AZOOSPERMIA—A DISCUSSION

What is Azoospermia?

Azoospermia is one of the most severe forms of male infertility. It is a



condition in which a man has complete absence of sperm in his



ejaculate.



Is it a common problem?


It is not a common problem. It affects only 2% of general population. But



it is thought that 10% -20%of men under treatment of infertility suffer



from Azoospermia.



What will be the cause for


Azoospermia?


Normally the sperm is produce in testicles, from the testes it passes



through epidydimis, ductus deferens, seminalvesicle, ejaculatory duct



and urethra.From the urethra the sperm to be implanted.So whatever the



problem in sperm production,transport or any infections of male



reproductive organs will cause azoospermia. Let us briefly discuss about



it. According to the cause azoospermia is divided in to two categories.



They are



1.obstructive cause.


2. Non obstructive cause.


Obstructive cause:


Obstructive azoospermia accounts for 40% of all cases of azoospermia.


The main causes are the following.



Genetic:


Genes may affect the sperm transport; the obstruction may be in


vasdeferens or epidydimis. For Ex: congenital absence of vasdeferens.



Infections:


Infections male reproductive organs such as

• Orchitis (infection of the testicles)

• Prostitis (infection of prostate)

• Balanitis(infection of glanspenis) etc.

Trauma:


Any trauma of male reproductive system including injury spine, lower


abdomen, pelvis, inguinal hernia repair may induce obstruction and cause

azoospermia.

Varicocele:

It is a condition in which the blood vessels of the scrotum, gets dilated


and enlarged.


Vasectomy:

It is a surgical procedure of birth control in male. Vas deferens is a tube

carrying sperm from the testes to seminal vesicle it was cut or tied.


Nonobstructive azoospermia:

Drugs:

Drugs, such as steroids, antibiotics, and drugs to treat inflammation or



cancer may affect male fertility.

Genetic:


Some genetic cause involve in non obstructive cause also. They are


Klinefelter's syndrome.


Kallmann's syndrome.


Hormones:


Disorders of the testicles may produce abnormal levels of hormones that



may cause azoospermia.


Radiation:


Radiation, used for the treatment of cancer, may affect sperm


production.



Retrograde ejaculation:


Retrograde ejaculation is a problem in which the semen will go inside the


bladder instead of coming out. It is due to spinal cord injuries, medicines,


diabetes and neck of the bladder injury.


Other factors:

Other factors include

• Smoking
  
  


• Drinking alcohol
  
  


• Pesticides
  
  


• Heavy metals
  
  


• Heat
  
  


• Un descended testes (testicles that did not move from the abdomen)
  
  
  

How is azoospermia diagnosed?

Azoospermia can be diagnosed, when a couple came for infertility

treatment. Once azoospermia was diagnosed, They may need the following

investigations.

Physical examination:

During the physical examination, the physician can examine one’s external genitals

and also examine about Varicocele. The common signs of hormonal imbalance are,

Increased body fat, body hair, and breast tissue.The size and shape of your testicles

will also be examined.

Biopsy:

To determine the ability of the testicles to produce normal sperm.

Blood investigations:

Genetic screening:

Genetic testing may be done to look for abnormal genes. To determine the

abnormal genes, it may cause Problems with sperm production, sperm transport, or

formation of the male reproductive organs.

Imaging tests:

Imaging tests may include the following:

• Magnetic resonance imaging scan:
  
  


• Spermatic venography:
  
  


• Ultrasonography:
  
  

Semen analysis:

To check a man's fertility

Urinanalysis:

To check retrograde ejaculation.

Azoospermia treatment:

It can be treated according to the cause.

Medicines:

Antibiotics may be given to treat an infection of the reproductive system.

Hormones are used to treat a hormonal imbalance.

Percutaneous embolization:

This procedure is for Varicocele.

Sperm extraction:

It should be more useful for obstructive case. The Sperm may be extracted

(removed) from the testicles or epidydimis. It can be extracted by following


methods.

MESA (Micro Epididymal Sperm Aspiration), in which sperm is removed from the

epididymis.

PESA (Percutaneous Sperm Aspiration), in which sperm is taken from directly from

the epididymis.

TESE (Testicular Sperm Extraction), in which a small tissue sample is taken from the

testicles in order to retrieve viable sperm.


Surgery:

It is also needed for obstructive cause.

How will you find support when you have

azoospermia?

Having azoospermia may be hard for each and every individual. One may feel angry,

depressed, or frightened. These are all normal feelings. Freely talk to your


caregiver,family, or friends about your feelings. You may need support from them


to share your feelings.

My experience about azoospermia

• In my clinical practice treating azoospermia is a challenging and interesting one.But it was very difficult for me to manage the patient’s feelings.

• All the patients are mentally depressed and frightened about the future. So they need more care and expect more love from their family members.

• Treating them and teaching them about their medical problems are important in my practice.

• Treatment for azoosperma is a step by step procedure according to every patient condition and cause.

• The procedure should be explained to all the patients and their family members.

• For all the patients routine investigation were done properly and they are adviced to maintain diet regimen and pathiyam.

• If there is any surgical cause,a secondary opinion was taken from a surgeon.

• Most probably 3-6 months period may be needed to treat azoospermia. For non obstructive causes such as infections can be treated successfully.

• In the treatment of azoospermia, we need not only the patient’s cooperation but expect full suport from the all family members.
  
  
  

HAVING AZOOSPERMIA IS NOT A SIN FOR THE INDIVIDUAL,WE

HAVE TO SUPPORT THEM MORALLY AND MENTALLY!