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What is Azoospermia? Causes, Symptoms, Treatments And More

What is Azoospermia? Causes, Symptoms, Treatments And More

What is Azoospermia?

This is a medical condition in men in which their sperm count becomes equal to zero. This is generally related to infertility but it can be treated. In humans, azoospermia affects about 1% of the male population. In this condition no sperm is found in the ejaculation. It is an uncommon but severe form of male infertility. 

Which parts are involved in the reproductive system?

Testicles: they produce sperms which are also known as male reproductive cells in a process called spermatogenesis. 

Seminiferous tubules: they are tiny tubes that make up most of the tissue of the testes.

Epididymis: it is the structure on the back of each testicle into which mature sperm are moved and stored. 

Vas deferens: it is the muscular tube that passes from the epididymis into the pelvis then curves around and enters the seminal vesicle.

Seminal vesicle: it is a tubular gland that produces and stores most of the fluid ingredients of semen. The vesicle narrows to form a straight duct, the seminal duct, which joins with the vas deferens.

Ejaculatory duct: it is created when the seminal vesicle duct merges with the vas deferens. The ejaculatory duct passes into the prostate gland and connects with the urethra.

Urethra: it is the tube that runs through the penis to eliminate urine from the bladder and semen from the vas deferens.

There are two types of sources which can cause azoospermia:

  •     Obstruction sources
  •     Non obstructive sources

There are many types of azoospermia which are there:

Pre-testicular azoospermia: in this your body becomes responsible for not producing the sperm but your testicles are normal. This can happen due to low hormone levels or many any medical treatments. It is due to inadequate stimulation of otherwise normal testicles and genital tract. This is pretty rare and not a lot of people suffer from this. Pretesticular azoospermia is a kind of non-obstructive azoospermia.

Testicular azoospermia: this is caused due to damage on your testicles and they are unable to make sperm. The testes become abnormal, atrophic, or absent and sperm production severely less. Causes can be failure include congenital issues such as in certain genetic conditions.

Your testicles could be damaged due to many other reasons:

  •     Infections like orchitis
  •     Surgery
  •     Trauma
  •     Cancer
  •     Any kind of accident or injury
  •     Klinefelter’s syndrome
  •     Childhood illness
  •     Urethritis

It is also a kind of non-obstructive azoospermia.

Post-testicular azoospermia: in this sperm are being produced but they are not ejaculated, a condition that affects 7-51% of azoospermic men. Your testicles make normal sperm, but they are not able to get out. The most common reason for this is if you have vasectomy done to you to induce contraceptive sterility. Retrograde ejaculation, when semen goes into your bladder instead of your penis during pleasure. The ejaculatory duct causes obstructions and some infection also develops. 

This is an obstructive type of azoospermia.

What are the symptoms of azoospermia?

You know that you have azoospermia as you are not able to get your partner pregnant. Your sperm reveals no sperm when examined under a high-powered microscope. Some other symptoms are:

  •     Unsuccessful sexual drive 
  •     Erectile dysfunction
  •     Cloudy urine after physical performance
  •     Pelvic pain
  •     Small or saggy testicles
  •     Smaller penis
  •     Swollen testicles
  •     Abnormal puberty
  •     Hormonal imbalance
  •     Male hair growth reduces

What are the causes of azoospermia?

The causes depend upon the type of azoospermia. Obstruction azoospermia occurs in the vas deferens, the epididymis or ejaculatory ducts. The main cause of this type of azoospermia are:

Infection

Blockage of epididymis or any other duct can be caused due to any infection or inflammation. The infection of the epididymis is known as epididymitis. This can happen due to an untreated sexually transmitted infection. If the infection has been treated the blockage can still be present and can create a problem. This is due to the formation of scar tissue which can be formed during the active inflammation stage of infection.

Surgical causes 

Any trauma to the male reproductive system can cause damage to the tissues or any types of vas deferens. If you had surgery done in any area which is indirectly or directly related to the male reproductive tract then that can lead to scarring or any type of injury. Surgeries like vasectomy can cause unintended cuts and blockages.

Development of cyst

If you have developed any type of cyst in any area close to the reproductive system then you can develop a problem. A cyst can also cause blockage and scarring. During the removal of the cyst it can cause serious damage to the tissues and other parts.

Cystic fibrosis gene mutation

It causes the vas deferens either not to form or to cause abnormal development such as semen getting blocked by a build-up of thick secretions in the vas deferens.

Causes of non-obstructive azoospermia

Hormonal imbalance

Some male parts work together in creating hormonal signals and chemicals required for sperm production. Some abnormalities in the production of hormones can cause infertility which can also result in non-obstructive azoospermia. Some also experience primary testicular failure when hormone imbalance is linked with tissues with the testes and it leads to inadequate production of testosterone or complete absence of sperm.

Genetic causes

Some genetic disorders can cause infertility.

Kallmann syndrome: it is an inherited disorder which is carried by X chromosome. If it is left untreated it can cause infertility

Klinefelter’s syndrome: the male carries out an extra X chromosome which makes XXY instead of XY. This results in infertility, along with lack of sexual or physical maturity and some learning difficulties.

Y chromosome deletion: the chromosomes which are responsible for sperm production are missing and they result in infertility.

Radiation or chemotherapy

Some exposure to toxic elements can lead to temporary or even permanent azoospermia. If some kind of radiation has been used directly on the male reproductive organs during any kind of treatment then azoospermia can happen.

Chemotherapy for treating cancer can lead to azoospermia but it may stop after the treatment has been done. If previously some chemical exposure at work has been done then it can result in male infertility and non-obstructive azoospermia.

Medications

If you have taken medication previously for treating some other problem then it can affect your fertility which can also cause azoospermia. Some drugs can cause certain side effects but it can be temporary.

Some medications which can cause azoospermia include:

  •     Colchicine (used to treat gout)
  •     Chlorambucil (cancer medication) 
  •     Cyclophosphamide (cancer medication)
  •     Procarbazine hydrochloride (treatment for Hodgkin’s disease)
  •     Vinblastine sulphate (cancer medication)
  •     Sirolimus (used to prevent organ rejection after transplant)

These are some medications which can cause azoospermia as a side effect.

Varicocele 

This involves the enlargement of a vein in the scrotum or testicle. This enlarged vein can cause blood to pool in the area, which increases the heat of the testicles and can cause swelling and shrinking of the testicles. Varicoceles are a very common cause of male infertility. It can lead to sperm counts.

Some testicular causes can include:

  •     Anorchia (absence of the testicles).
  •     Sertoli cell-only syndrome (testicles fail to produce living sperm cells).
  •     Spermatogenic arrest (testicles fail to produce fully mature sperm cells)
  •     Tumors
  •     Testicular torsion
  •     Radiation treatments
  •     Some diseases such as diabetes, cirrhosis or kidney failure

How to treat azoospermia?

Surgery 

You can get some surgeries done which can cause some repair. Some microsurgical treatment can be done to remove or treat a varicocele. When surgery can correct obstructive azoospermia, natural conception may also be possible. Surgical treatments cannot correct the whole problem overnight as it takes time. After the surgery has been done a sample will be ordered to see if the sperms levels are normal.

Get hormone treatments

As you know this can be a hormonal problem so you can get some hormonal treatment done. Hormones include follicle stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrozole and letrozole. Hormone treatment can be used to stimulate sperm development in some azoospermia men. It will allow enough sperm development so that healthy sperm cells can be extracted from the testicular via testicular biopsy.

Lifestyle changes

You can make some changes in your diet which can benefit you a lot. Changing your routine and adding some things in your diet can also affect this problem in a positive way. 

Some home remedies 

  •     Eat a diet full of whole, nutrient dense foods which can increase sperm production.
  •     Working out regularly as it may help in boosting testosterone levels.
  •     Try yoga and meditation to lower your stress levels. Cortisol can also impact your testosterone production.
  •     You can also use some herbs and supplements which may promote male fertility like tribulus terrestris, black seed, coenzyme Q10, folic acid, horse chestnut, L-carnitine and zinc.
  •     You can also use some treatments which can reconnect or reconstruct tubes or ducts.

How to prevent azoospermia?

There is no specific way in which you can prevent this problem or any other genetics problems.

  •     Use precaution while physical performances.
  •     Avoid exposure to radiation
  •     Lear completely about the medication which you are using and its harm.
  •     Don’t expose your testes to heat for a long time.
  •     Speak with your doctor about any symptom you are receiving from any medication.

Take Away 

There are many causes of azoospermia. You and your doctor will work together to determine the cause of your azoospermia and find the best treatment options.