In simple words and in a lay man’s language this could be explained as; azoospermia meaning ‘no sperm’ and oligospermia meaning ‘not much sperms’.
However, in medical language it is explained as follows;
Azoospermia is a medical condition where there is a complete absence of sperms in the semen sample of a male, given the sample is centrifuged. At least two semen samples should be studied before diagnosing a male with azoospermia. It affects about 1% of male population and accounts for 20% of male infertility cases.
Oligospermia is a condition where the amount of sperms required in a male’s ejaculate to conceive is less than the minimum level for conception. This condition is also called oligozoospermia. The cut off value, according to WHO is 20 million sperms per milliliter, any sperm count less than this value is labeled as oligospermia. It is the most common cause of decreased chances of conception and infertility in men.
Both these conditions are caused by a vast majority of factors, both congenital and acquired.
Causes of Azoospermia:
Congenital absence of the Vas Deferens
Ejaculatory duct obstruction
Undescended testes at birth
Trauma or surgery of the scrotum
Primary testicular failure (Klinefilter syndrome)
Chromosomal abnormality causing genetic infertility; this condition requires karyotyping
Micro deletion of the Y chromosome
Unexplained genetic infertility
Secondary testicular failure (Kallman syndrome)
Hyperprolactinemia; high level of prolactin in males
Unexplained gonadotropic hormones deficiency, these hormones are required for spermatogenesis
Cancer treatment; which includes chemotherapy, radiation and surgery
Drug induced pituitary suppression; drugs like glucocorticoids, anabolic steroids and alcohol
Congenital adrenal hyperplasia
Organ failure due to severe illness (kidney or liver failure)
Sickle cell anemia
Pesticide/toxin exposure; for example in hot tubs and baths
Causes of Oligospermia:
Certain medical conditions leading to oligospermia include:
Varicocele: This is caused by dilatation of testicular veins which increases testicular temperature and further disrupts spermatogenesis. For sperm production to take place the temperature of the testicles should not rise because if it rises then it affects the production of testosterone, the male hormone required for sperm production and the high temperature also causes damage to the sperm’s DNA.
Sexually transmitted diseases; it leads to infections and hence the sperm count
Medications; some medicines like beta blockers, blood pressure control medicines and antibiotics cause ejaculation problems and decrease the sperm count
Problems with ejaculation; retrograde ejaculation or those caused by cancer, injuries, past surgeries, tumors
Hormonal imbalance: gonadotropic releasing hormone, FSH, LH and Testosterone, all are required for healthy sperm production
The lifestyle of a male also accounts for a few factors responsible for Oligospermia, these include:
High testicular temperature: most often caused by placing laptop on the lap/near the genitals, sitting frequently and wearing tight clothing
Obese males; being overweight or obese has negative effects on sperm production as well as on hormonal production
Substance abuse and alcohol: drugs like cocaine and marijuana cause decreased sperm production. Excessive alcoholism and smoking cigarettes have the similar negative effects.
Environmental exposure; exposure to some chemicals and metals causes decreased sperm production, these include cleaning agents, pesticides, painting material and heavy metals like lead.
Treatment of azoospermia:
The treatment depends mainly on the cause of azoospermia.
Blockage: if the sperms are absent due to blockage then microsurgery is the option given to patients, it involves removing the obstruction for example in vas deferens or by passing it, allowing the sperms to pass through.
Hormonal imbalance: if the cause of absent sperms is lack of hormones then administration of the required hormones is the option given to patients.
However for men who have unexplained infertility and other issues are advised to undergo In Vitro Fertilization process in which the sperm(s) if any present in the testes are extracted directly using sperm retrieval procedures. The sperm is then used, to be injected directly into the female oocyte (egg) in a lab, a process called ICSI (Intra Cytoplasmic Sperm Injection)
These procedures are used depending on the infertility diagnosis and are as follows;
TESE: Testicular sperm extraction.
MESA: Microscopic Epididymal Sperm Aspiration.
PESA: Percutaneous Epididymal Sperm Aspiration
Treatment of Oligospermia:
Oligospermia is much easier to treat as compared to azoospermia, but again the treatment depends on the cause of oligospermia;
Varicocele: the treatment involves surgically ligating the dilated spermatic veins.
Infections: the treatment involves an antibiotic course to get rid of the urinary or reproductive tract infections.
Hormonal imbalance: medications and hormonal replacement treatments are given to fix the hormonal imbalance.
If the couple still fails to conceive, they should visit an infertility specialist and discuss their options of assisted reproductive techniques like IUI (Intra Uterine Insemination), IVF (In Vitro Fertilization), and ICSI (Intra Cytoplasmic Sperm Injection). Further more if the cause is mainly male infertility due to no sperm in the ejaculate or due to low sperm count then the options of testicular sperm retrieval should be considered, where the sperms are aspirated or extracted from the testes and used in assisted reproductive techniques to fertilize an egg.
By – Dr. Alvina Arslan Meer
ART Coordinator (MBBS) & Online Counselor