Azoospermia, what is it?

Azoospermia is a condition in a male with the sperm count being almost nil. This becomes an obvious reason for infertility or even worse ultimate sterility. Though it affects a small percentage of male population it is responsible for about 20% of infertility issues in male. There are treatments available for azoospermia, but it depends again on the diagnosis of the root cause.

Causes can be categorized as:

• Post-testicular.
• Pre-testicular.
• Testicular.

Azoospermia caused due to post-testicular disorders – Here the though there is sperm production happening, it fails to be ejaculated. Azoospermia can be caused due to most common procedure for sterility called vasectomy, this procedure normally causes obstruction in the post-testicular genital tracts leading to sterility, it is termed as obstructive azoospermia and it affects about 7% to 51% of men with azoospermia. Obstructions can also be of congenital in nature such as cystic fibrosis where in agenesis of vas deferens can be seen or also in a condition which acquired such as the EDO (obstruction of ejaculatory duct) caused by infection. Disorders in the ejaculatory system consist of retrograde ejaculation and also an-ejaculation – in such condition though the sperm is produced it is not ejaculated.

Azoospermia caused due to pre-testicular disorders – This condition is caused due to poor stimulation of the testicles and the genital tract which are otherwise normal and functional. FSH (follicle-stimulating hormone) is low in levels and hypogonadotropic proportions which lead to poor stimulation of testes to produce sperm. This condition affects about 2% of males with azoospermia. Endocrinal disorders such as hypopituitarism and hyperprolactinemia, this also includes disorder caused by testosterone such as suppression in exogenous follicle-stimulating hormones. Cancer therapies such as radiation and chemotherapy can also decrease sperm cell production or development.

Azoospermia caused due to testicular disorders – This condition is caused due abnormality in the testes, absent or atrophic testes. Production of sperm is absent or disturbed. Elevation in follicle-stimulating hormones (hypergonadotropic) is caused due to interruption in the feedback loop. This condition prevails in most of the cases of infertility and it is seen in about 49% to 93% of men diagnosed with azoospermia. Failure in production, poor production and maturation during development of sperm ultimately causes a condition called testicular failure. Testicular failure is caused due to congenital problems such as genetic conditions (example: Klinefelter syndrome), Sertoli cell-only syndrome and cryptorchidism; and also due to conditions which are acquired by infection (example: orchitis), surgery, trauma to the organs, radiation therapy or other idiopathic causes. Inflammatory mediators released by the mast cells most often decrease the sperm motility in a reversible manner leading to be the most common cause which leads to inflammation due to pathophysiological mechanism.

How can it be treated?

Azoospermia comes to light during the diagnosis of infertility. Evaluation of the testes and scrotum, clinical tests, scanning and imaging can confirm the presence of azoospermia. General health, sexual health, and libido can reveal traits of azoospermia. Exposure to toxins, steroids and hormonal replacement therapies, alpha-blockers, antibiotics, alpha-reductase inhibitors, chemotherapeutic and radiation treatment products, drugs and pesticides, alcohol abuse, and in certain cases heat exposure of the testes can become a cause for azoospermia. Surgical procedures or surgical trauma to genital organs can also cause azoospermia. Genetic abnormalities can also lead to azoospermia making it a hereditary disorder. Azoospermia can be caused if the vas deferens is absent and/or due retrograde ejaculation, both these conditions are diagnosed after thorough clinical examination. Levels of LH and follicle-stimulating hormones in lower quantities also can indicate pre-testicular problems leading to azoospermia. High levels in gonadotropins can indicate testicular problems leading azoospermia. Biopsy of testes is most often recommended to accurately decipher the exact cause for azoospermia.

While Pre-testicular and post-testicular azoospermia can be resolved, testicular azoospermia is most of the times a permanent issue. Azoospermia caused due to hyperprolactinemia can be treated and adequate sperm production can be assured. Likewise decrease in sperm production due to exogenous androgens can be rectified after abstaining from androgen intake.

In the recent times IVF with ICSI allows to success in fertilization with the sperm got from the testicular tissue. IVF with ICSI is boon to couples facing fertility issues due to azoospermia and many such conditions.

There are many remedies for azoospermia both medicinal as well as surgical, but it is always better to seek doctor’s advice before adopting any regime. It is always best to seek natural remedies than to go for chemical or surgical interventions as a solution. Natural remedies are gentle on health and come with 100% side-effects free, thus making it an ideal treatment for any medical conditions.