Azoospermia

Azoospermia

Azoospermia is a condition where there is no sperm in the semen when a man ejaculates. Azoospermia can occur due to genetic disorders, blockages in the testicular tract, hormonal disorders, or disorders of the testes. This condition is one of the causes of infertility in men.

Normally, a man's sperm count is 15–200 million cells per millimeter of semen. Men whose sperm count is below this number are considered to have a low sperm count.

Azoospermia and oligospermia are two different conditions. Oligospermia is a condition when the sperm count in semen is below 15 million per millimeter. Meanwhile, in azoospermia or empty sperm, there are no sperm cells at all.

Causes of Azoospermia

Azoospermia can be caused by a variety of conditions. Based on the cause, azoospermia is divided into two types, namely:

Obstructive azoospermia

This type of azoospermia occurs due to blockages in the channels of the male reproductive organs, such as the epididymis or sperm ducts (vas deferens). Some conditions that can cause the blockage are:

  • Injury
  • Infection or inflammation
  • Cyst
  • Pelvic surgery
  • Vasectomy procedure
  • Cystic fibrosis , which causes mucus-induced blockage in the vas deferens
  • Retrograde ejaculation, which is a condition when semen does not come out of the penis, but enters the urinary tract

Nonobstructive azoospermia

This type of azoospermia can occur due to hormonal disorders, or genetic disorders that make men unable to produce sperm at all. Some of these causes are:

  • Hormonal disorders, such as hypogonadism and hyperprolactinemia
  • Genetic or chromosomal disorders, such as Klinefelter syndrome, Kallmann syndrome, and Y-chromosomal microdeletions

In addition to the above conditions, this type of azoospermia can also occur due to abnormalities in the structure and function of the testes, which can be caused by the following conditions:

  • Testicular torsion
  • Absence of testicles ( anorchia )
  • Cryptorchidism
  • Testes fail to produce sperm ( Sertoli cell-only syndrome )
  • Inflammation of the testicles ( orchitis )
  • Testicular tumor or cancer
  • Varicocele
  • Certain diseases, such as diabetes and kidney failure
  • Medication side effects
  • Side effects of radiation exposure, such as from radiotherapy or chemotherapy

Symptoms of Azoospermia

The main symptom of azoospermia is the inability to have children ( infertility ). Apart from these symptoms, generally azoospermia does not cause any symptoms.

However, in azoospermia caused by a condition, sufferers can experience certain symptoms, including:

  • Erectile disorders
  • Loss of sexual desire
  • Pain, swelling, or lump in the testicle
  • Absence of signs of puberty in males, such as changes in voice, growth of Adam's Adam's apple, or growth of facial and genital hair

When to see a doctor

Check with your doctor if your partner doesn't get pregnant after 1 year of trying to have sex without using contraception, especially if you have the following conditions:

  • Sexual dysfunction , such as loss of sexual desire
  • Pain and discomfort in the testicles
  • Swelling or lump in the testicles
  • History of sexually transmitted diseases , or disorders of the testicles and prostate
  • History of surgery on the penis or scrotum

Diagnosis of Azoospermia

To diagnose azoospermia, the doctor will ask questions about the patient's symptoms, history of sexual activity, patient and family medical history, and patient's medical history.

After that, the doctor will perform a thorough physical examination, including an examination of the penis and scrotum. To establish a diagnosis, the doctor will perform supporting examinations, namely:

  • Semen test , to determine the number of sperm in the semen
  • Hormone tests, to check hormone levels in the body
  • Scans, such as testicular ultrasound, transrectal ultrasound, or CT scan, to see the condition of the testicles and their ducts
  • Genetic testing , to detect signs of genetic disorders, such as Klinefelter syndrome
  • Testicular biopsy, to detect abnormalities that cause interference with sperm production

Treatment of Azoospermia

Azoospermia treatment is adjusted according to the underlying cause, the age of the patient's partner, and the results of the tests that have been performed. Some of the treatment methods that can be done are:

Operation

Surgery is performed to treat azoospermia caused by a blockage in the male reproductive tract. Doctors can repair blocked ducts, or create ducts if the reproductive tract is not developing due to congenital abnormalities.

After the patient has undergone surgery, the doctor will carry out further sperm examinations 3–6 months after the patient is operated on. If the patient's sperm production is normal, the patient is allowed to start planning to have children with his partner.

Hormone therapy

Hormone therapy can be given to patients who experience azoospermia due to hormonal disorders. This therapy can increase levels of the hormone testosterone which functions in sperm formation. Some of the drugs that can be used in hormone therapy are:

  • Clomiphene
  • Anastrazole
  • Follicle-stimulating hormone (FSH)
  • Human chorionic gonadotropin (hCG)
  • Letrazole

In some cases, nonobstructive azoospermia cannot be treated, especially those caused by genetic disorders. In this condition, patients can still have children by undergoing IVF .

Sperm retrieval in IVF program is done by taking sperm cells directly from the testes using a small syringe.

Azoospermia complications

The main complication in patients with azoospermia is not being able to have children. This can cause sufferers or their partners to experience stress or depression .

In addition, surgery to treat azoospermia can also cause complications, such as:

  • Bleeding
  • Infection
  • Formation of scar tissue in the testes
  • Testicular shrinkage (testicular atrophy)

Azoospermia Prevention

Azoospermia caused by genetic disorders cannot be prevented. Meanwhile, to reduce the risk of azoospermia that is not related to genetic disorders, there are several things that can be done, namely:

  • No smoking
  • Limiting consumption of alcoholic beverages
  • Maintain body weight to remain ideal
  • Manage stress well
  • Avoid activities that can injure the male reproductive organs
  • Avoid radiation exposure
  • Keep the testes away from exposure to hot temperatures in the long term
  • Immediately seek treatment if you experience interference with the testicles
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