Azoospermia, commonly referred to as zero sperm count, is described as the absence of measurable sperm in the ejaculate (semen). Depending on the cause, it can be classified into two types: secretory or non-obstructive azoospermia, and obstructive azoospermia.
The chances of achieving pregnancy with azoospermia are dependent on the type, too. If it is obstructive azoospermia, sperm can be collected with a testicular biopsy to be used for ICSI. However, in cases of secretory azoospermia, retrieving sperm is more complicated, and the man might need to use donor sperm to have a baby.
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What is azoospermia and how is it diagnosed?
Azoospermia is a sperm disorder characterized by the total absence of spermatozoa after ejaculation. In the absence of spermatozoa, a natural pregnancy is not possible.
Approximately 3% to 10% of male infertility cases are caused by azoospermia.
Azoospermia is a disorder that has no noticeable symptoms for men, so for its diagnosis, it is necessary to perform a spermogram. This test consists of collecting a sample of the ejaculate after masturbation and with a period of abstinence of 3-5 days. The semen sample obtained will be examined in the laboratory to check, among other things, the concentration and motility of the spermatozoa.
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When the semen analysis report is available, sperm count is compared with the diagnostic reference values provided by the World Health Organization (WHO):
- Azoospermia
- No sperm in the semen.
- Cryptozoospermia
- Less than 100,000 sperm per milliliter of semen.
- Oligozoospermia
- Less than 15 M/ml.
- Normozoospermia
- All sperm parameters are normal.
Azoospermia is a medical condition that has no noticeable symptoms. This is the reason why, for its diagnosis, it is necessary to perform a semen analysis.
Determining FSH hormone levels might be useful as well. This hormone is produced by the brain and is responsible for spermatogenesis (production of spermatozoa) in the testes. If FSH levels are too high, it translates into a decreased level or the absence of stem cells in the sperm sample. A testosterone and fructose test is advisable, too.
What are the causes of azoospermia?
The fact that the man has no sperm in the semen can be due to two main causes:
- Secretory or non-obstructive azoospermia
- The testes are incapable of producing sperm.
- Obstructive azoospermia
- Sperm are produced, but the cannot be expelled with the ejaculate due to an obstruction in the ejaculatory ducts.
Carrying out a testicular biopsy is necessary in order to determine the type of azoospermia. It consists of taking a tissue sample from each testicle in order to check if it produces sperm (obstructive azoospermia) or not (secreting azoospermia). Getting your hormones tested might also help to determine the type of azoospermia. If the levels of hormones that play a role in spermatogenesis are altered, the diagnosis will be secretory azoospermia. However, this method is not so accurate as a testicular biopsy to determine whether a few sperms could be retrieved and used during fertility treatment.
Secretory azoospermia.
Secreting or non-obstructive azoospermia is the most severe, frequent type of azoospermia, being present in 70% of cases. It can be congenital (condition existing at birth) or acquired (due to an illness or treatment with toxic medicines). These are the most common causes:
- Undescended testicles
- Exposure to toxic substances: drugs, radiotherapy, and chemotherapy.
- Genetic disorder