Azoospermia is a real obstacle for couples looking to conceive.
Azoospermia means a man has no measurable amount of sperm in his ejaculation to successfully fertilize the egg.
Even though it is associated with male infertility, azoospermia doesn’t necessarily mean sterility.
Depending on what’s causing the problem, you still have a few chances to get pregnant.
You can try different ART methods, such as ICSI, IVF, and other treatment alternatives.
Here, you can get a detailed outlook on what causes azoospermia, the different treatments, and the options to have a baby.
What is azoospermia?
Azoospermia is a medical condition that causes a men’s semen to contain no sperm.
Here is how it works: Sperm is produced in the testicles in a system of small tubes known as the seminiferous tubules. The vas deferens (coiled tube) take the mature sperm to the urethra to prepare it for ejaculation.
The sperm travels through the reproductive tract and melds with the fluid produced in the seminal ducts. The fluid and the sperm create a white, thick ejaculate – this is the semen. The average man has 100 to 300 million sperm in his semen.
With azoospermia, there is zero sperm. You can still have ejaculate, but there won’t be any sperm.
You might have heard of the medical term “low sperm count.” However, azoospermia is known as “no sperm count.”
Living sperm is critical for a couple to get pregnant.
There aren’t any particular symptoms of azoospermia you can notice other than having trouble conceiving a biological child.
Any other azoospermia symptoms you might develop could be related to other ejaculation problems or health issues, such as:
- Swelling, lump, or discomfort around the testes
- Erectile dysfunction
- Reduced libido
- Sexually transmitted infections
What percentage of men have azoospermia?
Based on recent statistics, azoospermia affects almost 1% of the male population and around 10% to 15% of all men with infertility.
Worldwide, around 9% of couples fail to achieve pregnancy after a year or more of regular trying. And 50-60% of them seek care for infertility.
From a global standpoint, that accounts for 140 million people of reproductive age being unable to have children or relying on different treatment alternatives to reproduce.
Roughly 8% of men get medical help for infertility-related issues. And 1% to 10% of them have a medical problem that reduces their reproductive potential.
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How serious is azoospermia?
Even with effective stimulation and successful penetration, the lack of sperm production can pose a serious problem for men of reproductive age. Research shows that the pregnancy rate with 0 sperm count is significantly lower compared to healthy men.
Pregnancy and embryo implantation rates vary depending on the type of azoospermia. There is a drastically reduced pregnancy rate in non-obstructive azoospermia (11.3%) as opposed to obstructive azoospermia (31.9%).
Many couples looking to conceive also want to know, when does your body stop producing sperm? A man without azoospermia never stops producing sperm. But, sperm production drastically decreases with age.
Semen quality, sperm volume, semen count, and sperm motility have a major role to play in successful conception.
When sperm move, there is normal sperm count, motility, and morphology, then the odds of conception are much higher.
But, since only the strongest, fastest, and healthiest sperm get to fertilize the egg, couples often have to try multiple times to get pregnant.
However, when you have a serious abnormality, like azoospermia, that’s when the odds of conception drastically decrease.
On another note, men with azoospermia are prone to developing cancer. Data suggests there is a possible etiology between cancer development and azoospermia. So, if there is a history of tumors in your family, then it is best to consult a specialist.
Types of azoospermia
There are two main types of azoospermia:
- Obstructive azoospermia (OA) – Obstructive azoospermia means that the body may still make sperm. It’s just not getting out. Obstructive azoospermia can happen from blockage, surgery (i.e., vasectomy), trauma, or congenital defects. Removing the obstruction or getting the semen out directly can help.
- Non-obstructive azoospermia (NOA) – Non-obstructive azoospermia is a serious and often severe form of male infertility. Non-obstructive azoospermia means there is a failure of spermatogenesis in the testis. Nonobstructive azoospermia can occur due to gonadotropin deficiency or intrinsic testicular impairment. In men who don’t have enough gonadotropins, their testicular size doesn’t increase during puberty, and the testes won’t be capable of producing their own sperm and testosterone.
What causes a man to have no sperm in his semen?
The causes of azoospermia depend on the type of problem you have. A genetic condition can impact the Y chromosome and cause 10% to 15% of cases of low sperm count or no sperm count. But, there are other causes of azoospermia that may also play a role.
Non-obstructive azoospermia causes
Here is a list of some of the known causes of NOA:
- Genetic disease
- Hormone imbalance
- Y Chromosome deletion
- Toxins and radiation
- Karyotype abnormality
Other cases of NOA include excessive smoking, drug abuse, and drinking.
Gene defects can be a major contributor to NOA. These genetic abnormalities include a congenital bilateral absence of the vas deferens (CBAVD), cystic fibrosis, bilateral epididymal obstruction, Young syndrome, and unilateral absence of the vas deferens.
Having mumps orchitis in late puberty, anorchia (no testes at birth), Sertoli cell-only syndrome (testicles incapable of producing sperm), spermatogenic arrest (testicles that can’t create mature sperm), or cryptorchidism (undescended testicle) can lead to NOA.
The Y chromosome can also cause azoospermia. Y chromosome deletion results in up to 10% of azoospermia cases. If a father with Y chromosome deletion were to successfully conceive a child, then the son can inherit the defect.
Some exposures can also affect sperm production. These include radiation therapy, chemotherapy, and exposure to heavy metals. If you must get chemo, you should freeze the sperm ahead of time.
Consult with a healthcare provider if your taking medications that might affect the sperm cells. These can include anti-inflammatory agents (such as Colchicine), antineoplastic agents (such as Busulfan, Chlorambucil, and Cyclophosphamide), immunosuppressants, etc.
Obstructive azoospermia causes
Obstructive azoospermia is usually less severe than nonobstructive cases. It can be treated, and patients may have the potential to restore their fertility. But, to find the right azoospermia treatment, it is important to recognize the causes.
- Gene defects
Patients can develop an obstruction in the vas deferens, epididymis, or ejaculatory duct. Ejaculatory duct obstruction is a relatively common problem.
Various health issues can lead to a blockage. These include inflammation and infections (like epididymitis and sexually transmitted infections).
Having a recent injury to the scrotum, testes, or penis can also cause a buildup and force the semen to get stuck.
An accurate azoospermia diagnosis starts with 2 semen samples collected at different times. The sperm sample is taken to a lab for further testing.
Experts examine the semen under a high-powered microscope and spin the test sample in a centrifuge.
Other than a semen analysis, the doctor will also talk about:
- How long you’ve been trying to conceive
- Any illnesses, surgeries, or injuries to the pelvic floor
- History of sexually transmitted infections
- Infections to the reproductive tract or urinary tract
- Medical therapy
- Alcohol or drug abuse
- Hereditary defects (i.e., cystic fibrosis, reduced fertility rate, etc.)
Before the semen analysis evaluations, the doctor may also suggest a physical exam. The goal is to see if there are any signs of a lack of maturation of the reproductive organs. They can check the scrotum and penis for swelling, tenderness, or pain.
A healthcare provider may also suggest additional testing such as:
- Genetic testing
- Ultrasound or X-rays scans
- Tissue sampling of the testes
- Imaging to find signs of problems with the pituitary gland or brain
- Urine sample, in case of problems with the prostate gland
The treatment of azoospermia varies based on what’s causing the problem.
If the medication you are using is causing azoospermia, then stopping the causative agent can restore sperm production after some time. This can also be a practical cure for azoospermia caused by drug or alcohol abuse.
If azoospermia is a hormonal issue, like hypogonadotropic hypogonadism, then gonadotropin replacement therapy (GRT) or/and testosterone replacement therapy (TRT) can help. Only a doctor can suggest the best hormone therapy.
If there is a blockage, reconstruction might help. Azoospermia surgery, like microsurgery, can help fix the anatomical abnormality.
If surgery is not possible, men can use sperm extraction from the testis (TESE) or epididymis (PESA). They have a good sperm retrieval success rate for IVF (In vitro fertilization) or ICSI (intracytoplasmic sperm injection).
However, not all azoospermia cases can be cured. Consult a specialist to find potential treatments that might help with zero sperm count.
Options for pregnancy with azoospermia
My husband has no sperm, how can I get pregnant? To have offspring, the options couples have include sperm aspiration, testicular biopsy, or donor sperm.
Men with obstructive azoospermia can try to have their sperm extracted directly from the epididymis or testicles. Options like testicular sperm extraction have the best chances of finding a usable sperm sample.
Testicular biopsy, also known as Testicular Sperm Extraction (TESE), can be used for both NOA and OA. If none of these options work, the next option to consider might be donor sperm.
Donor sperm is psychologically and medically pre-screened to ensure its health state and comes with a relatively high success rate.
Another option is to get counseling. Infertility procedures can also have an emotional toll. Fertility counseling can help you navigate this difficult period in your life.
It can help couples process their feelings, reduce stress and grief, and make better decisions for the future.
Can azoospermia be prevented?
You can’t prevent genetic abnormalities. If your azoospermia is not genetic-related, then some of the following prevention tactics can help decrease the odds of this problem.
- Avoid physical activities that can hurt the penis, scrotum, or rectum.
- Check the risks and potential side effects of the medicine you are taking.
- Don’t expose the testes to very hot temperatures for a long time.
- Avoid exposing the pelvic area to radiation (if possible).
Every case of azoospermia is different. This health issue can have a notable impact on a man’s ability to conceive. But that doesn’t mean conception is completely out of the picture.
Depending on the underlying cause, some cases of azoospermia can be treated. Consult with your healthcare team to find treatments or other options that can help.