Azoospermia is the absence of vital or motile sperm in the male ejaculate, which can be attributed to various causes and disorders and is associated with male infertility (infertility). Azoospermia may be temporary or permanent depending on the underlying causes.
What is azoospermia?
Azoospermia is the term used to describe a fertility (fertility) disorder in which the male ejaculate lacks live or motile sperm (mature sperm cells). In a healthy male, the ejaculate has more than twenty million mature sperm cells per millimeter (sperm concentration), with at least half of the sperm having normal sperm mobility (motility) and sperm morphology (appearance, shape). In azoospermia, disorders are present with respect to these three criteria (sperm concentration, mobility and sperm morphology) and the affected man is considered infertile. Generally, a distinction is made between temporary (intermittent) and permanent (permanent) azoospermia.
Causes
Azoospermia can be attributed to a variety of causes. In most cases, there is a disturbance in the synthesis, development, or derivative transport of sperm from the testes (testis). Thus, spermatogenesis (sperm formation) may be temporarily disturbed due to overheating of the testis (hot baths, tight-fitting underwear). The consumption of medications (cimetidine), alcohol, nicotine, as well as contact with toxic substances (such as pesticides) or cancer therapy can also negatively affect spermatogenesis. Inflammation of the testicles (orchitis) or epididymis (epidymitis) can also lead to disruption of spermatogenesis. As a result of gonorrhea (gonorrhea) related epidymitis, the vas deferens can become permanently stuck (occlusive azoospermia). Furthermore, orchitis resulting from postpubertal mumps infection may cause permanent azoospermia. In addition, azoospermia may be genetic (Klinefelter syndrome) or, in rarer cases (1-8 percent), may be due to hormonal disorders (disorders of sex hormone synthesis).
Symptoms, complaints, and signs
Azoospermia generally results in infertility in a male. This is manifested by the inability of the female partner to become pregnant after sexual intercourse, so that both parties’ desire to have a child cannot be fulfilled as a result. As a rule, however, azoospermia does not have any further negative effect on the health or life of the affected person, so that there is no reduced life expectancy and in most cases no other complaints or complications. However, affected individuals and their partners often suffer from depression or other psychological complaints and upsets as a result of azoospermia. Tension between the partners can also occur and have a very negative effect on the relationship. If a tumor is responsible for azoospermia, the further course and the possible complaints and complications depend very much on the exact position and extent of the tumor. Possibly, the life expectancy of the affected person is then also reduced. If azoospermia occurs due to a high consumption of nicotine or alcohol, then the high consumption usually has a very negative effect on the overall health of the affected person and can thereby equally lead to various complaints.
Diagnosis and course
For the diagnosis and clarification of the cause of azoospermia, various tests are required in addition to a thorough medical history. In the course of a spermiogram (microscopic sperm analysis), the ejaculate of the affected person is analyzed with regard to sperm concentration, mobility and morphology. If less than 20 million sperm per millimeter are found in the ejaculate, oligozoospermia is present; if, on the other hand, no sperm are observed, azoospermia is present. Additional tests are required to determine the cause of azoospermia. These include genetic and hormonal testing as well as antibody screening, permeability testing of the vas deferens (patency), and a testicular biopsy. In the case of temporary azoospermia, normal spermatogenesis can usually resume once the triggering factors have been eliminated.In cases of permanent azoospermia associated with permanent infertility (infertility), the condition can be psychologically stressful if a child is desired, and psychological care may be required.
Complications
In most cases, azoospermia results in patient infertility. In the process, this can lead to severe psychological discomfort, causing those affected to suffer from depression and lowered self-esteem. Inferiority complexes can also result from azoospermia. It is not uncommon for partners to be affected by the disease as well. However, it does not occur permanently in all cases, so a cure may occur. Unfortunately, causal treatment of azoospermia is not possible in all cases. If the affected person takes high amounts of nicotine or alcohol, the disease can possibly be attributed to this. However, it cannot be guaranteed that azoospermia will disappear on its own if withdrawal is carried out. Likewise, certain medications can cause this disorder. Overheating of the testicles can also be responsible for azoospermia, although in this case the azoospermia is only temporary. If the transport pathways are stuck, they can be solved with the help of surgical intervention. If complete treatment is not possible, sperm can also be surgically ingested for fertilization. If the cause of azoospermia is a tumor, it must be treated and removed. Different complications may occur, depending mainly on the spread of the tumor.
When should you go to the doctor?
If a desire to have children remains unfulfilled for a long period of time despite regular sexual intercourse, a doctor should clarify the causes. The physician can then determine whether azoospermia is present and, if necessary, initiate the appropriate treatment measures. If the prescribed measures and medicines do not show any effect, this should be discussed with the doctor in charge. It is possible that azoospermia is due to another cause that cannot be treated. Sometimes the failure of male sperm cells is genetic or was caused by a viral disease. If this is the case, the doctor can refer the affected couple to a specialist for artificial insemination or show alternative possibilities through which the desire for a child can still be fulfilled. If azoospermia leads to psychological problems, it is advisable to talk to a therapist. If there are also physical complaints, a doctor should be consulted. If there is basically no desire to have children, azoospermia is unproblematic. A visit to the doctor is then only necessary to get certainty about the infertility.
Treatment and therapy
The therapy of azoospermia depends on the particular causes of the disease, and not every azoospermia can be treated successfully. Moreover, in nearly half of cases, the causes of azoospermia cannot be conclusively determined. Spermatogenesis disorders can be minimized in some cases by abstaining from alcohol, nicotine or azoospermia-promoting drugs. In the case of azoospermia that is hormonal, hormonal preparations can compensate for hormonal imbalances, while antibiotics are usually prescribed for azoospermia resulting from bacterial infections. If azoospermia is due to excessive heating of the testicles, the causes of overheating should be avoided; after a certain period of time, spermatogenesis normalizes. If the efferent transport pathways from the testicles are stuck, in some cases this disorder can be eliminated within the framework of a surgical intervention. If azoospermia is due to a spermiogenesis disorder, in 30-60 percent of cases vital sperm can be removed from the testicles in a biopsy and used for subsequent artificial insemination. In cases of occlusive azoospermia, the vital sperm can be obtained from the epididymis.
Prospect and prognosis
The prognosis in cases of azoospermia depends on the cause. Thus, in cases in which it is genetic, there is no possibility of treatment and the man remains infertile. The same applies to cases in which the germ cell producing organs (testicles) are severely damaged or degenerated. In addition, remediable causes of azoospermia can still be considered.Narrowed or obstructed vas deferens can be surgically repaired if necessary. The same applies to obstruction in the testis itself (near the seminiferous tubules). Hormonal fluctuations that lead to sperm production disorders can often be treated by hormone administration. There are also environmental factors that can limit sperm production to the point where azoospermia occurs. These include alcohol, various medications, nicotine or too much heat. In such cases, normal sperm production can often be achieved through a different lifestyle. The decisive factor here is what is causative. Bacterial infections can also hinder sperm production in the seminiferous tubules. In such cases, prompt antibiotic therapy can usually prevent permanent damage to the sperm production sites. If azoospermia cannot be corrected, the man is infertile. However, in cases in which sperm are still produced (but just not released), there is nevertheless the possibility of artificial insemination by direct extraction of the sperm from the testes.
Prevention
Azoospermia cannot be prevented in every case. However, some causes can be prevented. For example, a healthy diet and lifestyle, avoiding alcohol and nicotine, increases sperm quality. Inflammation of the testicles and epididymis should be avoided by vaccination (mumps) or condoms (gonorrhea). If therapeutic measures for cancer are necessary (chemotherapy, radiotherapy), sperm collection and storage should be considered in advance, as there is an increased risk of azoospermia.
Follow-up
If the lack of sperm in the ejaculate cannot be conclusively corrected, follow-up care can only point to alternatives such as adoption. A doctor usually orders psychotherapy in the case of a major mental condition. This is especially the case with genetic causes. These usually cannot be remedied. In about half of all cases, those affected can make a contribution to boosting sperm production. The desire to have children can be realized with a healthy lifestyle. The doctor will provide information on this. Nicotine and alcohol in particular are considered harmful to sperm production. Patients should therefore avoid these addictive substances at all costs. A minimum of sporting activity is also considered beneficial. Sometimes certain medications also prevent a fertile ejaculate. These should then be discontinued or replaced. The search for a cause of the lack of sperm production can be time-consuming. Even after causes have been found, regular follow-up examinations are necessary. The discussion between doctor and patient is of great importance. The affected person must provide a sample of his sperm several times, which is then analyzed in detail. Further examinations such as genetic tests, hormone analyses as well as imaging procedures sometimes follow. Azoospermia does not lead to life-threatening complications.
What you can do yourself
Azoospermia, in which the man’s ejaculate does not contain sperm, develops completely without symptoms and is usually detected only when there is a desire to have children and the causes are analyzed why the woman does not become pregnant. Therefore, special behavior in everyday life is not necessary. Self-help can be helpful and purposeful only in certain cases. A very simple self-help is to protect the testicles from too high temperature. A permanently increased temperature of the testicles, which can already be caused by unsuitable, tight clothing, leads to reversible azoospermia, which can be remedied by appropriate choice of clothing. No data are available on the incidence of this form of azoospermia. It is probably a rather rare form. If the condition is caused by a hormonal disorder, for example, triggered by an undesirable side effect of the medication, discontinuation of the medication or its substitution with another preparation may cure azoospermia. Drugs that can cause such side effects include certain neuroleptics and antidepressants. In these cases, too, self-help together with medical advice can overcome reversible azoospermia. If there is a (physical) blockage of the vas deferens, no adjustment in daily life is required, and there is no known self-help measure that could correct the problem.
