outline of male reproductive system

What is Azoospermia?

Azoospermia is one of the most severe forms of male factor infertility. It is a condition in which a man has no sperm in his ejaculate. In order to transport sperm outside of the body, it mixes with ejaculate (semen) at certain places throughout the male reproductive system. Sometimes, due to blockages or sperm production problems, sperm does not mix with ejaculate, and therefore cannot leave the body. This is why so many men with azoospermia find it difficult to have children.

What are the types ????

There are actually two types of azoospermia:

• Obstructive Azoospermia: Obstructive azoospermia accounts for 40% of all cases of azoospermia. It occurs when a blockage in your duct system prevents your sperm from mixing with your semen. These obstructions may be present in your vas deferens or epididymis.
• Non-Obstructive Azoospermia: Non-obstructive azoospermia accounts for 60% of all cases of azoospermia. It occurs when there is a problem with the actual production of sperm within your body. It is often the result of hormonal imbalances.

What are the causes?????

1) problem with sperm production

2) problem with sperm transport

Is it common ????

Azoospermia affects only about 2% of the general male population; however, it does account for a large percentage of those men actively seeking fertility treatments. It is thought that between 10% and 20% of men undergoing fertility treatments suffer from azoospermia. Most of these men have little or no sperm present in their ejaculate.

The symptoms are ______

Unfortunately, it is very difficult to recognize azoospermia without undergoing fertility testing. This is because there are no symptoms that occur along with the condition. You will likely have semen of a normal color and texture, and will encounter few difficulties with ejaculation. Only a sperm count can diagnose the condition.

Sperm Production problems ??

Sometimes, azoospermia is the result of a dysfunction within the testes themselves, making it impossible for your body to produce enough viable sperm. In order to produce sperm, the proper cells need to be present in the testes and the proper hormones need to trigger sperm production. Failed sperm production is often the result of:

• Hormonal Abnormalities: Sometimes your body may not produce enough of certain hormones involved in the sperm-making process, causing azoospermia. Hormonal imbalances caused by anabolic steroid use or particular disorders, like Cushing’s Syndrome, can contribute to azoospermia.
• Cryptorchidism: Cryptorchidism, or undescended testicles, is a condition in which your testes have not descended properly. It is generally corrected in childhood, however, if it isn’t corrected, your testicles will be unable to produce sperm properly.
• Vascular Trauma: Trauma to the testes or to the blood vessels within the testes can also prevent your body from producing sperm. Varicocele causes veins in the testes to enlarge and become swollen. As a result, blood pools in the testes, impairing sperm production.

Sperm Transport problem ???

In order for sperm to leave your body, it must be transported from your testes to your urethra. Sperm travels through a series of ducts inside of your reproductive system, until it eventually mixes with your ejaculate and exits your body. Sometimes, blockages can occur inside of these ducts preventing sperm from mixing with your ejaculate. Sperm transport problems are often caused by:

• Vasectomy: The vasectomy procedure introduces a cut or blockage into your vas deferens, preventing sperm from mixing with your ejaculate.
• Congenital Absence of Vans Deferens: Some men are born without the vas deferens, which are tiny tubes that carry sperm to the urethra for ejaculation.
• Infection: Certain infections, including STDS, can cause blockages in the epididymis or vas deferens, preventing sperm from mixing with your semen.

DIAGNOSIS ???

Physical Examination – Testis and ducts viability

Semen Analysis

Hormone Evaluation – FSH, LH, TSH

Transrectal USG – for blockage in ejaculatory duct

Urine Analysis – backward flow of sperm

Testicular Biopsy – primary testicular problem

Can we Treat it ?????

There are ways to treat azoospermia and possibly restore fertility in some men suffering from the condition. These treatments include:

• removing blockages in the duct system
• using medications to restore hormonal balances

Sometimes, however, it is impossible to restore the flow of sperm into a man’s ejaculate. This does not necessarily mean that you will be unable to father a biological child, though. New methods of surgical sperm removal are now available, which can remove small quantities of sperm from the testes or around blockages. Common methods include:

• 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.