What is Azoospemia or Zero sperm count evaluation?

Azoospermia is when a male semen sample has zero sperm or no sperm count, also known as zero sperm count evaluation (semen without sperm). A male suffering from azoospermia cannot become father naturally.

Male infertility constitutes 40% of the infertility causes of which Male suffering from Azoospermia (Zero sperm count) is found in 15% of cases.

In a normal male, testicles produce sperms and are stored in a thin tube called epididymis. Sperms then travel & get mixed with semen produced from the prostate gland. Finally, semen with sperm moves out through the urethra and penis.

There are 2 types of azoospermia

1. Obstructive Azoospermia (post testicular) – In Obstructive Azoospermia the Male testicles produces sperm but the sperm is not ejaculated (flown out) due to the block or obstruction in the Tube (genital tract).

Causes of Obstructive Azoospermia (post testicular)  –

• Injury or a trauma to the male testicles.
• Inflammation or Infections of epididymitis (tube block that carry sperm) or prostate.
• Retrograde ejaculation (dry orgasm, sperm travels to urine bladder instead of penis)
• Males born with prostate cysts or missing portions of their vas deferens.
• Surgical procedures executed to correct conditions such as a hernia produce scar tissue that obstructs the reproductive tract.
• A vasectomy blocks sperm ducts intentionally to stop semen from flowing.
• Non-Obstructive Azoospermia (pre-testicular & testicular) – In Non- Obstructive Azoospermia the Male testicles are unable to produce any sperm, this can be a congenital disorder (present from birth). There can also be a case where the sperm growth is stopped during the early stage of sperm maturation.

Causes of Non-Obstructive Azoospermia (pre-testicular & testicular) –

• Abnormal function of the testicles or reproductive hormones (low testosterone, hyperprolactinemia &  androgen)
• Genetic conditions like kallman syndrome (lack of sex hormone), Klinefelter syndrome (extra X chromosome), or  Y-chromosome micro-deletion.
• Varicose veins forming around testicles (varicocele) that affect the count and quality of sperms
• Lowered sperm production in the testicles (hypospermatogenesis) resulting in zero sperm or Azoospermia.
• Inadequate development or maturation of the sperm
• Reaction to certain medication which harms sperm production
• Not having testicles or having undescended testicles (testicles not dropping to scrotum before birth, requires surgery)
• Orchitis (swelling in testicles)
• Other factors including chemotherapy, diabetes, sickle-cell anemia, steroid intake, and exposure to heavy metals or toxins.

How is Azoospermia (zero sperm evaluation) Diagnosed?

AT Akruti IVF the full diagnosis of azoospermia is done by a Uro-Andrologist (Dcotor for male infertility & reproductive issues) who counsels, helps & explains the issue to the husband (male). The evaluation is done in 3 steps:

1. Taking History
2. Doing Physical examination
3. Conducting Investigations

1. HISTORY- Husband (Male partner) and his family’s detail history is taken to directly or indirectly correlate causes of his infertility, which may include Information such as :
2. About childhood or any medical illness/ abnormalities and treatment performed.
3. Hormonal imbalance (Diabetes, hypogonadotropic hypogonadism, CAH, etc.).
4. Occupational hazards –
5. Exposure to Environmental toxins such as pesticides,
6. Patient working in working in industries like chemical or radiation exposure
7. Patient exposure to excessive heat like furnace, boiler, heavy engine etc
8. Lifestyle factors:
9. Professional mental stress
10. Very tight undergarments
11. excessive Sauna baths,
12. Keeping laptop on lap & working long may cause sperm abnormalities.
13. Addictions:
14. Heavy or Chain Smokers,
15. Intake of marijuana, opiates, Hookah, cocaine, causes oxidative DNA damage of sperms.
16. Impact of steroids: Anabolic steroids used by Body builders (gym) and Use of testosterone supplementation causes toxic effects.
17. Chemotherapeutic agents: Due toxicity of the chemo agents it is advisable to do fertility preservation by cryopreserving the testicular tissue.
18. Drugs:
19. Antidepressant drugs
20. Antipsychotic drugs or antihypertensive drugs,
21. High antibiotics may cause Hyperprolactinaemia causing impair sexual activity.

• PHYSICAL EXAMINATION – At Akruti IVF the physical Andrological examination is done by a specialist uro-andrologist (Dcotor for male infertility & reproductive issues) when the semen analysis report shows abnormalities. 

Physical inspection is always indicated in

• Azoospermic individuals (undescended testes),
• Patient with history of failure to deposit semen in vagina
• Absence of beard, moustache
• Curvature of penis
• Palpation of testes
• Examination of scrotal sac,
• varicocele, rectal examination, etc.

• INVESTIGATIONS:  
• Semen analysis – A Semen Analysis is a IVF laboratory test done to identify azoospermia in Male. At Akruti IVF the test is done according to the WHO (world health Organisation) laboratory manual for evaluating human semen.
• Fructose test – A fructose test is done for patients suffering from azoospermia.
• Sperm DNA fragmentation: A male fertility test that identifies the amount of DNA damage to sperm.
• Other investigations: are done as per the patient medical condition e.g. Hormonal assessments, Genetic testing, Radiology, Diagnostic Testicular Biopsy.

How is azoopsermia treated?

Treatment of Azoospermia is based on the cause, appropriate genetic testing & Genetic counseling are the important aspects of azoospermia treatment, The treatment methods include;

• Performing surgery to unblock tubes or retrieve sperms via Microsurgery (microTESE)
• In case of Hormonal imbalance, administering Hormones to stimulate sperm production.
• Retrieving sperm directly from testes & performing ICSI procedure to fertilize eggs.
• Genetic counseling in cases where the azoospermia can be passed on to future baby.