Infertility is not necessarily a female condition; the presence of male factor infertility is the cause in almost an equal number of cases. The causes may be varied, although most of them are related with the sperm count ad quality. Azoospermia is one of the male infertility conditions that related to the sperm count. It is characterized by an undetectable sperm count in the patient’s semen. The condition is responsible for male infertility in almost 20% of the total infertility cases.
Azoospermia is detected through normal semen analysis. It is one of the preliminary tests conducted when a couple struggling with infertility issues approaches an infertility clinic. A complete absence of sperms in the semen is a warning signal that indicates azoospermia. Further analysis is required to determine the right course of action for resolving the problem. Primarily, azoospermia is classified into two categories, obstructive and non-obstructive azoospermia.
As the name suggests, obstructive azoospermia refers to absence of sperm due blockage in the male reproductive tract. The man is probably producing healthy sperm but it does not get to reach the ejaculate. The formation of scar tissue prevents the sperm from flowing through the vas deferens and reaching the semen. The blockage could be in any part of the genital tract, the epididymis, the vas deferens or the ejaculatory duct.
Such obstruction may be caused due to a congenital defect such as Congentital Bilateral Absence of the Vas Deferens (CBVAD). Other causes like trauma due to previous surgery or injury, or an infection caused after vasectomy may also be responsible. Obstructive azoospermia can be reversed with a microsurgical procedure, which involves opening up of the blockage. The exact location of the blockage is first identified and then a repair surgery is done to restore the flow of sperms into the semen. Pregnancy rates are considerably good after opening up of the obstruction.
Non-obstructive azoospermia, on the contrary, does not involve any obstruction in the genital tract but is caused by inadequate sperm production. The testis may be anatomically normal but are unable to produce sperms due to hormonal issues. On the other hand, atrophy or even absence of testes may be responsible for dysfunctional sperm production. An elevated FH level indicates testicular failure as it leads to low sperm production or sperm maturation problems.
Testicular failure could be attributed to genetic conditions, post-surgical or STD induced infection, vasectomy, cancer or cancer treatment. Obesity is another condition that puts patients at high risk. In some cases, azoospermia may be idiopathic, with reasons being unexplained. The treatment options for non-obstructive azoospermia are limited. To begin with, hormonal therapy may be prescribed to restore the hormone balance and resume the sperm production. For more acute cases, a testicular biopsy is first conducted to determine whether the testis have any sperms or not. IVF or ICSI are recommended for those who have a few live sperms available. The success of these assisted techniques depends upon the number and quality of sperms retrieved during the testicular biopsy.
Diagnosis and Evaluation of Azoospermia
When a couple has difficulty in conceiving, they are subjected to a series of diagnostic tests. Semen analysis is used to determine the sperm count and quality. The patient’s ejaculate is checked for this purpose. Absence of sperms is deemed as zero sperm count or azoospermia. It may be well understood the absence of sperm in the ejaculate does not indicate that there is no sperm in the testis. In fact, the sperm might be unable to make it to the semen due to obstructive azoopermia.
Other diagnostic tests used to evaluate the condition include a physical examination of the patient. The infertility specialist may also inquire about his family history, past surgery, other medical complications, and any medications he may be taking. A blood test to determine the FH levels is also performed, in addition to semen analysis. Advanced tests like testicular biopsy may be needed to determine whether the condition is due to blockage or complete failure of sperm production.
The right treatment option for the patient is decided on the basis of these diagnostic results. While surgical removal of blockage is used to resolve obstructive azoospermia, hormonal therapy is indicated for testicular failure. In more complicated cases, IVF or ICSI serves as the only option. The procedure is done in conjugation of testicular sperm retrieval. Those suffering from genetic conditions may not have any option other than adoption. Besides medical treatment, healthy diet and lifestyle are also recommended for improving the sperm count and quality.
At Gaudium IVF, the top IVF centre Delhi, patients can get advanced treatment for male and female infertility, in addition to comprehensive gynecological care and support.
For a free second opinion, contact Dr Manika Khanna, the leading IVF specialist in Delhi.