What is Azoospermia

Azoospermia, or zero sperm count, is a condition where no sperm is found on semen analysis reports, resulting in male infertility. There are many causes and types of azoospermia, some of which are treatable.

In order to find out if this condition is curable or not we must first find out the cause of azoospermia as its treatment is cause specific.

What causes Azoospermia?

The etiology of Azoospermia falls under two classifications; obstructive azoospermia and non-obstructive azoospermia.

Obstructive azoospermia:

Obstructive azoospermia is a condition with blockage in the pathway that carries sperm. This blockage can occur in the testes, epididymis, vas deferens, and vesicles. It is the most common type of azoospermia and is sometimes treatable and reversible. A male fertility doctor may perform a surgical procedure known as testicular biopsy, Testicular Sperm Extraction (TESE), or Testicular Sperm Aspiration (TESA) for obstructive azoospermia treatment. Surgical exploration options for reversing the obstruction are also available for specific conditions. 

The causes of obstructive azoospermia maybe Congenital or Acquired.

The Congenital causes include:

• Congenital absence of vas deferens
• Cystic fibrosis
• Prostatic cysts

And Acquired causes include:

• Vasectomy
• Trauma
• Post infectious diseases
• Surgical procedure in inguinal, pelvic or abdominal region.

Males with congenital reproductive tract obstruction and suspected with cystic fibrosis should undergo genetic analysis for mutation prior to performing IUI (intra uterine insemination) or IVF (in vitro fertilization), because these male patients are at a higher risk of carrying Cystic Fibrosis (CF) gene mutation.

Non-Obstructive azoospermia

In non-obstructive azoospermia, testicular cells do not produce sperm or undergo spermatogenesis. Hormonal abnormalities, injury to the testes both chemically and physically, inflammations, infections, and genetic problems can all contribute to it. Treatment with medicine could be helpful for this issue.

Men suffering from non-obstructive azoospermia may benefit from hormone replacement treatment (HRT), which can increase sperm recovery into semen or increase the chance of sperm recovery after surgery. Hormones such as FSH, LH, and Hcg can help achieve this. Certain drugs, such as letrozole, anastrozole, and clomiphene, may aid in the restoration of sperm in cases of azoospermia. It’s necessary to seek guidance from a male infertility specialist for a proper diagnosis and treatment of azoospermia.

Pre-Testicular Azoospermia

It is a condition where the male genital tract and testicles are normal however there is inadequate hormonal stimulation. Most typically the levels of Follicle stimulating hormones are low, and FSH is necessary for stimulating the testicles for production of sperms.

Testicular Azoospermia

It is a condition where the production of sperms is completely absent due to abnormal, atrophic or absent testes.

Causes of testicular failure include;

• Genetic conditions
• Infections due to STD’s
• Surgery (which may lead to infection and trauma)
• Vasectomy
• Cancer
• Radiation and chemotherapy
• Trauma

Treatment for azoospermia

An infertility specialist will provide you with treatment options according to the diagnosis. Depending on the cause, the treatment options will vary since there are multiple causes of azoospermia. Except for congenital cases of azoospermia, most cases with obstructive azoospermia are repairable surgically to remove the blockage, with microsurgical or endoscopic reconstruction. Men with genetic causes of azoospermia will have varying treatments options from limited to no treatment, depending on the type of genetic defect.
In cases which are not due to obstruction called non obstructive azoospermia like testicular failure, can be treated with hormonal therapy which helps some men develop ejaculated sperm. However, in most instances the only hope to have a biological family is to retrieve sperms from the testes using assisted reproductive technique. Several tests are performed to determine if there is any sperm cell production in the testis, if there is then sperms are extracted to be used in IVF.

There are different methods used for sperm extraction, they include:

TESE:

It stands for Testicular Sperm Extraction, it is a minor surgical procedure in which after administering local anesthetic to numb the test is and scrotum, your doctor makes a small incision into your scrotum to reveal the testis beneath, the doctor then takes a small piece of the testis and sends it to the lab where an embryologist studies the tissue and looks for sperms, if sperms are found they are extracted to be used for ICSI (intra cytoplasmic sperm injection), where the sperm is directly injected into your partner’s egg.

PESA:

It stands for Percutaneous Epidydimal Sperm Aspiration, it is a procedure where after locally anesthetizing the testes and scrotum, your doctor inserts a final needle in the scrotum and then into the epididymis where the sperms are stored. The needle will then be used to gently suck out the sperms out of the epididymis, the insertion may be performed into multiple areas of the scrotum to retrieve maximum number of sperms possible. The sperms retrieved are then used to fertilize your partner’s egg in a lab, a process called ICSI.
PESA is mostly advised by doctors if the cause of infertility is obstruction or absence of the vas deferens.

Natural options for Azoospermia

These options though limited, are advised by some infertility specialists either alone or along the medical and surgical treatments of Azoospermia.

They include changing the diet, since our modern diets are more harmful than helpful, sperms need nutrients to grow and hence a diet rich in nutrients would be offered by your doctor for enhancing sperm production and healthy growth. Obesity and being overweight plays a role in causing infertility related to azoospermia, hence a weight loss program may be offered to you by your doctor if you fall under this category.

Finally, since the causes of azoospermia vary and have different treatment options, your doctor should be specialized in infertility and have a thorough knowledge of these causes so he can give you the treatment options appropriate for you. In addition, natural treatment options are important for normal and healthy growth of the male body and the reproductive system and hence you should discuss this in detail with your doctor, but of course these should not be taken up as the sole treatment option.
Your infertility specialist doctor would be the best person to discuss this with in order to target treatment according to the cause.