Azoospermia is a condition where a person has no sperm in their ejaculate. It can be caused by blockages in the reproductive tract, hormonal imbalances, testicular dysfunction, or problems with sperm ejaculation. Several causes are treatable, while other instances might need to recover the sperm by employing assisted reproductive technology like IVF.
What is Azoospermia?
Azoospermia is defined when there is no sperm within the semen, though the seminal fluid itself exists. The sperm, usually produced in the testicles, moves around through the various reproductive parts to mix with fluids, which form the semen. But in azoospermia, the seminal fluid is existing but has no sperm. This condition can either be congenital (from birth) or develop later in life. Fortunately, there are treatments available, and having azoospermia does not necessarily prevent biological children from being conceived.
Types of Azoospermia
In azoospermia, sperm are absent from the semen, although the semen is present. Semen itself is formed from a mixture of sperm and fluids, which is then ejaculated into the reproductive system through the penile urethra. But in azoospermia, semen is there, and the sperm are not. Azoospermia can either be congenital, meaning one has had it since birth, or it can develop at some point later in life. Thankfully, it can be treated, and having it does not rule out biological children from being conceived.
Types of Azoospermia
There are three types of azoospermia:
- Post-Testicular Azoospermia (Obstructive Azoospermia): Obstruction in the reproductive tract prevents sperm from leaving the testicles, which is the most common and affects 40% of those with azoospermia.
- Testicular Azoospermia (Non-Obstructive Azoospermia): This occurs due to poor sperm production in testicles or it is not present at all; this happens generally due to issues in the form of structure and function.
- Pretesticular Azoospermia: This type is due to a lack of hormonal stimulation to the testes and usually occurs after chemotherapy or an imbalance in hormone function. It is also a form of non-obstructive azoospermia.
How common is azoospermia?
Azoospermia affects approximately 1% of all people assigned male at birth (AMAB). It is the cause of infertility in about 10% of men or people AMAB diagnosed with infertility.
Causes and Symptoms of Azoospermia
Azoospermia is often diagnosed when a couple fails to conceive. Some men may experience symptoms from the underlying cause, such as low libido from hormonal imbalances or testicular lumps from infections.
The main causes of azoospermia are:
Post-Testicular Azoospermia (Obstructive): obstructions that prevent sperm from leaving the testicles, typically in areas like the epididymis, vas deferens, or ejaculatory ducts. Possible causes include:
- Testicular trauma or injury
- Epididymitis
- Retrograde ejaculation
- History of previous pelvic surgery
- Vasectomy
- Genetic anomalies, such as cystic fibrosis
Pretesticular and Testicular Azoospermia (Non-Obstructive): This group of causes includes genetic defects or hormonal imbalances leading to an inability to produce sperm. Such causes include:
- Genetic abnormalities, for example, Klinefelter’s syndrome, Kallmann syndrome
- Hormonal imbalances, such as low testosterone levels, hyperprolactinemia
- Varicocele
- Drug side effects or toxin exposure.
- Chemotherapy and radiation therapy.
Diagnosis and Tests
Azoospermia is diagnosed when a semen analysis, conducted on two separate occasions, shows no sperm. Diagnosing the condition will require an all-inclusive history concerning previous fertility, surgeries, drugs, infections, and other aspects of one’s life. Additional studies by the provider may involve:
- Blood workup for assessment of hormone level in the body; these hormones may include the ones related to testicular production of hormones and FSH, amongst others.
- Genetic analysis.
- Scrotal ultrasound and X-rays
- Brain imaging with an MRI for viewing the pituitary or hypothalamus.
Treatment is based on the cause of azoospermia
In some cases, surgery is undertaken to open blocked ducts and allow the restoration of sperm flow. Hormone replacement may also be initiated for causes of this condition resulting from low hormone levels. If no sperm production exists, retrieval of the sperm directly from the testicle using a needle can be achieved to use them with assisted reproductive techniques such as IVF or ICSI.
Is There a Cure for Azoospermia?
Reversing azoospermia is possible if its cause is due to blockage, as surgery can correct this problem and allow the sperm to flow again. But if the cause of the problem is sperm production or testicular function, then it is irreversible. Still, assisted reproductive technologies like sperm retrieval and IVF may be available for biological children.
Preventing Azoospermia
Though it is unavoidable to avoid genetic factors, some lifestyle habits may minimize the possibility of azoospermia. These include:
- Avoidance of trauma to the reproductive organs (e.g., wearing protective gear during sporting activities)
- Decreased exposure to radiation
- Exercise caution when it comes to medication that may cause damage to the sperm.
- Decrease excessive exposure to heat, such as saunas or hot tubs.
Prognosis and Outlook
The prognosis for an individual with azoospermia depends on the cause. Many cases, especially those due to hormonal or obstructive issues, can be treated successfully, and fertility may be restored. Even when azoospermia is caused by testicular disorders, sperm can often be retrieved and used in IVF, offering another route to biological parenthood.
FAQs?
Can I still become pregnant with azoospermia if the partner has azoospermia?
Pregnancy is still possible in some cases, especially if the azoospermia is treatable or if sperm can be retrieved for use in IVF. A fertility specialist can give the best guidance on treatment and options.
Is IVF the only choice for azoospermia?
In the case of azoospermia resulting from testicular damage and necessitating sperm retrieval, IVF is the solution. However, if the condition is treatable, then alternative treatments can be pursued before resorting to IVF.
Living with Azoospermia
Being diagnosed with azoospermia is emotionally challenging. It’s essential to lean on your healthcare provider for guidance and to seek support from your partner, family, or friends during this time. It’s normal to feel overwhelmed, but many individuals with azoospermia successfully have biological children through sperm retrieval or other treatments.
When Should You See a Doctor?
If you and your partner have been unable to conceive after 12 months of trying, or if you have concerns about your fertility, it’s important to consult a healthcare provider. A sperm analysis is often one of the first steps in diagnosing azoospermia.
What are the causes of having no sperm?
Causes of azoospermia are due to obstructions in the male reproductive tract (e.g., vasectomy, infections, cysts), genetic causes (e.g., Klinefelter syndrome, Y chromosome deletions), hormonal causes (e.g., low testosterone), testicular damage or failure (e.g., trauma, varicocele), past treatments including chemotherapy or radiation, and lifestyle causes such as overexposure to heat, substance, or alcohol abuse. Diagnosing a cause involves medical history, physical examinations, and tests.
Will I be able to have biological children?
Azoospermia can allow you to conceive biological children. Depending on the cause of azoospermia, treatable conditions such as blockages or hormonal imbalances can restore fertility. For other causes, retrieval techniques combined with assisted reproductive technologies like IVF or ICSI might be a means to having biological children.
What treatment do you recommend?
The recommended treatment depends on the cause of azoospermia. Treatment may involve surgery to open up the reproductive ducts, hormone therapy for hormonal imbalances, or sperm retrieval directly from the testicles for use in assisted reproductive techniques like IVF or ICSI. Your healthcare provider will guide you based on your specific diagnosis.
A note from Baby Soon Fertility & IVF
The term azoospermia may be scary to many people, but it is not a complete end to parenthood. Treatment and support may make the options of these couples quite viable in their journey to having a family. If you have questions or are ready to explore your treatment options, Baby Soon Fertility & IVF is here to help. Contact us for more information on how we can help you through your fertility journey.
