Azoospermia is a term used to describe a condition in males, where there is a complete absence of sperms in a semen sample. In order to find out if this condition is curable or not we must first find out the cause of azoospermia as its treatment is cause specific.
The etiology of azoospermia falls under two classifications; obstructive azoospermia and non-obstructive azoospermia.
This is the type of azoospermia where sperms are produced but are not ejaculated, most commonly due to an obstruction in the male reproductive tract. It is also called as post testicular obstruction and affects 10 to 50% of azoospermia cases. The causes of obstructive azoospermia maybe Congenital or Acquired.
The Congenital causes include:
And Acquired causes include:
Males with congenital reproductive tract obstruction and suspected with cystic fibrosis should undergo genetic analysis for mutation prior to performing IUI (intra uterine insemination) or IVF (in vitro fertilization), because these male patients are at a higher risk of carrying Cystic Fibrosis (CF) gene mutation.
This is the type of azoospermia where there is inadequate production of sperms in the male reproductive system. It is divided into pre testicular and testicular azoospermia.
Pre-testicular azoospermia is a condition where the male genital tract and testicles are normal however there is inadequate hormonal stimulation. Most typically the levels of Follicle stimulating hormones are low, and FSH is necessary for stimulating the testicles for production of sperms.
Testicular azoospermia is a condition where the production of sperms is completely absent due to abnormal, atrophic or absent testes.
Causes of testicular failure include;
1. Genetic conditions
2. Infections due to STD’s
3. Surgery (which may lead to infection and trauma)
4. Vasectomy
5. Cancer
6. Radiation and chemotherapy
7. Trauma
An infertility specialist will provide you with treatment options according to the diagnosis. Depending on the cause, the treatment options will vary since there are multiple causes of azoospermia.
Except for congenital cases of azoospermia, most cases with obstructive azoospermia are repairable surgically to remove the blockage, with microsurgical or endoscopic reconstruction.
Men with genetic causes of azoospermia will have varying treatments options from limited to no treatment, depending on the type of genetic defect.
In cases which are not due to obstruction called non obstructive azoospermia like testicular failure, can be treated with hormonal therapy which helps some men develop ejaculated sperm. However, in most instances the only hope to have a biological family is to retrieve sperms from the testes using assisted reproductive technique. Several tests are performed to determine if there is any sperm cell production in the testis, if there is then sperms are extracted to be used in IVF.
