Azoospermia is the absence of spermatozoa in the seminal fluid in the presence of immature spermatogenesis cells, as well as seminal vesicles and products of prostate secretion.
The main symptom of azoospermia is the incapacity of conception in the absence of sexual and ejaculatory disorders. During diagnostics, it turns out that the germ cells in the ejaculate are either very few or not at all.
In addition, the following signs may indirectly indicate the presence of azoospermia:
How to treat azoospermia? Various treatments for azoospermia can be used to restore sperm fertility.
Treatment for secretory azoospermia depends on the underlying causes and may include conservative and surgical methods, as well as the use of assisted reproductive technologies. So, the treatment of non-obstructive azoospermia caused by genetic pathologies may involve taking medications that helps to adjust the hormonal balance; if an infection is detected, azoospermia is treated by destroying the pathogen and follow-up spermatogenesis stimulating.
Treatment of obstructive azoospermia may involve anastomosis of the ducts and epididymis. However, the percentage of pregnancy after reconstructive surgeries is not great for a variety of reasons due to the imposition of anastomosis of the ducts. In this regard, today preference is given to the extraction of spermatozoa from the testicle or epididymis with further use in the IVF-ICSI program.
Several types of azoospermia are distinguished: secretory (non-obstructive) and excretory (obstructive) form.
The secretory form of azoospermia (NOA) is characterized by disorder of sperm production in the testicles and can be either primary or acquired.
Obstructive azoospermia (OA) is caused by blockage of the vas deferens while the testicles maintain normal sperm production.
In addition, transient azoospermia should be mentioned separately, it is a condition when germ cells in the seminal fluid are absent only for a certain period of time.
Mostly, the development of pathology is based on only two reasons:
Obstructive azoospermia (OA) can be caused by:
Non-obstructive azoospermia (NOA) can be caused by the following factors:
There are also factors that can cause both secretory (non-obstructive) and obstructive azoospermia. These include:
Transient azoospermia can be triggered by the intake of certain medications (for example, steroids), significant psycho-emotional overstrain, bad habits (alcohol abuse, drug use) and excessively active sex life.
The absence of sperm in the ejaculate can lead to complications such as:
Usually, azoospermia is detected in patients who consult with a specialist about infertility.
In order to identify the causes of decreased fertility and develop the most effective treatment regimen, a complete examination is required.
The doctor needs to find out whether infertility is primary or secondary, that is why he asks questions about whether the patient has biological children, whether a pregnancy has ever occurred with the use his sperm. Also, the specialist will be interested in hereditary and chronic diseases, injuries and operations in the testicular area, infections that occurred in the past.
External exam makes it possible to assess the patient's sexual development, identify problems with excess weight, gynecomastia and other signs that may indicate the likely causes of azoospermia.
By palpating the testicles, the doctor determines their size, shape, consistency.
Also, when viewed using functional tests, varicocele, which is varicose veins of the spermatic cord, can be detected.
Azoospermia cannot be diagnosed basing on the results of a single semen analysis. If there are no germ cells in the ejaculate, the doctor will recommend to redo the analysis, but only in 10-14 days.
With transient azoospermia, after a while, mature motile spermatozoa can be found in the ejaculate.
It is necessary to determine the level of follicle-stimulating (FSH) and luteinizing (LH) hormones, testosterone, estradiol, prolactin. A significant indicator is the concentration of inhibin B, the level of which reflects the quality of reproductive function.
Through ultrasound scan the doctor can assess the condition of organs such as the testes and epididymus. During transrectal ultrasound, the condition of the prostate and seminal vesicles is examined. For example, specialist can detect echo signs of blockage of the vas deferens or abnormalities in testicular tissue.
Since azoospermia is often caused by genetic pathologies, the patient will need to do the following tests:
If the exact cause of the absence of germ cells in the ejaculate is not determined, the doctor may recommend a diagnostic biopsy of the testicular. During this manipulation, spermatozoa can be detected, in this case spermatozoa are vitrified for further use in the IVF-ICSI cycle. If secretory azoospermia is suspected, biopsy can be performed on different parts of the testicle.
In some cases, surgery can be performed with the imposition of anastomoses on the vas deferens and epididymus, but the chances of restoring natural fertility after reconstructive surgery are rather small. As a result, specialists prefer assisted reproduction methods. Sex gametes for use in the ART program (IVF-ICSI) are obtained by biopsy from the testicle or its epididymis.
In case of not obstructive azoospermia, several methods of surgical sperm extraction are used: PESA, MESA, TESA, TESE, and microTESE. Extracted spermatozoa can be immediately used for fertilization in the IVF-ICSI program or cryopreserved for a certain period of time.
In this case, it is important to eliminate the negative factor. Depending on whether azoospermia is obstructive or secretory, the doctor develops the optimal treatment regimen, which may involve conservative therapy or surgical intervention. In the absence of a positive effect, the use of ART methods is recommended.
The prognosis depends on what causes azoospermia. The chances of restoring natural fertility and success of the ART program are higher in case of OA (obstructive azoospermia).
To reduce the risk of developing azoospermia, it is recommended: