Over the last couple of decades, we have seen a sharp rise in infertility. It is not just a female issue. In some cases, both partners suffer from some degree of infertility. There are many reasons for male infertility. These problems of male infertility prevent the couple from being able to get pregnant naturally. Almost 50% of the infertility cases pertain to the male partner or both partners. One of the possible causes of male infertility is nil sperm count.
- What is Azoospermia?
- Azoospermia Symptoms
- Azoospermia Diagnosis and Tests
- Causes of Azoospermia
- How common is Azoospermia?
- Azoospermia - Success Story
- Doctor's Suggestion
- Oligospermia and Azoospermia – The Difference?
- Treatment for Azoospermia
- Azoospermia Treatment Cost
- Becoming a Father with Azoospermia
- Is azoospermia treatable?
- What causes azoospermia?
- How to cure azoospermia naturally?
- How to treat zero sperm count?
- Is there any hope for men with azoospermia to father a child?
- Can a man with azoospermia impregnate a woman naturally?
- Is azoospermia common among men?
- How common is azoospermia?
- Is azoospermia reversible?
What is Azoospermia?
Azoospermia is the absence of sperm in the ejaculate. Prior to ejaculation the semen is mixed with sperm. The sperm is the male contribution for conception and is crucial for fertility. When male ejaculate is in the vaginal passage, the sperm travel to the fallopian tubes in search of the female egg. Once the female egg has been located, one healthy and robust sperm then enters the egg and fertilises it to form an embryo.
The azoospermia definition can be summed up as a zero sperm count. It is a condition which makes a male infertile. The male partner needs to have a certain minimum sperm count, which deems him fertile. Without the required sperm count present in the semen, a man is not able to impregnate his female partner naturally. A male should have a minimum sperm count of at least 20 million per millilitre of semen.
How does a man get to know that he has a zero-sperm count? It is not a sickness or a disease. It is a condition which does not allow a certain function of the body. This is due to the malfunction of an organ or could also be due to the blockage of ducts. In this case, it is the production of healthy sperm, which is impaired. There are no specific external symptoms of azoospermia. So, a male will not suffer any external or noticeable symptoms with this condition and may appear absolutely healthy and robust. The symptoms are not visible, and hence, usually, a male is not even aware that he has a fertility issue.
Seema and Nikhil started trying for a baby when they turned 30. After 6 months Seema found that her periods were regular and she was not conceiving. She decided to visit a gynaecologist to see if everything was fine with her. After several tests, it was found that she has no medical problems which would hinder her from getting pregnant. After another 8 months passed, she was still not pregnant. Seema happened to meet a friend who had just delivered a baby after IVF treatment at Medicover Fertility. She praised their services and suggested that Seema and Nikhil at least meet the fertility consultant at Medicover Fertility.
They booked an appointment and met Dr Sweta Gupta. After several tests, it was found that Nikhil has azoospermia due to a genetic condition. The doctor apprised them that azoospermia was not uncommon among men, and there was a good possibility of getting pregnant with IVF treatment. The azoospermia treatment success rate in India is quite high. The couple took a week to think it over and finally signed up for IVF treatment at Medicover Fertility, one of the best IVF clinics in India.
Azoospermia Diagnosis and Tests
- A detailed medical history including reviews of any earlier medical records defining male infertility of the patient.
- Physical examination
- Hormone testing
- Genetic screening
- Genetic tract imaging using ultrasound, MRI (magnetic resonance imaging) or CT (computed tomography) scan.
- Testicular Biopsy – An important tool in diagnosing male infertility.
Causes of Azoospermia
In a man who has Azoospermia, before initiating treatment, it is important to know the cause for lack of sperm in the ejaculate, whether it is from an obstructive or non-obstructive process. Azoospermia can thus be divided into two broad categories.
Obstructive Azoospermia – It means that sperm are being produced normally inside the testicle, but there is a blockage or obstruction in the reproductive tubing, that is not allowing the sperm to come out in the ejaculate.
Non-Obstructive Azoospermia – It means that sperm are being produced normally inside the testicle, but there is a blockage or obstruction in the reproductive tubing, that is not allowing the sperm to come out in the ejaculate.
Causes of Obstructive Azoospermia
Obstructive Azoospermia causes can be genetic, congenital or acquired.
Vasectomy – The most common cause of obstructive azoospermia is Vasectomy. Vasectomy interrupts the sperm ducts to stop the flow of the sperm. Hence no sperm are found in the semen.
Infection – Obstructive Azoospermia can also be caused by infections of the testicles, prostate or reproductive tracts such as epididymitis, prostatitis and other venereal diseases. These can cause a blockage in the small tubules of the epididymis or the ejaculatory duct.
Congenital Conditions – Some conditions are genetic. Some men are born with a missing portion of the vas deferens. Others may be born with a cyst in the prostate that blocks the ejaculatory ducts.
Surgical Complications – Some surgical procedures performed on the urogenital organs or hernia surgery can result in scarring that leads to a blockage. Mostly children are at risk because their reproductive tract is very small, and surgery can cause complication.
Causes of Non-Obstructive Azoospermia
Non-Obstructive azoospermia can be caused due to the abnormalities within the testicles or hormonal causes. The causes can be genetic, congenital or acquired.
Genetic Cause – These include chromosomal abnormalities. The most common chromosomal problem causing azoospermia in men is a situation where there is an extra X chromosome, and the syndrome is called Klinefelter’s syndrome. Another genetic cause of azoospermia is a deletion of some of the genes on the Y chromosome. These genetic causes of azoospermia are not reversible, but still, most men with genetic issues can produce small amounts of sperm within the testicles that can be used to father a child.
Varicoceles – They are characterised by the presence of varicose veins around the testicles. This condition is reversible and is the most common cause of male infertility.
Hypospermatogenesis – This means that there is sperm production in testicles, but lower than the normal sperm count, which may not be enough to impregnate a female.
Maturation Arrest – Some men suffer from a problem in which the sperm produced in their testes do not mature. A few sperm may mature, but the majority of the sperm remain in the precursor stage. For pregnancy, mature sperm are required.
Sertoli Cell-Only Syndrome or Germ Cell Aplasia – With Sertoli cell-only syndrome or germ cell aplasia, the germ cells that divide and become sperm are missing from the testicles. However, still, 15-20% of men will have some low level of sperm production somewhere in the testicles.
Testicular Cancer – At times, the first sign of testicular cancer is azoospermia or a very low sperm count. So, men with abnormal sperm count must be examined thoroughly.
Medical Treatment – Chemotherapy and radiation therapy used to treat cancer patients can cause temporary azoospermia. It is an acquired cause. Once treatment stops, the sperm production resumes may be within 2 years.
Supplements & Drugs – Another cause of Non-obstructive azoospermia is the use of testosterone and steroids. These can cause sterilisation and are very common. It is also an acquired cause and is reversible.
How Common is Azoospermia?
Azoospermia is not a very common condition. It affects only about 1% of the entire male population. The absence of sperm prohibits natural conception. For a male to have sperm in his semen is imperative to be able to father a child. Male infertility is quite common today, especially in urban areas. When a couple is not able to conceive, there is a high probability that one of the causes is male infertility. Among the couples that seek treatment for infertility, we find that about 20% of them suffer from zero sperm count.
AZOOSPERMIA – SUCCESS STORY
As soon as we got married, we decided to start a family. My husband worked with his father in the family business, and there was no need for me to work. We wanted a large family and planned to have many children. After a year of marriage, I was still not pregnant though we were having very regular sex. I would keep track of my ovulation days, and we ensured that we didn’t miss any opportunity during my fertile period. Finally, after almost a year and a half, we decided to visit a doctor to find out what was wrong and why I was not getting pregnant. I underwent many tests, all of which turned out to be clear, and my doctor declared that I was fertile and fine. Now it was my husband’s turn to have some tests. He was not happy at the prospect. However, when his semen analysis test came the doctor diagnosed that he had non-obstructive azoospermia. We were not prepared for this and didn’t know how to deal with it. A friend referred us to Medicover for fertility treatment, and the rest is history. Today we are proud parents of 3 lovely children, and we owe a big thanks to the team at Medicover Fertility for helping us through the most difficult time of our lives. – Ritika, 27 years
Fertility consultant at Medicover Fertility Clinic: The patient had a Non-Obstructive Azoospermia condition, which made him unable to impregnate his wife. When the couple first came to me, I prescribed certain preliminary tests for both of them to ascertain what was preventing conception. Ritika’s test results were fine, and she was healthy and fertile. The semen analysis test of her husband raised some concern. After more tests, we found that he suffered from sperm maturation arrest. It is a condition in which the required quantity of sperm is produced by the testes, but these sperm do not mature as they are naturally supposed to. To help this couple get pregnant we suggested testicular sperm extraction in which we hoped to find a few mature sperm.
In most cases of maturation arrest there are still few sperm found which do mature. Fortunately we were able to find a small percentage of mature sperm which could be used for Ritika’s IVF procedure. We used the ICSI fertilisation technique, which was successful.
Many men are not even aware that there is no sperm in their semen. It is only when they are not able to make their wives pregnant that they realise that something is not right. Fortunately, with the use of the latest technology, there is hope for men suffering from azoospermia at Medicover Fertility.
Oligospermia and Azoospermia–The Difference?
Azoospermia is the absence of sperm in the semen. Oligospermia is a condition when a male has less than 15 million sperm in a millilitre of semen. Oligospermia and azoospermia are both conditions in which natural conception is not possible. Male suffering from either of these conditions will need medical help to father a child. IVF with ICSI is the best fertility treatment recommended for azoospermia as well as severe oligospermia.
Treatment for Azoospermia
The type of azoospermia treatment in India for the absence of sperm depends on the cause of the condition. For some conditions, there may be an azoospermia cure, but in most of the situations, the patient may have to undergo alternative treatment to assist with fertility.
Blockage – Absence of sperm due to a blockage in the duct can be rectified by microsurgery. Obstruction in the vas deferens or the tubes can be removed, or a bypass created to allow the sperm to travel freely.
Hormonal causes – The lack of sperm production due to hormonal imbalance can be rectified by administering the required hormones to instigate the proper production of sperm. In some cases of non-obstructive azoospermia, surgery does not help. In various other conditions, the doctor may prescribe medicine for azoospermia. This medication will help to improve the sperm production and in turn, increase the sperm count. The absence of sperm in the semen only becomes a concern when a male wants to have a child. Usually, a man will not have his sperm count or have a fertility check as part of a regular health check-up. Men who have been diagnosed with zero sperm count will have to undergo fertility treatment to become a parent. Medicover has been able to help numerous men with Azoospermia to have children through In vitro fertilisation technique. There are several types of sperm retrieval procedures which can be used depending on the infertility diagnosis.
MESA (Microscopic Epididymal Sperm Aspiration) – This is a sperm retrieval technique which Is performed using microsurgery. A small incision is made in the testes, and the sperm is taken out from the epididymis, where it is stored after production.
TESE (Testicular Sperm Extraction) – In the TESE procedure, is a type of azoospermia cure, in which a small tissue sample is lacerated from the testes. This microsurgical procedure involves making a small incision in the testes through which the required tissue is removed. This tissue is then taken to the lab, and the sperm is removed from it.
Micro - TESEis a procedure used when there is a low sperm concentration in the tissue that is extracted from the testes. With the help of powerful magnification, the few available sperm in the tissue are extracted.
PESA (Percutaneous Epididymal Sperm Aspiration) is a simple procedure whereby the sperm are extracted directly from the epididymis with the help of a syringe.
Testicular Biopsy – may be used to retrieve sperm for use in IVF. It is done when sperm are being made in the testicles but are not present in the semen. They are of 2 types:
PTBX (Percutaneous Testicular Biopsy) – In this procedure, a hollow needle is used to extract small cores of testes tissue. The sperm found in this tissue is then aspirated.
Open Biopsy – Also called a surgical biopsy. A cut is made in the skin as well as in the testicle. Then a small tissue sample is taken out from the opening.
Azoospermia Treatment Cost
The azoospermia treatment cost depends on the type of treatment that the patient needs to undergo. A simple surgical procedure will cost very little. Treatment like sperm extraction is combined either with preservation of the sperm through freezing or with IVF treatment, and this would include the cost of the accompanying treatment as well.
Becoming a Father with Azoospermia
Medicover Fertility is a renowned international brand. We have a team of highly skilled and experienced doctors who help men with various types of azoospermia. Medicover Fertility has a very high possibility of pregnancy when partner with azoospermia as we use the latest technology fertility treatments.
Medicover Fertility has many azoospermia success stories to share. Couples who had lost all hope, saw their heart’s desire become a reality in Medicover. Medicover Fertility is one of the leading fertility clinics and has a very high success ratio for helping patients with azoospermia to successfully conceive. We also help with fertility preservation for couples who want to plan for more children. We are proud to have some of the best fertility experts in the country working at Medicover Fertility.
Q: Is azoospermia treatable?
A: Some types of this condition can be treated directly. Moreover, in other cases, men with azoospermia can become fathers with the help of IVF treatment.
Q: What causes azoospermia?
A: There are several causes such as scarring from surgery, infection of the urinary tract, missing vas deference, blockage of ducts used for transporting the sperm etc. Some men suffer from congenital disabilities, which results in a lack of sperm production. Genetics can also lead to azoospermia.
Q: How to cure azoospermia naturally?
A: A good diet which is high in zinc and Vitamin C is recommended for men with a poor sperm count. Some cases of non-obstructive azoospermia can improve their sperm count with diet and medication. Men with obstructive azoospermia need to get medical help.
Q: How to treat zero sperm count?
A: Treatment of zero sperm count include surgery like varicocele, assisted reproductive technology like ICSI-IVF, etc.
Q: Is there any hope for men with azoospermia to father a child?
A: Medicover promises that you can have a baby if you have even traces of sperm in your testes. In Vitro, Fertilisation is a technique in which the sperm can be extracted directly from the testes and used to fertilise the female partner’s egg in the laboratory.
Q: Can a man with azoospermia impregnate a woman?
A: A man who has nil sperm count cannot impregnate a woman naturally; however, with medical help, he can have children. IVF is the most highly recommended fertility treatment.
Q: Is azoospermia common among males?
A: It is considered a rare condition and affects only a very small percentage of men.
Q: How common is Azoospermia?
A: Approximately 1% of all men across the globe, and almost 10-15% of the infertile men have azoospermia.
Q: Is Azoospermia Reversible?
A: Although the genetic causes of Azoospermia is not reversible, however, men with genetic issues do still produce some amount of sperm within the testicles, that can be utilized to father his child.
a) https://www.sciencedirect.com/science/article/pii/S0022534718399646 b) https://www.jurology.com/article/S0022-5347(18)41216-5/abstract c) https://www.jurology.com/article/S0022-5347(18)39531-4/abstract d) http://journals.sagepub.com/doi/abs/10.5301/uj.5000253