Azoospermia

Nakshatra Clinic

Your Trusted Partner in the Journey to Parenthood

Azoospermia

Overview

Many couples undergo infertility treatments because they face problems in conceiving naturally. These infertility issues can be related to either the female partner or the male partner. Of total infertility cases, almost 50% of cases are due to male-related problems.
Out of these male infertility problems, Azoospermia, or a lack of the total sperm count in the semen, is the most common. As sperm count plays a vital role in pregnancy, a lack of it in the male partner can cause infertility problems.
Azoospermia or zero sperm count doesn’t end your chances of becoming a mom and dad. However, some treatments and other options can help you become the dad of your biological child.

About Azoospermia

Azoospermia

Azoospermia is a health condition where a man’s body doesn’t produce any sperm. It can be a result of a blockage in the reproductive tract, hormonal or ejaculation problems, or issues with testicular structure or functions issue. This blockage in sperm production causes infertility that directly affects the chances of pregnancy.
Moreover, the average amount of sperm count is 15 million to the highest of 200 million sperms per millimetre in a man. In azoospermia, there is zero production of sperm counts. An average of 10% of infertile men and 1% of total men can have it.

Normally, the Azoospermia divides into two parts, which includes:

Obstructive Azoospermia
Here, your body produces sperm, but a blockage in testicles restricts ejaculation in the urethra.

Non-Obstructive Azoospermia (NOA)
This indicates that sperm count is not enough in the semen. Testicles produce a smaller amount of sperm which is also equivalent to zero. A person can again produce sperm even after getting affected by the NOA.
Each type of Azoospermia can contain different types of causes or conditions. Usually, genetic disorders may affect the Y chromosome, leading to Azoospermia. Moreover, due to the above fact, an average of 10-15% of cases is found with low or zero sperm count.

The causes of Obstructive Azoospermia are:

  • Vasectomy– The vas deferens that carry the sperm at the time of ejaculation from the testicles to the urethra is cut out with the help of Vasectomy and are a common reason for Azoospermia.

  • Cystic Fibrosis (CF)– CF is a congenital lung disorder that directly affects male fertility. We also consider CF as the congenital bilateral absence of the vas deferens (CBAVD). An average of 95% of men fail epididymis ducts formation on both sides of the testicles, and thus it leads to Azoospermia.

  • Ejaculatory Duct Obstruction– This indicates obstruction in ducts by congenital cysts, and stops the semen with sperm from flowing.

  • Surgical Complications– Sometimes surgery can lead to blocked or injured vas deferens and can further prevent the normal flow of sperm at the time of ejaculation.

  • Phimosis– Phimosis is the process that collapses the foreskin and blocks the semen from coming out of the penis.

  • Scarring– Sexually transmitted diseases can lead to scarring that prevents sperm production.

  • Middle Congenital Cysts– Cysts block the vas deferens and can cause Azoospermia.

The causes of Non-Obstructive Azoospermia (NOA) are:
We have divided Non-Obstructive Azoospermia (NOA) into two categories that include:

  1. Pre-testicular Azoospermia– Several genetic disorders can cause this health condition. For instance, the Kallmann Syndrome affects the body and stops the formation of Gonadotropin-Releasing hormone (GnRH), which directly impacts Sperm production. The pituitary gland can damage the brain and result in Azoospermia.

  2. Testicular Azoospermia– Following reasons can cause it:

    • The absence of the anorchia is commonly known as the testicles.

    • Cryptorchidism is where the testicles refuse to drop.

    • Sertoli cell-only syndrome, where the testicles cannot produce sperm.

    • Spermatogenic arrest, where the testicles don’t make effective and mature sperm.

The first difficulty couples face in conceiving even after trying it for a year. After visiting a fertility specialist, the doctor does checkups on both partners. If there’s Azoospermia, it gets detected in the tests. But before its diagnosis, there are some symptoms you may feel if you are affected by Azoospermia:

  • Stubby Sex drive
  • Erectile Dysfunction
  • Swelling, discomfort, or formation of a lump around the testicles. 
  • Sudden falling of hair or decreased amount o hair in the face or body.

You can perform an Azoospermia Diagnosis on two different occasions, either when your sperm sample will detect no sperm or when you cannot conceive. We diagnose it with the help of a centrifuge, a laboratory instrument that further spins a test sample at the highest speed so that it gets divided into several parts. With a centrifuge, we can separate and view sperms under the microscope.
For diagnosis, your healthcare provider will further ask you about your medical past and will question regarding:

  • The success or failure of fertility in the past. 
  • Your childhood history regarding past illness or injury.
  • Family background regarding cyst fibrosis or issues related to fertility. 
  • Submission to radiation or chemotherapy. 
  • Medication, drug, or alcohol consumption history.

Other things to consider include:

  • We can perform a blood test to understand the levels of the hormones. 
  • Ultrasound that helps in visualizing the scrotum includes other areas of the vas deferens. 
  • We perform brain imaging to find out the issues related to the hypothalamus or pituitary gland. 
  • Sometimes we consider biopsy as well.

Several Therapies and medications to cure the problem of RIF are further listed below and can be broadly divided into 4 following parts:

1. Uterine Medications
Uterine Medication can be performed by a doctor when an international endometrial injury can be spotted including hysteroscopy. This form of medication also includes endometrial sampling for histology and microbiological investigations and endometritis treatment; atosiban administration; copper intrauterine device placement.

2. Laboratory and Procedural Technologies and medications
This further includes the sequential ET process where the ET medium is enriched with hyaluronic acid that is further provided by the doctor. The doctor also looks into some other factors to perform the Laboratory and Procedural Technology. Moreover, the process includes things like autologous embryo-cumulus cells co-culture relation including intracytoplasmic morphologically selected sperm injection (IMSI); blastocyst stage ET; zygote intrafallopian tube transfer (ZIFT); assisted hatching (AH); preimplantation genetic testing for aneuploidies (PGT-A)).

All the above techniques can be valuable and can provide good results if performed by a good and experienced doctor.

3. Immunomodulatory Therapies
Performing Immunomodulatory Therapy can be daunting and this needs a good efficiency of doctors as well. To perform the Immunomodulatory Therapy some basic things are also performed by the doctor that further includes the intravenous immunoglobulin (IVIG); intrauterine peripheral blood mononuclear cell (PBMC) infusion; tacrolimus; subcutaneous or intrauterine granulocyte colony-stimulating factor (G-CSF) administration; intrauterine autologous platelet-rich plasma (PRP) infusion; intravenous intralipid; intrauterine human chorionic gonadotropin (hCG) injection; low-molecular-weight heparin (LMWH); aspirin; prednisolone)

4. Endometrial Receptivity
This is the final process related to treatments glorifying the endometrial receptivity or technologies. This, in addition, is performed by the doctor to identify the endometrial gap window of Implantation (WOI). For instance, the trimascular growth hormone (GH), vaginal sildenafil; endometrial receptivity array (ERA) are some good examples of this strategy.

Sometimes home remedies can help to improve the production of sperm. Besides eating healthy and drinking a lot of water, male partners should consider changing their lifestyles. It is important to talk with the doctor and ask for home therapies that can help.
Some things that you can try to prevent azoospermia might include:

  • Eat a whole meal of nutrient-rich foods to improve sperm production.
  • Perform exercises and workouts regularly to boost your testosterone levels. 
  • Yoga and mediations are also great to decrease stress levels. Also, Cortisol (stress hormone) can hamper the production of testosterone.
  • Tribulus terrestris trusted Source, black seed, Coenzyme Q10, folic acid, horse chestnut, L-carnitine, Panax ginseng, and zinc are some natural herbs and supplements that you can also ask from your doctor.