Azoospermia is the condition describing a complete lack of sperm cells in the ejaculate. There is a 1% incidence in all men and 10-15% incidence in infertile men. Azoospermia is divided into three categories: pre-testicular, testicular and post testicular. Pre testicular azoospermia usually has endocrinological causes which affect spermatogenesis. Hypogonadotrophic hypogonadism can cause azoospermia but can be treated with hormone replacement therapy. Primary testicular failure applies to problems relating to the testicles specifically. Post testicular problems usually relate to ejaculation dysfunction or obstruction in the ducts. Incidences of this nature are found in 40% of the cases.
Pre and post testicular abnormalities are treatable. Testicular failure is irreversible. Varicocele is excluded from this group however. Another way of categorizing azoospermia is by dividing up groups based on whether or not the ducts are blocked. Obstructive azoospermia: Although there is sperm production in the testes, the ducts which move the sperm are blocked (e.g. due to a previous infection). These patients can have cells removed from their testes or surrounding ducts with the help of an injector and fine needle. Non-Obstructive Azoospermia: In this case there is no sperm production, or tissue biopsy indicates immature cells do not complete the maturation process. This type of azoospermia maybe due to several reasons: undescended testicles, genetic or environmental reasons are some. Doctors take small samples of tissue from the testicles by making small incisions or using a fine needle to aspirate. The samples are then examined for sperm cells.
- TESA: TEsticular Sperm Aspiration
- TESE: TEsticular Sperm Ekstraction
- PESA: PErcutaneousr Sperm Aspiration
- MESA: Microsurgical Epydydimal Sperm Aspiration
Normal semen analysis values
Volume: between 1.5-5ml
Concentration: 15 million /ml
Motility: over 50%.
Morphology: over 30% according to WHO or 14% and over according to Kruger’s Strict Criteria.
Progressive motile: must be over 20 %
Varicocele and Azoospermia:
Some studies suggest that azoospermic men with clinical type varicocele might benefit from varicocele surgery. According to research results 50% of patients show resumption of spermatogenesis and 20% report spontaneous pregnancy. Testicular biopsy done before or during surgery will give the doctors an idea of the sucess of the procedure. Men who have immature sperm cells may start sperm production but patients who had no spermatogenesis, previously, do not start producing sperm after varicocele treatment. Consequently azoospermic patients with varicocele who have begun infertility treatment, and have sperm cells found in testicular biopsy, should be treated for varicocele even if they get pregnant through IVF.