Azoospermia (No Sperm Count) – Causes, Symptoms, and Treatment
If you and your partner are having unprotected sex for a while now (a year, to be precise) in order to conceive, and not getting the ‘good news’, chances are that you could be infertile. For a couple who is eager to have a baby, hearing that they are infertile can obviously be disheartening and intimidating. After trying to conceive for a year now, you may suspect that you could have infertility issues and may wonder what you should do next. The first thing that you need to know is that you’re not alone. Many couples face infertility issues and half of these cases can be attributed to male infertility, and one of the possible reasons for the same can be azoospermia.
In this article, we will tell you about this infertility condition that affects men, its types, causes, treatment, and more.
What Is Azoospermia?
Azoospermia is a male infertility condition where there is no sperm found in the ejaculate or the semen after the orgasm. Though it is a very rare condition, however, zero sperm count or azoospermia is a very severe form of infertility condition that may affect 1 in 10 men experiencing male infertility. Men who suffer from this condition have usually normal semen volumes or fluids and they may not be aware until or unless they get themselves tested. If your spouse has infertility issues, azoospermia could be a cause for the same. Nevertheless, there are treatment options available that may help him father your child.
Types of Azoospermia
The types of azoospermia can be classified in two ways. Either by determining at what juncture in the reproductive cycle the glitches occurred or has it occurred as a result of blockage or not. Well, if we talk about the reproductive cycle, azoospermia can be classified into three parts:
1. Pre-testicular azoospermia
If your spouse suffers from this condition, it means that the testicles are normal but his brain may not be able to send signals to produce healthy sperms. This occurs when the endocrine glands present in the brain are unable to guide the body to assist healthy sperm development.
2. Testicular azoospermia
In this condition, infertility occurs because of the problem present in the testicles. The testes may not respond to the hormones released by the brain for healthy sperm development. Testicular azoospermia may also occur if there is some problem in the cellular development of sperm.
3. Post-testicular azoospermia
In this condition, the testicles produce normal sperm but either some kind of blockage or ejaculation dysfunction hampers it from getting out.
The above-mentioned are the types of azoospermia according to the reproductive cycle. However, this condition is commonly characterized by a blockage or no blockage. In this context, your doctor will tell you whether your spouse has obstructive (which happens when the sperm cannot get into the semen because of issues with ejaculation or blockage) or non-obstructive azoospermia (which occurs either due to hormonal issues or some kind of issues with healthy sperm development).
Causes of Azoospermia
Mentioned below are the possible causes of obstructive and non-obstructive azoospermia:
Obstructive azoospermia may occur due to any of the following reasons:
1. Infection or inflammation in the male reproductive tract
Sometimes infections or inflammation that may be present due to untreated sexual disease or non-sexually transmitted diseases such as childhood diseases (mumps, etc.) may lead to this infertility condition.
2. Congenital anomaly
Sometimes genetic reasons such as congenital anomalies may lead to blockage in one or both sides of the male reproductive tracts.
3. Retrograde ejaculation
Sometimes no or low sperm count can be a result of retrograde ejaculation. In this condition, the semen moves backwards to the bladder rather than getting out of the urethra.
4. Surgery or Trauma
A surgery that may have been performed in the male reproductive part may lead to unintentional injury or scarring, which may become a cause of obstructive azoospermia. Also, certain traumas to the male reproductive parts may lead to scar tissue, blockage or damage to the epididymis or ejaculatory duct leading to this condition.
Here are some causes of non-obstructive azoospermia:
1. Hormonal imbalance
A disrupted hormonal level in the body can lead to non-obstructive azoospermia. A right hormonal balance is important to healthy sperm production.
2. Toxin exposure, radiation, or chemotherapy
Any kind of exposure to toxins may lead to permanent or temporary non-obstructive azoospermia. Also, if any direct radiation therapy has been performed to cure any kind of cancer treatment, this condition may occur. Again, chemotherapy may also lead to this condition, however, it may or may not get better post-therapy.
3. Chromosomal or genetic anomalies
Non-obstructive azoospermia can be caused by genetic or chromosomal anomalies such as Kallmann syndrome, Klinefelter syndrome, etc.
4. Side effects of certain medication
Certain medicines may cause temporary or long-term side effects that can lead to this condition. Some of these drugs are Cyclophosphamide, Chlorambucil, Colchicine, etc.
Signs of Azoospermia
The signs and symptoms of azoospermia may go unnoticed until a couple fails to get pregnant even after having unprotected sex for more than a year. Azoospermia as such has no prominent or evident symptoms, however, infertility can be one of the indications. In some cases of azoospermia, there can be some noticeable symptoms, such as:
- Pain while urinating
- Cloudy urine after sexual intercourse
- Low ejaculation fluid or having a dry orgasm
- Pain in the pelvic region
- Undescended or small testicles
- Swollen testicles
- Experiencing low sex drive
- Abnormal or delayed puberty
- Lesser male hair growth
- Difficulty in erection or ejaculation
- Muscle loss
- Smaller penis
There is a likelihood that a man may have none of the above-mentioned symptoms but he may still suffer from azoospermia.
How Is Azoospermia Diagnosed?
If your doctor suspects that a person has azoospermia, he may be asked to get the semen analysis done. Your spouse will have to deposit the semen sample in a cup, which will then be sent to the lab for testing. If there is no sperm count present in the sample, there is a strong possibility that he may have azoospermia. However, the doctor may like to repeat the test after a couple of months to be sure that there is no sperm count. Apart from testing the semen samples, the doctor may also like to conduct a few more tests that may include the following:
- Conducting a physical exam to check the testicles
- Conducting some blood tests to establish FSH and testosterone levels. The doctor may also check estrogen and prolactin levels
- Checking the medical history to know of any childhood illnesses or any previous history of sexually transmitted diseases
- Conducting TRUS or Transrectal ultrasound to check for any blockage in the reproductive tract
- Conducting Karyotype testing and in some cases, even genetic testing to establish any inheritable genetic condition that may have led to congenital azoospermia
- In some cases, the doctor may recommend getting a testicular biopsy
Your spouse may not be required to undergo any invasive tests such as testicular biopsy if other above-mentioned procedures or tests may have helped in diagnosing the condition. After the diagnosis is complete, the doctor will suggest the correct treatment option based on the cause of the condition.
The treatment or azoospermia cure majorly depends on the cause of the condition. Some cases of azoospermia respond well to medication such as retrograde ejaculation. Apart from taking medicines for azoospermia, hormonal therapies sometimes are fruitful in stimulating sperm development.
If your spouse is suffering from obstructive azoospermia, the doctor may suggest microsurgical treatment options to correct severed or blocked connections. Surgeries are often helpful in curing retrograde ejaculation or even for treating or removing varicocele.
In the case of retrograde ejaculation, if treatment is not possible, the doctor may suggest extracting sperm from post-ejaculate urine and according to the number of sperms available or whether or not there are any female fertility problems, the doctor may suggest IVF or IUI treatment.
Natural Remedies for Azoospermia
Men with low sperm count can also try some natural remedies such as making dietary changes or consuming certain herbs, however, these kinds of natural remedies may not work that well in case of azoospermia. Here are some of the things that men can try:
- Eat a well-balanced and nutritious diet that can help in the production of sperm.
- Exercise on a regular basis, doing so may help in boosting the testosterone levels.
- Practice mindfulness by doing meditation and yoga. Doing so can help in keeping a tab on cortisol, a stress hormone, which is responsible for impacting the testosterone production.
- Consider some supplements or herbs that are known to promote male fertility such as horse chestnut, zinc, black seed, folic acid, etc.
If azoospermia has occurred by taking certain kinds of medication, injury, or other such reasons, the good news is that there are tips that may help in preventing it. Here are some tips that can come handy:
- Limiting exposure to any kind of radiations.
- Staying away from activities or sports that may harm or injure the testicles or reproductive organs.
- Refraining from doing activities that may lead to exposing testes to high temperatures such as steam baths and saunas.
Azoospermia is a rare male infertility condition but if your partner is diagnosed with this condition, do not lose hope. It is still possible for him to be a biological father. However, it is imperative to understand the cause of the condition. Once the doctor establishes the cause, measures can be taken to cure the problem or come up with a correct treatment plan. On the other hand, the procedures of IUI or IVF have been helpful in getting pregnant. You can always consider foster parenting or adopting a child if you wish to be parents.
Coping with the condition and weighing your options can be overwhelming for some couples. You should get in touch with a professional counsellor and seek support from family and friends to sail smoothly through this phase!