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After attempting to conceive through unprotected sex for about a year, couples are generally considered infertile. Entering into the realm of infertility can be daunting and overwhelming, as pregnancy announcements seem to be everywhere and uncertainty about overall health can arise.
It's important to remember that you're not alone. Around 12 to 13 out of 100 couples experience infertility, with up to 50 percent of cases attributed to male-factor infertility. One potential cause is azoospermia, a condition where no sperm is present in semen. Although rare, about 1 percent of men have azoospermia, which accounts for 10 to 15 percent of infertility cases.
Let's discuss how the male reproductive system works in brief: The testicles generate sperm that moves through the reproductive pathway and fuses with fluid in the seminal ducts. This combination creates semen, the thick, white fluid that is ejaculated from the penis.
However, in cases of azoospermia, the sperm component is absent. Even though you may have an ejaculation, there is no sperm in it. While "low sperm count" implies some sperm are present, azoospermia, in contrast, indicates a "no sperm count."
There are various possible causes or associated conditions for each type of azoospermia. In general, genetic conditions affecting the Y chromosome may account for 10 to 15 percent of cases with low or no sperm count.
Pre-testicular azoospermia can be caused by certain genetic disorders, such as Kallmann syndrome, which affects the production of gonadotropin-releasing hormone (GnRH) and impacts sperm production. Damage to the hypothalamus or pituitary gland, medication use, and radiation treatments for cancer may also cause this type of azoospermia.
Testicular azoospermia can occur due to different reasons, including the absence of testicles (anorchia), undescended testicles (cryptorchidism), testicles that do not produce sperm (sertoli cell-only syndrome), and testicles that do not produce mature sperm (spermatogenic arrest). Klinefelter syndrome, which results from a person being born with XXY chromosomes instead of XY, is another possible cause.
Other factors that may contribute to testicular azoospermia include tumors, radiation exposure, diabetes, prior surgery, reactions to certain medications, and varicocele, a condition characterized by dilated veins emerging from the testicles.
In around 40 percent of azoospermia cases, the cause is post-testicular azoospermia, which is an obstructive type. Obstruction can occur due to a missing connection somewhere along the epididymis or vas deferens tubes, which are responsible for moving and storing sperm.
Congenital conditions may also lead to obstruction, such as congenital bilateral absence of the vas deferens (CBAVD), a genetic condition where the vas deferens ducts that carry sperm from the testes may be absent. CBAVD is associated with having or carrying genes for cystic fibrosis.
Other possible causes of obstructive azoospermia include previous or current infection, cysts, injury, or vasectomy.
Azoospermia may not present any symptoms, and individuals may only realize they have it when their attempts to conceive fail. Other symptoms experienced may be associated with the underlying causes such as hormonal imbalances or genetic chromosomal conditions.
However, some potential symptoms of azoospermia may include:
Semen analysis is the most common method used to diagnose azoospermia. A doctor will ask the patient to provide a semen sample in a cup for laboratory testing. The absence of living sperm in the ejaculate may indicate azoospermia.
Additionally, a doctor may conduct a physical exam and gather medical history information. Questions may be asked about the patient's fertility history, family history, illnesses from childhood, surgeries or procedures done to the pelvic region or reproductive tract, infections such as UTIs or STIs, exposure to radiation or chemotherapy, medication use, drug or alcohol abuse, recent illnesses involving fever, and exposure to high heat.
Other diagnostic methods may include blood tests to assess hormone levels or genetic disorders, ultrasound to examine the scrotum and other reproductive tract parts, brain imaging to look for issues with the hypothalamus or pituitary gland, and biopsies to closely investigate sperm production.
Medical treatments for azoospermia vary depending on the type and underlying cause of the condition. Obstructive azoospermia may require surgery or other procedures to reconnect or reconstruct the blocked tubes or ducts. Hormonal treatments and medications may also be used to address low hormone production.
In non-obstructive azoospermia, medical treatment may or may not be effective. However, there are still options for achieving biological pregnancy, such as in vitro fertilization or intracytoplasmic sperm injection. In these procedures, a doctor can extract sperm from the testes using a needle, even if only a few sperm are present. It is important to undergo genetic counseling to understand any potential impact on any biological children.
It is important to note that the success rate of these treatments can vary depending on individual factors and the severity of the condition.
In cases where azoospermia is caused by factors such as injury or certain medications, there are some steps you can take to protect sperm production.
The bottom line is that receiving a diagnosis of azoospermia or a "no sperm count" result can be anxiety-inducing. However, don't panic, as there are still chances to have biological Children. The initial step is to identify the underlying cause of the condition. Once the root cause is identified and addressed, your doctor may present you with various treatment alternatives to alleviate the blockage.
Jai Andrology and Men’s Health is the first exclusive centre in Vijayawada that’s instrumental in bringing men’s health as an independent area of focus not only for Fertility, but also Erectile Dysfunction and sexual concerns. With state-of-art technology, advanced treatment and personalized care, we help you deal, grow out of your reproductive health worries and help you take your first steps towards parenthood.
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