Azoospermia: Causes, Symptoms, Treatment, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Azoospermia

The content of the article:

1. Causes
2. Forms
3. Signs
4. Diagnostics
5. Treatment
6. Prevention
7. Consequences and complications

Azoospermia is a pathological condition characterized by the absence of sperm in the ejaculate. This is not an independent disease, but a clinical symptom of some pathological processes occurring in a man's body.

Azospermia is characterized by the absence of sperm in the ejaculate

Causes

One of the reasons for the absence of spermatozoa in the composition of the semen may be a violation of the patency of the vas deferens. In this case, the spermatozoa are produced in sufficient quantities, they retain the usual mobility and correct morphology, but due to the existing obstacle they cannot enter the ejaculate. Lead to obstruction of the vas deferens can:

• stricture of the urethra;
• aplasia of the vas deferens;
• operations for hydrocele;
• orchitis;
• hernia repair with inguinal hernia;
• epididymitis;
• inguinal-scrotal hernia;
• vesiculitis;
• varicocele;
• prostatitis;
• traumatic damage to the scrotum.

Frequent visits to the sauna or bath is a provoking factor in azoospermia

Another cause of azoospermia is a violation of spermatogenesis, that is, the process of formation and maturation of sperm in the testes. The factors that can cause it are:

• syphilis;
• bilateral cryptorchidism;
• mumps, complicated by orchiepididymitis;
• testicular tumors;
• pituitary tumors;
• hypogonadism;
• spinal injury;
• celiac disease;
• diabetes;
• exposure to ionizing radiation and various kinds of toxins.

With frequent visits to saunas and baths, as well as against the background of stress, a number of acute diseases and the use of certain medications (cytostatics, antibiotics, steroid hormones), functional disorders of the gonads occur, which can also lead to the development of azoospermia. In this case, it is temporary: after the termination of the negative factor, the process of spermatogenesis is restored.

Forms

Depending on the cause underlying the development of azoospermia, the following forms are distinguished:

• secretory (non-obstructive). It is associated with the cessation of the formation of sperm cells in the testicles;
• excretory (obstructive). It is caused by a violation of the patency of the vas deferens;
• combined (mixed). It combines signs of obstructive and non-obstructive forms;
• temporary (functional). It passes after the termination of the influence of the harmful factor and does not require treatment.

Spermogram indicators: norm and pathology

Negative factors can lead to a decrease in the content of sperm in the semen. Depending on the number of sperm, the following stages are identified:

1. Oligozoospermia, in which 1 ml of ejaculate contains less than 20 million live and motile spermatozoa.
2. Asthenozoospermia. At this stage, the shape and number of sperm in the semen are normal, but only less than half of them have progressive linear (type I) and progressive non-rectilinear (type II) movement.
3. Teratozoospermia. The number of spermatozoa in the ejaculate and their mobility are normal, but more than 50% of them have pronounced disorders in the structure of the tail and head.
4. Azoospermia. Spermatozoa are completely absent in semen.

Signs

With azoospermia, the sexual function in a man usually does not suffer, the only manifestation of pathology is male infertility. All other clinical symptoms that may accompany this condition are always associated with the underlying disease.

The main symptom of azoospermia is male infertility

With the secretory form of azoospermia, the patient may have erectile dysfunction, decreased libido, testicular hypoplasia, and an underdeveloped penis.

Azoospermia against the background of hypogonadism is accompanied by gynecomastia, the female body type, and poor hair growth.

The symptoms of obstructive azoospermia are:

• discomfort in the groin area;
• swelling or obvious swelling of the scrotum;
• pain in the scrotum;
• retrograde ejaculation.

On palpation, you can notice a slight increase in the epididymis, which is explained by the accumulation of spermatozoa in them.

Diagnostics

Azoospermia is diagnosed according to spermogram data. Normally, 1 ml of ejaculate should contain at least 20 million sperm. If they are not found, this is evidence of azoospermia.

It is more difficult to establish the cause of the pathology. The patient should be examined by an andrologist, endocrinologist and urologist. After that, a plan is drawn up for a comprehensive laboratory and instrumental examination, the purpose of which is to obtain complete information about the state of the male reproductive system. It includes:

• TRUS of the prostate;
• dopplerography (USDG) of the blood vessels of the scrotum;
• Ultrasound of the scrotum;
• determination of the content of antisperm antibodies in the blood;
• a blood test for the content of hormones (FSH, testosterone, LH, estradiol and prolactin).

Prostate TRUS will help to identify azoospermia in time

Taking into account that one of the causes of azoospermia can be sexually transmitted diseases, they must be diagnosed by PCR, RIF, ELISA.

If retrograde ejaculation is suspected, post-ejaculatory urinalysis is performed.

In difficult diagnostic cases, there is a need for a testicular biopsy with subsequent cytological and histological examination.

Treatment

With azoospermia, therapy is aimed at eliminating the cause that caused it.

Obstructive forms of azoospermia are an indication for reconstructive surgical intervention aimed at restoring the lumen of the vas deferens. As a result, fertility is restored in 27–55% of patients.

Treatment of secretory forms of azoospermia, which have arisen against the background of endocrine disorders, requires stimulating or hormone replacement therapy.

With the ineffectiveness of conservative or surgical treatment, the onset of pregnancy in a partner can be achieved using reproductive technologies. The most effective in this case is the ICSI technique. To obtain the spermatozoa necessary for in vitro fertilization of an egg, an aspiration or open biopsy of the testicular or epididymis tissue is performed. If, with the secretory form of azoospermia, it is not possible to restore the process of spermatogenesis, the couple is offered to resort to fertilization with donor sperm.

ICSI procedure will help a couple to become pregnant if the treatment of azospermia is ineffective

Prevention

To prevent azoospermia, it is necessary to lead a correct lifestyle, which includes:

• balanced diet;
• moderate exercise;
• rejection of bad habits;
• refusal to wear tight underwear;
• refusal of casual sex;
• timely treatment of any diseases.

It is also advisable to refuse frequent visits to the bathhouse or sauna.

Consequences and complications

Azoospermia does not pose a threat to life, but the infertility caused by it negatively affects the psychological state of a man. The level of self-esteem decreases, insomnia, irritability, and depressive states occur. To correct such problems, the consultation of a psychologist or psychotherapist is required.

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Elena Minkina Doctor anesthesiologist-resuscitator About the author

Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.

Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!