Infertility is a difficult diagnosis but for those dealing with compromised fertility, you aren’t alone. According to infertility statistics from the Centers for Disease Control, one in five women of childbearing years experience difficulty conceiving after one year of trying. Of all infertility cases worldwide male factor infertility accounts for up to 50%.
The causes of male factor infertility, defined as an inability for a male to bring about pregnancy in a female, vary in a few different ways. The most common cause of male infertility relates to sperm disorders. Healthy, viable sperm is necessary to fertilization. Some men don’t make enough sperm or some men make sperm that has motility (movement) issues, and misshapen sperm may also be an issue for some men. Occasionally a man receives a diagnosis of a condition called Azoospermia.
What is Azoospermia?
Azoospermia is a condition of male infertility characterized by the total absence of sperm in the semen. It’s rare, affecting only about 1% of men, but it is at the root of roughly 10%-15% of infertility causes. Azoospermia results from a blockage which prevents sperm from entering the ejaculate, or non-obstructive and due to decreased sperm production in the testes.
Causes of Azoospermia
The absence of sperm has many potential causes. These range from genetic conditions affecting the the Y chromosome to treatment for cancer and use of recreational drugs. There are three basic types of azoospermia, and each type has its own associated causes and conditions. They are as follows:
This form of non-obstructive azoospermia often links back to genetic disorders. For instance Kallmann Syndrome inhibits the body from producing an essential gonadaotropin-releasing hormone, impacting sperm production.
Damage to the pituitary gland or the hypothalamus from brain issues may cause pre-testicular azoospermia as well. Certain medication and treatment for cancer using radiation also contribute to this type of azoospermia.
Another type of azoospermia that is non-obstructive, testicular azoospermia may occur due to the following.
- Cryptorchidism or testicles that fail to drop.
- Anorchia or the absence of testicles.
- The failure of the testicles production of mature sperm, spermatogenic arrest.
- Testicles that fail to produce sperm, also called sertoli cell-only syndrome.
- Klinefelter’s Syndrome, a chromosomal condition resulting from the male being born with XXY instead of XY chromosomes.
Some additional causes of testicular azoospermia are:
- Prior surgery
- Medication reaction
- Contracting the mumps late in puberty
- Wide or inflamed veins in the testicles also called a Varicocele
Obstruction in any area that stores or produces sperm may result in post-testicular azoospermia. The obstruction could exist in the epididymis, a narrow tube connected to the testicles and that stores sperm until maturation, or in the vas deferens, a duct that moves sperm from the verticals to the urethra.
This obstructive type of azoospermia is present is about 40% of the cases. Congenital causes such as CBAVD, congenital bilateral absence of the vas deferens are a common obstruction. The genetic condition, CBAVD results when there are missing the vas deferens ducts that carry the sperm from the testes. Commonly this condition presents in cystic fibrosis patients.
Post-testicular azoospermia also results from injury, cysts, infections, current or previous, or a vasectomy.
Symptoms of Azoospermia
In most cases there are no notable symptoms of this condition other than the failure to conceive. The underlying causes of azoospermia ma present with the following symptoms:
- Erectile dysfunction
- Testicular lump, swelling or pain
- Decreased facial or body hair
- Low libido (sex drive)
Testing for azoospermia begins with a thorough medical history, physical exam and a semen analysis. During your medical history your doctor inquires about the following:
- Childhood illnesses
- Family history (Including whether or not your immediate relatives had fertility issues or cystic fibrosis.)
- Sexual history and if you’ve had any STIs (sexual transmitted infections)
- Exposure to toxins, radiation or chemotherapy
- Urinary tract infections
- Exposure to intense heat
- Surgeries of the reproductive or pelvic region
- Medications you previously or currently take
- Recreational use of drugs and alcohol
In addition to these tests, your physician may also include:
- Ultrasound of the reproductive tract
- Blood tests to assess hormone levels and genetic conditions
- Imaging of the brain to assess the hypothalamus and pituitary gland health
- Examination of sperm production through a biopsy
Treatment for Azoospermia
Obviously your treatment options depend on your diagnosis. If an obstruction causes our azoospermia, your doctor may perform surgery connecting or reconstructing tubes or ducts preventing your sperm from flowing. Hormone treatments and certain medications help balance your hormones should that be the cause of your azoospermia.
Non-obstructive azoospermia doesn’t always respond to treatment. In that case pregnancy isn’t necessarily ruled out. Conception through IVF or ICSI (intracytoplasmic sperm injection) makes it possible for pregnancy with a biological child.
Your physician extracts sperm directly from your testicles using a very small needle. Your doctor performs this procedure during a biopsy if necessary. You can have this procedure even if you have very few sperm. Of course you need genetic counseling in order to assess the root cause and whether or not your condition affects our biological child.
Get Help Today
For more on male factor infertility, including azoospermia, contact LA IVF. We understand our goal of growing your family and help you every step mom the way.