When a man has no sperm cell found in the ejaculate, he is said to be suffering from azoospermia. It affects about 1 in 100 men, but more common in up to 1 in 10 men with fertility problems. It is an uncommon but severe form of male infertility. You might assume that men with azoospermia can’t have genetic children, but this isn’t necessarily so. With the help of Assisted reproductive Technology (ART), some men with azoospermiacan have genetic offspring.
Receiving a diagnosis of azoospermia can be emotionally difficult. Some men may feel ashamed or embarrassed about their condition, and therefore not tell their primary care provider about their male infertility diagnosis. However, because of the increased risk of overall health problems, it is important to be honest with your doctor and let them know.
Azoospermia is a severe cause of male infertility, but there are possible treatment options. Some men may still be able to have a genetic child after a diagnosis of azoospermia, while others may need to consider using a sperm donor or looking at adoption, foster parenting, or living a childfree life.
Normally, a man’s fertility declines as he ages, but the current rate of decline as a result of poor sperm parameters is significant. With 40 percent of fertility issues being male related, male infertility is becoming more predominant as a result of men being diagnosed with low sperm count and poor motility. Men are being identified as the reason why couples are not getting pregnant.
In Nigeria, 25 percent of couples are infertile, and that half of the causes are due to male factor issues. A “normal” sperm count will have an overall volume of at least 1.5ml, a density of more than 15 million sperm per ml and motility of at least 40 per cent and a proportion of normal forms of three to four per cent or greater.
That is not to say that couples with a lower sperm count won’t get pregnant – after all, it just takes one sperm – just that the chances of pregnancy are reduced by low sperm counts or sperm that do not swim well. The complete absence of sperm in the ejaculate (azoospermia) can be either because of a blockage in the organ that stores and nourishes sperm as they mature (epididymis) or in the long tube that transports sperm cells from the epididymis to the testicles (vas deferens), or a problem with the actual production of sperm in the testicles.
There are two ways to talk about azoospermia: in terms of at what point in the reproductive cycle things go wrong, or regarding whether it’s caused by a blockage or not. If talking about where in the reproductive cycle things go wrong, the most common way to talk about azoospermia is in reference to whether it’s caused by blockage or not. Your doctor may tell you that you have obstructive azoospermia or nonobstructiveazoospermia.
Obstructive azoospermia is when the sperm can’t get into the semen or ejaculate due to a blockage or issue with ejaculation. Non-obstructive azoospermia is when the cause is primarily hormonal or an issue with the sperm development. Azoospermiaitself—a lack of sperm in the semen—doesn’t have any specific symptoms.
There are some genetic causes or congenital anomalies that can lead to obstructive azoospermia. Some men are born with a blockage in the epididymis or ejaculatory duct, while others may be missing the vas deferens on one or both sides of the reproductive tract. The causes of these anomalies are not always known.
Semen analysis is the only way to know if your sperm count is abnormal or zero. If your first semen analysis comes back with zero sperm, your doctor will have you repeat the test a few months later.
Azoospermia is diagnosed after two separate semen analyses are completed, and no sperm are found in the semen samples. After azoospermia is diagnosed, the next step is to attempt to identity the cause of the problem. Your treatment plan will be based on whatever is the suspected cause for the zero sperm count.
Fertility treatment will depend on the specific kind of azoospermia and the cause of the problem. Also, the female partner’s fertility situation will also determine treatment choices.
Testicular sperm extraction, or TESE, may be used to extract sperm cells directly from the testes. You will receive sedation or general anesthesia before the procedure. The doctor will make a small incision in the scrotum and extract tissue from your testes. That tissue will be examined for sperm cells and, if not being used right away, cryopreserved.
TESE can be used when obstructive azoospermia is blocking sperm cells from getting into the ejaculate. TESE may also be used in cases of nonobstructive azoospermia to look for some usable, mature sperm cells that may be being produced, but not enough to get into the semen.
Sperm cells extracted via TESE can only be used with IVF andICSI— Intracytoplasmic Sperm Injection—is when a single sperm cell is directly injected into an egg. If successful fertilization takes place (even if the sperm cell was forced into the egg), then the resulting embryo is transferred to the woman’s uterus.
Genetic counseling is frequently recommended if there is any possibility that the azoospermia is linked to a congenital condition. It’s also recommended if IVF with ICSI is being used.Some conditions can only be passed on if both genetic parents are carriers.
This is why both partners may be tested, and not just the man. If you discover you are at risk for passing on an inheritable disease, a possible option is to utilize preimplantation genetic diagnosis or PGD, that allows doctors to screen embryos for some genetic conditions. Then, the healthier embryos can be transferred.
Another possible fertility treatment option is to use a sperm donor. A sperm donor may be chosen because getting sperm isn’t an option (for example, testicular sperm extraction is not always successful or possible), or this can be a first-line choice after diagnosis because other treatment options are too expensive.
Some men choose to go with a sperm donor because they don’t want to risk passing along male infertility to their child (a possibility in some cases).
Another possible option is using an embryo donor. The donated embryo would be transferred to the woman’s uterus (or a surrogate.) If you choose to use an embryo donor, neither intended parent would be genetically related to the child.
Abayomi Ajayi
MD/CEO Nordica Fertility Centre
