Azoospermia- No Sperm Count

WHAT IS AZOOSPERMIA?

Men with no sperm in their semen have a condition called azoospermia. The average man has 100–300 million sperm in his semen, but if there is no sperm, it can be difficult for couples to get pregnant.

THERE ARE TWO TYPES OF AZOOSPERMIA:

1. Obstructive Azoospermia
2. Non-Obstructive Azoospermia

We can diagnose azoospermia by performing at least two semen analyses in the laboratory.

OBSTRUCTIVE AZOOSPERMIA

In obstructive azoospermia, a man’s testes produce enough sperm, but there is a plumbing problem that prevents the sperm from traveling out of the testes and entering the ejaculate in the urethra/penis.

OBSTRUCTIVE AZOOSPERMIA CAUSES

Vasectomy: The most common cause of obstructive azoospermia is from a vasectomy. The vas deferens, which carries sperm from the testicles to the urethra during ejaculation, has been purposefully cut in half during a vasectomy.

Cystic Fibrosis (CF): Cystic fibrosis is a congenital lung disease that can affect fertility. Nearly all men (95 percent) with cystic fibrosis (CF) don’t develop all or part of their vas and epididymis ducts on both sides of their testicles. This condition is called congenital bilateral absence of the vas deferens (CBAVD).

Ejaculatory Duct Obstruction: Ejaculatory ducts allow sperm from the vas deferens and fluid in semen from the seminal vesicles to enter the urethra. These ducts can be blocked by congenital cysts (that some men are born with) or from inflammation and scarring from sexually transmitted infections.

Surgical Complications: Men who have had bilateral hernia repairs can have blocked or injured vas deferens. This prevents the normal flow of sperm into the ejaculate.

Phimosis: Narrowing of the foreskin that can block semen from coming out of the penis.

Scarring: Sexually transmitted infections can cause scarring.

Midline Congenital Cysts: These cysts block the vas deferens from emptying into the urethra.

NON-OBSTRUCTIVE AZOOSPERMIA

Non-obstructive azoospermia is a set of disorders that cause a man to produce abnormal sperm. All of these disorders either decrease production or cause no sperm production at all.

CAUSES OF NON-OBSTRUCTIVE AZOOSPERMIA

Non-obstructive azoospermia can be subdivided into pretesticular and testicular causes.

Pretesticular Non-Obstructive Azoospermia: All pretesticular conditions disrupt the hormones a man needs for normal sperm creation. If a man has any of these conditions, this means he can’t produce healthy, normal sperm.

CAUSES OF PRETESTICULAR NON-OBSTRUCTIVE AZOOSPERMIA INCLUDE:

• Hypogonadotropic hypogonadism—This is a problem with the pituitary gland where it doesn’t make the hormones needed to create sperm or testosterone.
• Hypothyroidism.
• Use of certain medications.
• Elevated estradiol.
• Kallman’s syndrome.
• Certain rare types of pituitary tumors.

Testicular Non-Obstructive Azoospermia: If you have testicular non-obstructive azoospermia, this means that something is preventing your testes from creating normal sperm. Many things can cause testicular non-obstructive azoospermia.

THESE CONDITIONS MAKE UP MOST NON-OBSTRUCTIVE AZOOSPERMIA CASES:

• Varicoceles, or varicose veins in the scrotum, which disrupt sperm production in the testicle (but rarely lead to azoospermia).
• Bilateral undescended testicles or cryptorchidism.
• Testicular cancer.
• Gonadotoxins, such as radiation, chemotherapy, and some industrial chemicals that are toxic to the testes or gonads.
• Immunologic causes, such as post-pubertal mumps orchitis (when a man who has already gone through puberty develops a mumps infection inside his testicle(s)).
• Sertoli-cell only syndrome (when the testis doesn’t have any sperm cells).
• Incomplete development, where all of a man’s sperm can only reach a certain, incomplete stage of development.
• Genetic syndromes, such as Klinefelters (this is when a man has an extra X chromosome, so they have XXY instead of XY).

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