Azoospermia

Azoospermia is a term used to describe the condition where there is a complete absence of sperm in the semen. When a man ejaculates, he will still produce a liquid (the semen); it just will not contain any sperm.

There are two main types of azoospermia: obstructive azoospermia and non-obstructive azoospermia.

Obstructive Azoospermia:

Obstructive azoospermia occurs when there is a physical blockage or obstruction in the male reproductive tract that prevents the sperm from mixing with the semen.

Cause: The blockage can occur anywhere along the pathway that sperm takes from the testicles to the tip of the penis, including the epididymis, vas deferens, or ejaculatory ducts. 

Common causes include 

• congenital anomalies (a man can be born with any part of the reproductive tract missing and never know until he undergoes investigations)
• Previous infections
• Surgical complications
• Previous vasectomy.

Symptoms: Men with obstructive azoospermia typically have normal sized testicles and normal hormonal blood tests. 

They will continue to produce normal levels of sperm, but the sperm cannot be ejaculated due to the blockage. They may not have any symptoms other than infertility.

 Surgical intervention may be necessary to remove the blockage or bypass it. Procedures such as vasectomy reversal, epididymal or testicular sperm extraction (TESE), or reconstruction of the ejaculatory ducts may be performed to retrieve sperm for assisted reproductive techniques like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Non-Obstructive Azoospermia:

Non-obstructive azoospermia occurs when there is a problem with sperm production within the testes, leading to little or no sperm in the semen, despite an unobstructed reproductive tract.

Cause: This condition is often caused by issues with sperm production

-Genetic abnormalities

– Hormonal imbalances

-Testicular injury

-Infection

-Environmental factors

-Idiopathic (unknown)

Symptoms: Men with non-obstructive azoospermia may have smaller than normal testicles, hormonal imbalances such as a low testosterone and a raised FSH blood test. Although many men will have no obvious signs or symptoms.

Treatment: Treatment for non-obstructive azoospermia depends on the underlying cause. In some cases, hormonal therapy or medications may be prescribed to stimulate sperm production. Pippa Sangster has many years of experience of hormonal investigations and treatments to help improve semen parameters or success of surgical sperm retrieval.

Men with nonobstructive azoospermia are best treated with a specialist procedure called a MicroTESE, which Pippa is a world renowned expert. Pippa wrote a compelling article about azoospermia you can read here. 

 Any sperm found can then be used in assisted reproductive techniques like ICSI (intracytoplasmic sperm injection).