What is azoospermia?
Azoospermia means absence of any sperms in the semen. It can only be diagnosed after semen is tested in the laboratory.
What are the reasons for azoospermia?
The most common cause is failure of the testes to produce adequate sperms. The reason may be problems since birth (congenital), genetic causes, undescended testes (testes not lying properly within the scrotum), infection like mumps and tuberculosis, tumours, injury and some medicines (particularly chemotherapy) etc. Varicocele (dilatation of veins of the testes) can also be responsible. Lifestyle factors may also be responsible like excessive weight, working in hot temperature (like prolonged siting, driving), smoking, excessive alcohol, anabolic steroids (taken for body-building).
Sometimes the problem may be due to diseases in the pituitary gland producing inadequate hormones to stimulate the testes. The reasons may be tumour, congenital, operations or injury to brain.
In some cases, there is adequate sperm production in the testes, but due to obstruction in the sperm-conducting tract, the sperms are not coming out. The reasons may be congenital, infection (sexually transmitted- STI mainly) and some operations.
How can I know that I am having azoospermia?
Unfortunately, in most of the cases, the men are not aware that he is having azoospermia. However, if you have any problems in genital organs since birth, any operations (particularly hernia), infections (mumps, tuberculosis, STI), injury, then he should be alert. Men treated for cancers (by chemotherapy), taking anabolic steroids, having problems in pituitary gland or liver diseases are at high risk. Men, having inadequate body hair, sexual dysfunction and varicocele should also discuss this issue with their doctor.
My semen test shows no sperm. What should I do?
If a single report is not conclusive. This is, because, sperm production requires 3 months and it needs cool temperature than rest of the body. This is why, men have their testes hanging outside the body in the scrotum. Thus, today's semen analysis reflects a man's health 3 months before. Again, the results can vary from one laboratory to another.
So, we usually advise repeating the test after few days, preferably from a second laboratory. Sometimes, careful examination may reveal few sperms, that can be used for ICSI (see below).
The repeat test also showed azoospermia. What is the next step?
The next step is to find out the cause. Your doctor may ask you some questions and with your permission, may check your body areas (hair growth, breast development, penis, scrotum, testicular size etc). Doctor can advise you some tests like ultrasound of your testes, or sometimes of your prostate gland. Some hormonal tests are advised (blood tests- LH, FSH, Testosterone, prolactin etc) and in some occasions, karyotyping (chromosomal analysis)
What treatment can be done?
If the pituitary gland is found to be defective, the treatment gives excellent results by hormone replacement, which will improve the sperm count and you can father your baby by natural conception.
However, in other cases, it may not be possible to improve your sperm count by any medicines, still you can father your baby using your own sperms.
Is there any role of surgery?
If the problem is due to adequate sperm production but blockage in the sperm conducting duct, surgery can be done to relieve the obstruction, to help you to father your baby by natural conception. However, the results of the surgery are not always satisfactory. But sperms can be collected and frozen at the time of surgery for future use, in case the surgery fails.
What is the actual treatment?
In most cases the men are offered a special type of IVF (In Vitro Fertilization) using the technique called ICSI (Intracytoplasmic sperm injection). In standard IVF, your wife will be given some injections to mature her eggs, which will be collected under anaesthesia through the vagina using ultrasound. These eggs are then mixed with the sperms in the laboratory and the embryos, thus produced, are either directly put inside your wife's uterus or some may be frozen and kept for future use. In ICSI, the sperms collected from your body are directly injected, under the microscope, inside the eggs.
How sperms are collected?
If any obstruction in your sperm-conducting passage is suspected, sperms can be collected from the epididymis (small gland above the testis) by small needle (PESA- Percutaneous Epididymal Sperm Aspiration) or and or sometimes, by a small cut (MESE Microsurgical Epididymal Sperm Extraction). All these are done under anaesthesia. If these fail, TESA or TESE (see below) are done to collect the sperms.
If there is problem in sperm production, there may still be some sperms found inside the testes. These can be collected using small needle (TESA- Testicular Sperm Aspiration), or a small cut in the testes (TESE- Testicular Sperm Extraction); all under anaesthesia.
In all cases, sperms can be frozen for future use.
What are the chances that sperms can be collected from my body?
If there is obstruction, the chance is nearly 100%. That means, out of 100 such men, almost all cases, sperms can be obtained from his body. If it’s due to inadequate sperm production from the testes, then the chance of collecting sperms is 50-60%.
However, in small number of cases, the sperms collected from your body may not be of good quality. In that case, you may be offered using donor sperms; it is never used without consent from you and your partner.
When donor sperm is used and how?
If a man cannot afford ICSI, donor insemination an alternative. But it is done only with consent from both husband and wife. The process will remain confidential and the identity of the donor is not revealed. Donor is tested for diseases like STI, HIV, Hepatitis B or C, thalassaemia etc. Usual attempt is taken to choose donor having blood group and skin colour similar to those of the husband.
Azoospermia is not the end of treatment. Never lose hope. It’s important to find out the cause by number of tests so that you can be helped to father your own baby by collecting sperms from your body.