What is azoospermia?

Azoospermia is when we don’t have a single sperm in ejaculate. This can be mainly due to two different reasons. Either because there are an obstruction and the testicles can produce sperm, but these sperm do not reach ejaculate. For example, in the vasa deferentia agenesia, which is quite a common situation in the Mediterranean area, or it could be because the testicles are not able to produce a sufficient amount of sperm.

The first one is called obstructive azoospermia, the second one is called secretory azoospermia, and the prognosis tends to be worse.

Azoospermia means that there is no sperm seen in the sample that we have received in the lab. Sometimes we have to centrifuge the sperm for 10 minutes or so to see if we find anything in what we call a pellet at the bottom of the tube and if we still cannot see any sperm after it’s been centrifuged then, we say that this sperm is azoospermic – that means there is no sperm seen in the sample and it’s just the seminal fluid and some other cells. Now, it can be different reasons it can be due to blockage in the tubes of the testicles, it can be due to a lack of production where the production of a sperm completely has halted in the in the testicles, it could be due to genetic reasons (so genetically there is a problem with producing sperm) and this is what we see in in patients that have got Y chromosome defects. It could also be hormonal – it could be that the right amount of hormones are not produced in the men’s body in order to get the sperm production going.

Azoospermia can happen for all different reasons. If you’ve had a vasectomy, if you have a cystic fibrosis gene, so with the cystic fibrosis gene it may be that you have what’s called absence of the vas deferens which basically connects your tissue your testicles to your tubules, so when you ejaculate, there’s nothing connecting there and the sperm can’t get out; it can be because of hormonal, so high FSH and which is the drive to your testicles, so this testicles are not producing sperm because of your testicles have been suppressed – it’s called primary spermatogenic failure; it can be because of certain types of drugs, if you’ve had chemotherapy – it’s sort of destroyed your sperm cells. There’s all different types of reasons and what we do with these sperm is you produce a sperm sample and then we centrifuge it down to a very small pellet. Any sperm in your entire ejaculate gets concentrated into that very small volume and then we can go through it bit by bit to see if we can find some sperm. If we can’t find any sperm then the next option would be to do surgical sperm retrieval.

Azoospermia or azoospermia is a diagnosis where the ejaculate of the gentleman does not contain any sperm cells – no sperm cells, live or dead are found in the sample. This can have many possible reasons, a detailed patient history is important. One of the reasons for this might be a prolonged uptake of anabolics or steroids in some sports categories. It’s quite popular amongst the bodybuilders, this can effectively destroy the spermiogram altogether or the spermatogenesis however, it could be a sign of a genetic problem or the obstruction of the sperm duct. Usually when we find a sample without any sperm cells, blood tests are performed and one of the few one of the first examinations would be genetic consult. A blood test for karyotype is performed both in the gentleman and the woman and then cystic fibrosis and hormonal levels FSH, testosterone so, we definitely can consult these results with a geneticist, eventually with a urologist or an andrologist and based on the findings, we then discuss various alternatives how to approach this problem. In some cases medications or surgery may be helpful, in other cases the surgical methods such as TESE (the testicular sperm extraction) where the sperm cells are actually obtained directly from the testes might be helpful, in some cases we will eventually have to discuss donated sperm cells.

Azoospermia is considered the most severe form of male infertility. To be diagnosed with azoospermia, we need at least two different sperm checks that reveal the absence, the total absence of spermatozoa into the seminal, into the ejaculate samples after centrifugation. So, if at this first check there are no spermatozoa under the microscope, we need to take this whole sample, centrifuge it for, let’s say, 5 to 10 or 20 minutes, take the pellet, check the pellet and if there are still no spermatozoa after the pellet has been thoroughly checked, then we can talk about azoospermia but we should not resort to a diagnosis unless we have checked a second or a third sample from the same man.

When we do a routine semen analysis and we don’t find sperm in the ejaculate, we are talking about an azoospermic sample. In this case, the first thing to do is repeat the semen analysis and if it is still azoospermia, do a hormonal analysis to know if it’s secretory or obstructive. The karyotype helps us know if there is a genetic problem. The obstruction consists of a defect in the seminiferous tubules or vas deferens that prevents the exit of the ejaculate, but there is production of sperm. The secretory implies a defect in spermatogenesis. How can we solve this? A testicular biopsy to collect sperm and then IVF treatment can be done, in this case always ICSI (the Intracytoplasmic Sperm Injection). We can organise the testicular biopsy the same day of the egg collection, or do the biopsy, freeze sperm and plan the egg collection another day, to make sure that we obtained sperm in the biopsy procedure.In the case of secretory azoospermia there are treatments depending on the case and it can be reversible.

Azoospermia is the complete absence of sperm in the man’s semen. It can be caused by a production type problem or a blockage type problem. Now because only one to two percent of the by looking at your semen whether the sperm is there or not all the fluid comes from glands called the seminal vesicles and the prostate gland which are higher up downstream of the testicles. So there’s no real way of knowing we’re looking at the volume of the sperm there is or not.

Azoospermia is defined as the absence of spermatozoa in the ejaculate. Globally 1 out of 100 men of reproductive age and up to 10% of men affected with infertility are azoospermic. Azoospermia can be classified as obstructive and nonobstructive. In case of obstructive azoospermia, the ejaculate does not present any spermatozoa although the production is normal because the physical obstruction prevents the spermatozoa from reaching the semen. Non obstructive azoospermia can be caused by hormonal abnormalities. Hormones are important to produce the spermatozoa and if their function is compromised, the production is affected.

Azoospermia is defined when we cannot find any sperm in the ejaculate. The reason for azoospermia can be obstructive or non-obstructive. If it’s obstructive probably we can find a solution to retrieve the sperm from the testicle directly. However, when it’s non-obstructive we need to look at the source of the cause if it’s a genetic cause or if it’s related to other factors. You should visit a specialist call Andrologist that they will look for the reason of the azoospermia.

Even for men who have no sperm in their ejaculate it could very well be that the reason for that is they’ve got a blockage – obstructive azoospermia. So those men are producing sperm quite well in their testes but there’s a blockage somewhere and the sperm can’t get out and now, we have very sophisticated and easy procedures (under anesthetic of course) to get tiny portions of the seminiferous tubules as they’re called, just the little tubes where the sperm are growing and those can be taken and used in the procedure called ICSI and that is very successful for the men who don’t have sperm in their ejaculate.

Azoospermia is a condition in which there’s no sperm measurable in a man’s ejaculate. Approximately, 1% of the men have azoospermia, and specifically around 10% of infertile men are diagnosed as azoospermic. 
This pathology doesn’t have noticeable symptoms for the man, so it’s important to perform a seminogram for the diagnosis. Moreover, for a more accurate diagnosis it’s important to analyse hormones as FSH, testosterone and molecules as fructose.
There are two main types of azoospermia depending on the cause. Obstructive azoospermia and nonobstructive or secretory azoospermia.
 
I will start by explaining a little bit about the obstructive azoospermia. In this type of azoospermia we see that there is a blockage or a lack of connection in the reproductive tract between the testicle and the urethra. That means that the man is producing sperm but that sperm is not able to be ejaculated because it is getting blocked from exit. Therefore, there is no measurable sperm in the semen.  The common causes are the absence of different conductors, since birth or due to a surgery, and inflammation or trauma in testicles, epididymis, prostate or deferent conduct.
 
Surgery is the only treatment that can be effective in those patients, and it is based on unblocking the duct in order to allow the passage of the sperm. However, in the cases that it is not possible, or it doesn’t work, testicular biopsy (TESE) or microsurgical epididymal sperm aspiration (MESA) is another option to get viable sperm and then perform an ICSI. However, in other cases it is very difficult to get sperm from the biopsy and it is necessary in those cases to use a donor sample.
 
On the other hand, nonobstructive azoospermia or also known as secretory azoospermia, is the most common and severe type of azoospermia that we find in the 70% of the cases of azoospermia. In those patients we don’t find sperm in the ejaculate, but in this case, it is caused due to problems in the production of the sperm during the spermatogenesis. This pathology can be congenic, since birth, or acquired, due to an illness, toxic drugs during a treatment or cancer treatment that can affect the production of sperm. It is a serious pathology even though it can be solved in some cases after treatment. So, we can say that in some cases, the secretory azoospermia may be reversible and can allow pregnancy without the need of IVF techniques.
 
It’s very important to determine which type of azoospermia is present in the patient in order to know which is the best option for the man in that case.
 

Azoospermia is defined as a condition where there is no sperm in ejaculate. At least 2 samples should be analysed and also the sediment should be analysed. What is sediment? When we do a seminal analysis we centrifuge the sample when no sperm are seen in the fresh sample. In this way we can centrifuge and concentrate the sperm at the bottom of a tube. We obtain a small pellet and analyse it for the presence of sperm. It is important to discriminate between azoospermia, absence of sperm and cryptozoospermia, another condition where a very small amount of sperm is present, even if it is tiny. It is important that this condition affects around 10 to 15 percent of infertile males and can have different physiologies.