Azoospermia
Production or Delivery Problem?

Azoospermia is the term describing a complete absence of sperm in the ejaculate. Fortunately men diagnosed with this condition are in the minority of the male infertility causes. Depending on the circumstances or reason for the condition, there are also fertility treatment options available to treat the condition.

It is automatically assumed by many that if there is no sperm in the ejaculate this must mean impregnating his partner would be impossible. After all sperm is what makes it possible to conceive! A semen analysis of a sperm deposit is the only accurate means of determining azoospermia.

The analysis will show if there is a complete absence of sperm, but this does not preclude if sperm is being produced. It may mean that sperm is produced but not delivered to the semen. It may also indicate that medical interventions, such as fertility drugs, may be required, to aid the production of sperm.

Causes of azoospermia

There may be a number of different causes, the primary one being whether the problem is as a result of sperm production or sperm delivery. The testes could be producing sperm, but unable to deliver it to the ejaculate, or the testes may in fact not be producing any sperm. It is for this reason a sperm evaluation is essential, as the two are quite different conditions.

If the testes are producing sperm, but unable to send to the ejaculate, then the sperm will have to be retrieved through other means. The one option is by restoring the flow, which is a minor procedure. If no sperm is produced, then it may be necessary to retrieve the sperm though one of the Assisted Reproductive Technology processes. The retrieval process is called MESA.

MESA - Micro-epididymal sperm aspiration, describes the surgical extraction and retrieval of sperm from the epididymis as a treatment option of azoospermia, depending on the results of the tests.

Male infertility causes

Causes of male infertility with lack of sperm production can be categorized into three major areas:

• Hormonal - Sperm is produced in the testicles upon stimulation by the pituitary hormones. A hormonal imbalance or lack of, could severely affect sperm production.

• Testicular failure - This could be a genetic condition. The testicle is unable to produce adequate numbers of mature sperm. This failure to produce could be as a result of a lack of cells required to divide to make enough sperm, or it may be due to the inability of the sperm to completely develop.

• Varicocele - Varicose veins develop in the scrotum. Blood does not drain away and thus extra blood pools in the scrotum, increasing the heat factor of the testicle, with a severe impact on sperm production.

Sperm delivery complications can either be as a result of blockage of the ducts that carries the sperm. Problems with the ducts can be as a result of a either a genetic abnormality or blocked as a result of a hernia or hydrocele repairs. The conditions may be:

• Ducts can be blocked

• Absence of the vas deferens

• Obstructions at the epididymis (the tubular structure draining the testes)

• Obstructions higher up in the vas deferens

Behind each testis is the epididymis, a tube leading to another tube called the vas deferens. The vas deferens are one of a pair of tubes that carries the seminal fluid from the testes to the urethra. The top of each vas deferens is joined by a duct that drains from the seminal vesicles.

Sperm delivery complications also arise from problems with ejaculation. Before sperm is rushed out of the penis, the entry to the bladder is closed. If for any reason this does not happen, sperm will enter the bladder, and will be lost upon urination.

Physical examination

The testicle will be physically examined to assess the size of the scrotum, which can indicate the hormonal imbalance if it is severely diminished in size. The testicle is one of a pair of male sex organs that produces sperm and the males sex hormones (androgens), which includes testosterone.

The scrotum is examined for the appearance of varicocele. An ultrasound probe placed on the skin at the scrotum, will confirm their presence.

The ducts will be felt during the physical examination. In the event they are absence, this could be due to a genetic disorder. The epididymis will also be examined through touch, to determine if it is laying flat and the middle is not felt. This could indicate a dilated epididymis which may be indicative of blockage.

Treatments

• Hormonal imbalance - Hormone blood tests will determine if the cause is from inadequate hormonal stimulation. If the testicle does not produce enough sperm, the pituitary produces more FSH - Follicle stimulating hormone - resulting in a significantly higher level than normal. Other hormone levels that will be checked are: Testosterone, polactin, LH - Leutenizing hormone, as well as TSH - Thyroid stimulating hormone, all of which impact the healthy production of sperm. Testosterone is a hormone produced by the testes, responsible for the development of male secondary sex characteristics and function of the male reproductive organs.

• Blockage - An ultrasound of the ejaculatory duct and seminal vesicles will be required to confirm this diagnosis. A surgical procedure may be required, once and if a blockage is established. Blockage could be due to a cyst in the ejaculatory ducts, which an be operated on through the urethra to open it.

• Backward ejaculation - for semen that is pushed into the bladder, it is necessary to establish this by means of a urinalysis. The patient is required to firstly empty his bladder, and then ejaculate into a sterile container. He is then required to urinate again into a separate container which will be tested to establish if it contains sperm. Treatment can be through oral medication, or the sperm can be harvested from the urine, and prepared, through sperm washing. This would normally precede an ICSI - Intracytoplasmic Sperm Injection- which could also be required as part of an In Vitro Fertilization process as detailed on test tube baby.

Azoospermia is a complex diagnosis, and previously it was important to establish exactly how much sperm the semen did contain. Fortunately with the advent of Assisted Reproductive Technology treatments, even if there is no sperm in the ejaculate, sperm can be harvested and used in an ART treatment process, as an infertility treatment option.

A male can have a biological child, even if diagnosed with azoospermia.

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