Azoospermia - Types, Causes, Signs, Symptoms, and Treatment

Azoospermia is a condition in which there are no spermatozoa in ejaculation. It can occur for various reasons, the most common of which are a lack of sperm production or a lack of sperm transfer to the ejaculate. Azoospermia affects one out of every 100 people in a population. This article gives a general overview of the ailment, including its kinds, causes, and treatment options.

What Are the Different Types of Azoospermia?

The average sperm count is between 15 and 300 million per milliliter of semen. The seminal fluid is centrifuged at 3000 rpm (rotations per minute) for 15 minutes to ascertain the sperm count, then counted. Azoospermia is the absence of spermatozoa, while cryptozoospermia is defined as a sperm count of less than 500 per milliliter. Azoospermia is classified based on the etiology into:

• Pre-testicular azoospermia.

• Testicular or non-obstructive azoospermia.

• Post-testicular or obstructive azoospermia

What Are the Causes for Azoospermia?

Pre-testicular azoospermia is mainly caused by:

• Hypogonadotropic Hypogonadism - It causes a significant drop in testosterone levels, which are required for sperm synthesis.

• Pituitary or Endocrine Disorders - GnRH(gonadotropin-releasing hormone) secretion is reduced.

• Low FSH (Follicle-Stimulating Hormone) Or LH (Luteinizing Hormone).

• Kallmann Syndrome - It is characterized by the absence of puberty.

Testicular azoospermia is caused by:

• Idiopathic Reasons - When the causes are unknown, it is idiopathic.

• Spinal Injury - Suppression of the hypothalamic-pituitary-testicular axis creates a significant alteration in the hormonal environment.

• Chemotherapy - The chemotherapy medicines kill fast-growing mutant cells and other active cells like sperm-producing cells, resulting in azoospermia.

• Radiotherapy - When the pelvic region is exposed to high radiation levels, the stem cells are killed, resulting in azoospermia.

• A malignant lesion in and around testes.

• Torsion of the Testes - The function of the testes is hindered here due to hypoxia caused by torsion.

• Bladder Neck Surgery - Can cause retrograde ejaculation.

• Diabetes Mellitus - It damages the DNA of the sperm by oxidative stress.

• Cryptorchidism - Also called undescended testes. Azoospermia is a result of the testis fate in this case.

• Orchidopexy - It is the surgical procedure for removing testes.

• Mumps Orchitis - Viral infection of the testes.

• Abnormal karyotype.

• Testicular atrophy.

• Retroperitoneal lymphadenectomy.

• Genetic causes such as microdeletion of the Y chromosome.

Post testicular or obstructive azoospermia can be caused by:

• Sexually Transmitted Infections (STIs) - Infections acquired through sexual contacts, such as gonorrhea and chlamydia, can damage the DNA of sperm, resulting in infertility and azoospermia.

• Vasectomy - A vasectomy is a male sterility surgery in which the vas deferentia is severed to prevent sperm passage from the testes after ejaculation.

• Vasectomy reversal.

• Swollen testis.

• Distended Epididymis - The epididymis is where the sperm is stored and converted into a mature and motile one. Inflammation of epididymis is epididymitis which can cause male sterility.

• Absence of epididymis.

• Absence of vasa deferentia.

Is There a Genetic Component to Azoospermia?

A variety of factors cause azoospermia. Conditions like bilateral vas deferens absence, which results in azoospermia, are caused by mutation of genes. A few azoospermia-related syndromes are Klinefelter syndrome, Mixed gonadal dysgenesis, and Kallman syndrome.

What Are the Signs and Symptoms of Azoospermia?

Although medical diagnosis is required for azoospermia, there are a few signs and symptoms that can be noted, such as

• Decreased libido (low sex drive).

• Reduced quantity of ejaculatory fluid.

• Cloudy and painful urination after intercourse.

• Pelvic pain.

• Presence of lump or mass in the testicular region.

• Delayed puberty.

• Problems with erection.

• Undescended testes.

• Smaller penis (2.5 standard deviations compared to the average size).

• Gynecomastia (enlarged breasts).

• Decreased body hair.

• Lean stature resulting from muscle loss.

How Is Azoospermia Treated?

The cause of azoospermia, such as obstructive or non-obstructive, is part of the diagnosis. And the treatment is determined by the root of the problem.

Obstructive Azoospermia - The goal of treatment for obstructive azoospermia is to restore seminal tract patency:

Recanalization of the Seminal Tract With Microsurgery

• Epididymal Tubal Vasostomy- Obstruction of the epididymis (vasoepididymostomy).

• Vasovasostomy- Obstruction of the vas deferens.

• TURNED- Ejaculatory ducts transurethral resection.

• TRUC- Ultrasound-guided transrectal unblocking.

• Washout of the seminal tract.

For artificial reproductive treatment, surgical or procedural sperm collection is done by the following methods.

• TESE - Testicular sperm extraction.

• TESA - Testicular sperm aspiration.

• TEFNA - Testicular fine needle aspiration.

• MESA - Microsurgical epididymal sperm aspiration.

• PESA - Percutaneous epididymal sperm aspiration.

• ESE - Epididymal sperm extraction.

• MVSA - Microscopic vasal sperm aspiration.

• DISTA - Distal seminal tract aspiration.

Non-obstructive Azoospermia - The goal of treatment is to eradicate the medical condition causing azoospermia by

• Pharmacotherapy.

• Electroejaculation in anejaculation cases

• Hormonal therapy.

• Reducing the exposure of gonadotoxins.

Can Azoospermia Be Avoided?

Because azoospermia is complex, some aspects, such as genetics, cannot be controlled, but others, such as environmental influences, can be controlled by :

• Avoid known gonadotoxins such as tobacco, drugs, and alcohol.

• Maintain a healthy diet.

• Do regular exercise to avoid being obese.

• Seek a therapist to help to manage stress and depression.

• Avoid the usage of steroids for muscle growth.

• Avoid working in chemical factories or use proper protection when dealing with chemicals and radiations known to cause azoospermia.

• Follow the precautions to avoid STIs (Sexually transmitted infections).

• Use of gonadotrophic shields during radiotherapy of the pelvic region.

What Should You Do if Your Partner or Spouse Has Azoospermia?

Because azoospermia is linked to a lack of sex drive, strategies to boost sex drive should be used with hormone shots or injections. Sexual enjoyment is also impacted, necessitating professional assistance. Also, because they cannot conceive naturally, couples can use artificial treatments such as IVF(in vitro fertilization) to conceive. One of the procedures indicated above can be used to retrieve sperm.

Conclusion

Receiving an azoospermia diagnosis can be devastating emotionally. Azoospermia has been linked to an increased risk of overall health concerns, not just fertility issues. Azoospermia is a severe form of male infertility, although treatments are available. After a diagnosis of azoospermia, some men may still be able to have a genetic child, while others may need to use a sperm donor or explore adoption. More crucially, a specialist's review is required to rule out any potentially dangerous underlying medical disorders, to assist couples in maximizing their chances of having the family they want, and provide advice on risk and testing for health issues later in life.