Azoospermia: what is it, causes, treatment, diagnosis, reviews

Male infertility occurs today in 40% of couples who cannot conceive a child for a long time. And, as a rule, such a pathology has to be discovered after the fact, when the family begins an examination in the clinic to find out the reasons for unsuccessful attempts to conceive. Doctors identify many types of pathologies of male sperm, but the most complex is azoospermia, as a result of which there are no sperm germ cells in a man’s semen.

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In men, azoospermia in most cases is completely asymptomatic, and only a spermogram can identify low-quality sperm. Azoospermia is often diagnosed in men who are genetically predisposed to such a pathology, although external negative factors can also lead to its development. Provided the causes of azoospermia are established and eliminated, the doctor can predict a man’s chance of having children in the future.

Causes

One of the reasons for the absence of sperm in the seminal fluid may be a violation of the patency of the vas deferens. In this case, sperm are produced in sufficient quantities, they retain their normal motility and correct morphology, but due to the existing obstacle they cannot enter the ejaculate. The following can lead to obstruction of the vas deferens:

urethral stricture;
aplasia of the vas deferens;
surgeries for hydrocele;
orchitis;
hernia repair for inguinal hernia;
epididymitis;
inguinoscrotal hernia;
vesiculitis;
varicocele;
prostatitis;
traumatic injuries to the scrotum.

Frequent visits to the sauna or steam bath are a provoking factor for azoospermia

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

syphilis;
bilateral cryptorchidism;
mumps, complicated by epididymitis orchio;
testicular tumors;
pituitary tumors;
hypogonadism;
spinal injuries;
celiac disease;
diabetes;
exposure to ionizing radiation and various types of toxins.

The key to successfully eliminating azoospermia is identifying the cause that caused its occurrence.

With frequent visits to saunas and baths, as well as against the background of stress, a number of acute diseases and taking 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 cessation of the negative factor, the process of spermatogenesis is restored.

Is it possible to cure male infertility?

Only medical specialists - urologist, andrologist and endocrinologist can determine the form of the disease and identify the main causes of spermatogenesis pathology. Doctors examine the condition of the reproductive, reproductive and urinary systems. An analysis of the body's vascular and immune systems may be necessary. Treatment of azoospermia is aimed at eliminating the causes of the pathology and treating important areas of the body.

Diagnosis and treatment methods for azoospermia

The main symptom of azoospermia is male infertility. When a man asks such a question, a urologist (andrologist) conducts an external examination of the man’s body: physique, groin organs. If there are problems with the prostate, then a rectal digital examination of the prostate gland is performed. If a man has problems with sexual functions or a painful condition of the urinary organs, an additional examination is prescribed by an endocrinologist.

To determine a complete picture of the patient’s health status, a man will have to undergo several studies of the body:

general blood analysis;
blood chemistry;
blood test for hormones;
urine analysis after ejaculation;
spermogram;
Ultrasound of the pelvic organs;
X-ray examinations of the internal and external organs of the groin;
testicular biopsy.

As additional diagnostics, studies are prescribed for genetic abnormalities, MRI of the head, analysis of prostate secretions and other examinations, if required to determine the causes of pathological spermatogenesis.

Identified deviations in the process of normal appearance and maturation of sperm provide several methods for treating azoospermia:

the use of drugs to eliminate inflammatory and infectious causes of azoospermia;
use of hormone-containing drugs;
products of natural origin to improve male fertility;
surgical restoration of the vas deferens;
isolation and collection of healthy sperm for artificial insemination of a female egg.

Surgical intervention in which cases is surgery necessary?

In some cases, surgical intervention is necessary.
In the obstructive form of azoospermia, they most often resort to surgical plastic surgery of the vas deferens. This operation is indicated for acquired defects in the testes and seminal fluid transport ducts (cystic formations, fusion of tumors on the walls of organs).

With the help of surgical equipment, pathological formations are excised, and the seminal tract becomes capable of normal functioning. If there is a genetic abnormality in the structure of the vas deferens and testes, this operation will not be effective. In this case, an operation is prescribed to remove active sperm from the testicle.

Carrying out other operations during the treatment of azoospermia on the genitourinary organs is associated with eliminating the causes of pathology caused by prolonged dysfunction of the system involved in spermatogenesis: urethritis, varicocele, epididymitis, prostatitis and other diseases.

For some couples, surgical treatment of azoospermia is the only chance to become parents. Currently, many modern clinics offer their services to childless couples. For each client, a method of conception is individually selected, taking into account the wishes, health conditions of the patients and carefully checking the causes of azoospermia.

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Drug treatment of reproductive system dysfunction

Drug treatment of pathology is aimed at eliminating the causes of dysfunction of the reproductive system: antibacterial, anti-inflammatory, hormonal therapy. The non-obstructive form of azoospermia is treated with medications.

Based on the condition of the sperm, the doctor prescribes the following drugs to the man to correct spermatogenesis:

Pyrogenal. It has an anti-inflammatory effect and enhances the body's immune properties. Indicated for use in cases of existing inflammatory pathologies of the genitourinary system;
Pentoxifylline. It helps to improve blood circulation in the vessels, enhance sexual functions, stimulating the activity of the reproductive organs;
Actovegin. It is recommended to use injections of the drug to improve metabolic processes. The medication improves the activity of the vascular, muscular, and immune systems. The drug has a positive effect on reproductive abilities and spermatogenesis in combination with other drugs;
Speman. The drug improves sperm motility and promotes the accumulation of semen in the male body;
Klostilbegit. In case of a pathological state of the hormonal system, it is recommended as a means of enhancing the production of male semen by changing the amount of sex hormones;
Endur-E 200. Contains vitamin E and Calcium phosphate. It has an antioxidant effect, stimulates metabolism in cells, and prevents the development of inflammatory processes. Prescribed in complex therapy for the treatment of infertility;
Profertil. A complex of vitamins to improve the reproductive abilities of men. It is a source of L-carnitine, selenium, zinc, folic acid, vitamin E - the main substances for the production and preservation of sperm in the male body.

Forms

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

secretory (non-obstructive). It is associated with the cessation of sperm production by testicular cells;
excretory (obstructive). Caused by obstruction of the vas deferens;
combined (mixed). It combines signs of obstructive and non-obstructive forms;
temporary (functional). It goes away after the influence of the harmful factor ceases and does not require treatment.

Spermogram indicators: normal and pathological

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

Oligozoospermia, in which 1 ml of ejaculate contains less than 20 million living and motile sperm.
Asthenozoospermia. At this stage, the shape and number of sperm in the seminal fluid are normal, but only less than half of them have progressive linear (type I) and progressive non-rectilinear (type II) movement.
Teratozoospermia. The number of sperm in the ejaculate and their motility are normal, but more than 50% of them have pronounced abnormalities in the structure of the tail and head.
Azoospermia. There are no sperm in the seminal fluid.

Traditional treatment to increase spermatogenesis in men

Another way to increase spermatogenesis in a man is to use traditional medicine recipes. For some, this is the last chance to have children, when other treatment methods do not give the desired result. By taking nutritional mixtures and decoctions from beneficial components of natural origin, the body receives the necessary substances for the proper functioning of systems and organs.

Folk remedies for improving sperm quality and quantity

Fruits and vegetables have a positive effect on sperm quality.
Herbal remedies have no side effects (except for allergies to ingredients), you can take manufactured products for a long time, suitable for treating men of any age group. The use of natural raw materials is a good preventive measure for the body.

The following diet will help improve the quality and quantity of sperm:

carrot juice taken daily improves spermatogenesis;
pomegranate can be used throughout the treatment of azoospermia, as a tasty and healthy dessert. The fruit restores blood flow in the pelvic organs, stimulates the genitourinary system to function fully;
hawthorn fruits. Prepare a decoction of them, leave for 24 hours and take half a glass 2-3 times a day;
pumpkin seeds, peeled and dried, but not fried, help improve reproductive function;
a nut cocktail made from walnuts, almond kernels and sesame seeds, seasoned, improves sexual function and sperm quality.

Signs

With azoospermia, a man’s sexual function 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 experience erectile dysfunction, decreased libido, testicular hypoplasia, and an underdeveloped penis.

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

Temporary azoospermia can develop due to frequent visits to saunas and baths, and taking certain medications.

Symptoms of obstructive azoospermia are:

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

Upon palpation, you can notice a slight enlargement of the epididymis, which is explained by the accumulation of sperm in them.

Diagnostics

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

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

TRUS of the prostate;
Doppler ultrasound (USDG) of the blood vessels of the scrotum;
Ultrasound of the scrotum;
determination of antisperm antibodies in the blood;
blood test for hormone levels (FSH, testosterone, LH, estradiol and prolactin).

TRUS of the prostate will help to detect azoospermia in a timely manner.

Taking into account the fact that one of the causes of azoospermia may be sexually transmitted diseases, they must be diagnosed using PCR, RIF, and ELISA methods.

If retrograde ejaculation is suspected, a post-ejaculatory urine test is performed.

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

Symptoms

If we are talking about anejaculation, then the man himself understands perfectly well that something is wrong, since ejaculation does not occur. If there is sperm, ejaculation occurs, sexual life is normal, then the man may not even suspect that there are no sperm in his ejaculate. This can only be detected through special laboratory tests.

Symptoms depend on what type of aspermia the man has and for what reason there is no ejaculate or sperm in it. If the lack of sperm is due to obstruction of the deferent ducts, then the man may experience pain at the moment when ejaculation should occur. In the case of varicocele (dilation of the veins of the spermatic cord), the veins compress the seminiferous tubules, which prevents the release of germ cells.

Congenital pathologies are usually known from childhood. If a man does not have testicles, then there is no place for sperm to be produced, and infertility is unconditional. If the testicles do not descend into the scrotum, sperm production can occur, however, they immediately die. The fact is that male reproductive cells need a temperature of no more than 34 degrees for normal development, so a man’s testicles are located outside the abdominal cavity, brought out. When the testicle is not descended, it is inside the body, and therefore the temperature in it is about 36.6 degrees, which is unacceptable for the sperm, and it dies. Today this problem is easily eliminated surgically.

Symptoms may be completely absent, or manifestations of the disease that caused aspermia may be observed. The only significant manifestation of this condition will be the absence of children in a man if attempts to conceive are made regularly. In any case, you should consult a doctor to determine the cause of infertility.

Treatment

For azoospermia, therapy is aimed at eliminating the cause that caused its occurrence.

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

Azoospermia does not pose a threat to life, but the infertility caused by it negatively affects the psychological state of a man.

Treatment of secretory forms of azoospermia that arise against the background of endocrine disorders requires stimulating or hormone replacement therapy.

If conservative or surgical treatment is ineffective, pregnancy can be achieved in the partner using reproductive technologies. The ICSI technique is most effective in this case. To obtain the sperm necessary for in vitro fertilization of the egg, an aspiration or open biopsy of the tissue of the testicle or its epididymis 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.

The ICSI procedure will help a couple become pregnant if treatment for azospermia is ineffective

Chances of paternity

If, despite the surgical and conservative treatment of azoospermia, the partner still becomes pregnant, assisted reproductive technologies come to the rescue

Surgery to relieve obstruction of the vas deferens helps in approximately 25-50% of cases. With a successful combination of circumstances, a man will be able to become a father. In other cases, surgery may be practiced to extract seminal fluid from the testicle for the purpose of subsequent artificial insemination. For obstructive forms of the disease, this method is 100% effective. The prognosis for paternity with secretory azoospermia is in most cases unfavorable.