermia.

Q: How to cure azoospermia naturally?

A: A good diet which is high in zinc and Vitamin C is recommended for men with a poor sperm count. Some cases of non-obstructive azoospermia can improve their sperm count with diet and medication. Men with obstructive azoospermia need to get medical help.

Q: Is there any hope for men with azoospermia to father a child?

A: Medicover promises that you can have a baby if you have even traces of sperms in your testes. In Vitro Fertilisation is a technique in which the sperm can be extracted directly from the testes and used to fertilise the female partner’s egg in the laboratory.

Q: Can a man with azoospermia impregnate a woman?

A; A man who has nil sperm count cannot impregnate a woman naturally, however with medical help he can have children. IVF is the most highly recommended fertility treatment.

Q: Is azoospermia common among males?

A: It is considered a rare condition and affects only a very small percentage of men.

References :
a) https://www.sciencedirect.com/science/article/pii/S0022534718399646
b) https://www.jurology.com/article/S0022-5347(18)41216-5/abstract
c) https://www.jurology.com/article/S0022-5347(18)39531-4/abstract
d) http://journals.sagepub.com/doi/abs/10.5301/uj.5000253

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