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Azoospermia - Causes, Symptoms, Diagnosis, and Treatment

What is azoospermia?

Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. In some cases (eg blockage or absence of duct) the testes do actually produce sperm but it is not ejaculated and in other cases (hormonal problems, varicocele) there is no sperm production. In humans, azoospermia affects about 1% of the male population[1] and may be seen in up to 20% of male infertility situations.

What are azoospermia types?

There are two types of azoospermia. Non-obstructive azoospermia results from abnormal sperm production. Obstructive azoospermia is caused by an obstruction or blockage that prevents or harms sperm delivery into the ejaculate.

What are azoospermia causes?

Azoospermia can result from a problem with sperm production or sperm delivery, including:
- High fever - causing temporary lack of sperm
- Undescended testicle
- Testicle conditions
- Obstructions of seminal passages
- Testicle infection
- Certain hormonal disorders
- Sperm duct blockage

What are azoospermia symptoms?

Azoospermia doesn't cause any symptom in men. However men with azoospermia may find it difficult to make their wife or girlfriend conceive.

How is azoospermia diagnosed?

Azoospermia is diagnosed initially when no sperm can be detected under a high-powered microscope on two separate occasions.

Subsequent diagnostics will focus on determining the cause of azoospermia, which can help your doctor recommend treatment options. Your initial evaluation will include a complete medical history, physical examination, and tests of selected hormones. Your doctor will ask questions about your prior fertility, childhood illnesses or disorders, such as undescended testicles, genital trauma, infections, exposure to toxins, and family history of reproductive problems and other disorders.

Your doctor will then do a physical examination, taking into account things like testis size, secondary sex characteristics, and presence of varicoceles, which aer varicose veins in the scrotum.

An initial endocrine evaluation will also be done. You may be tested for measurements of serum total testosterone and follicle-stimulating hormone (FSH). Elevated levels of FSH may indicate that your testicles are not adequately producing sperm.

Other tests may include a transrectal ultrasound, urinalysis, or testicular biopsy.

How is azoospermia treated?

Pre- and post-testicular azoospermia are frequently correctible, while testicular azoospermia is usually permanent. In the former the cause of the azoospermia needs to be considered and it opens up possibilities to manage this situation directly. Thus men with azoospermia due to hyperprolactinemia may resume sperm production after treatment of hyperprolactinemia or men whose sperm production is suppressed by exogenous androgens are expected to produce sperm after cessation of androgen intake. In situations where the testes are normal but unstimulated gonadotropin therapy can be expected to induce sperm production.

A major advancement in recent years has been the introduction of IVF with ICSI which allows successful fertilization even with immature sperm or sperm obtained directly from testicular tissue. IVF-ICSI allows for pregnancy in couples where the man has irreversible testicular azoospermia as long as it is possible to recover sperm material from the testes. Thus men with non-mosaic Klinefelter's syndrome have fathered children using IVF-ICSI. Pregnancies have been achieved in situations where azoospermia was associated with cryptorchism and sperm where obtained by testicular sperm extraction (TESE).

In men with posttesticular azoospermia a number of approaches are available. For obstructive azoospermia IVF-ICSI or surgery can be used and individual factors need to be considered for the choice of treatment. Medication may be helpful for retrograde ejaculation.

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