Azoospermia

As Azoospermia is the term used to describe the lack of vital or mobile sperm in male ejaculate, which can be attributed to various causes and disorders and which is associated with infertility (sterility) in men. Azoospermia can be temporary or permanent, depending on the underlying causes.

What is azoospermia?

In most cases there is a disruption in the synthesis, development or transport of the sperm from the testes (testis). Spermatogenesis (sperm formation) can be temporarily disrupted due to overheating of the testis (hot baths, tight-fitting underwear).
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Azoospermia is a fertility disorder (fertility disorder) in which the male ejaculate lacks living or mobile sperm (mature sperm cells).

In a healthy man, 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 there are disorders with regard to these three criteria (sperm concentration, mobility and morphology) and the affected man is considered sterile. A general distinction is made between temporary (temporarily occurring) and permanent (permanent) azoospermia.

causes

Azoospermia can be attributed to various causes. In most cases there is a disruption in the synthesis, development or transport of the sperm from the testes (testis). Spermatogenesis (sperm formation) can be temporarily disrupted due to overheating of the testis (hot baths, tight-fitting underwear). The consumption of medication (cimetidine), alcohol, nicotine as well as contact with toxic substances (such as pesticides) or cancer therapy can negatively affect spermatogenesis.

Inflammation of the testicles (orchitis) or epididymis (epidymitis) can also lead to a disruption of spermatogenesis. As a result of epidymitis caused by gonorrhea (gonorrhea), the vas deferens can permanently stick together (occlusive azo-spermia).

In addition, orchitis as a result of post-pubertal mumps infection can trigger permanent azoospermia. In addition, azoospermia can be of genetic origin (Klinefelter syndrome) or, in rarer cases (1-8 percent), can be attributed to hormonal disorders (disorders of sex hormone synthesis).

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Symptoms, ailments & signs

Azoospermia generally causes infertility in a man. This is shown by the fact that the partner cannot become pregnant after sexual intercourse, so that both parties' desire to have children cannot be fulfilled. As a rule, azoospermia does not have any negative effects on the health or life of the person affected, so that there is no reduced life expectancy and in most cases no other complaints and complications.

As a result of azoospermia, those affected and their partners often suffer from depression or other psychological complaints and moods. Tension between the partners can also arise and have a very negative effect on the relationship. If a tumor is responsible for the azoospermia, the further course and the possible complaints and complications depend very much on the exact location and severity of the tumor.

This may also reduce the life expectancy of the person affected. If azoospermia occurs as a result of a high consumption of nicotine or alcohol, the high consumption usually has a very negative effect on the overall health of the person concerned and can also lead to various complaints.

Diagnosis & course

In addition to a thorough medical history, different tests are required to diagnose and clarify the cause of azoospermia. As part of a spermiogram (microscopic sperm analysis), the affected person's ejaculate is analyzed with regard to sperm concentration, mobility and morphology.

If fewer than 20 million sperm per millimeter are found in the ejaculate, oligozoospermia is present, but if no sperm are observed, azoospermia. Additional examinations are required to clarify the cause of azoospermia. This includes genetic and hormonal tests as well as antibody screenings, permeability tests of the vas deferens (patency) and a testicular biopsy.

In the case of temporary azoospermia, normal spermatogenesis can usually take place again after the triggering factors have been eliminated. In the case of permanent azoospermia, which is associated with permanent infertility (sterility), the disease can be psychologically stressful if you are trying to have children, so that psychological care may be necessary.

Complications

In most cases, the patient becomes infertile due to azoospermia. This can lead to severe psychological complaints, so that those affected suffer from depression and reduced self-esteem. Inferiority complexes can also arise from azoospermia.

Not infrequently, the partners are also affected by the disease. However, this does not occur permanently in all cases, so that healing can occur. Unfortunately, a causal treatment of azoospermia is not possible in all cases. If the affected person ingests large amounts of nicotine or alcohol, the disease can possibly be attributed to it.

However, it cannot be guaranteed that azoospermia will go away on its own if withdrawal is carried out. Certain medications can also cause this disorder. Overheating of the testicles can also be responsible for azoospermia, in which case azoospermia is only temporary.

If the transport routes are stuck, they can be solved with the help of an operative intervention. If full 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 can arise, which mainly depend on the spread of the tumor.

When should you go to the doctor?

If the desire to have children remains unfulfilled for a long period despite regular sexual intercourse, a doctor should clarify the causes. The doctor can then determine whether azoospermia is present and, if necessary, initiate appropriate treatment measures. If the prescribed measures and drugs show no effect, this should be discussed with the responsible doctor. Azoospermia may be caused by another cause that cannot be treated.

Sometimes the defect in male sperm cells is genetic or caused by a viral disease. If this is the case, the doctor can refer the affected couple to a specialist in artificial insemination or point out alternative options through which the desire for children can still be fulfilled.

If there are psychological impairments as a result of azoospermia, we recommend talking to a therapist. If there are physical complaints, a doctor must be consulted. If there is basically no desire to have children, azoospermia is not a problem. A doctor's visit is then only necessary to be certain about the infertility.

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Treatment & Therapy

The therapy for azoospermia depends on the respective causes of the disease, although not every azoospermia can be treated successfully.

In almost half of the cases, the causes of azoospermia cannot be conclusively clarified. Spermatogenesis disorders can in some cases be minimized by avoiding alcohol, nicotine or drugs that favor azoospermia.

For hormonal azoospermia, hormone preparations can correct the hormonal imbalances, while antibiotics are usually prescribed for azoospermia due to bacterial infections. If azoospermia is based on excessive heating of the testicles, the causes of the overheating should be avoided, after a certain period of time spermatogenesis normalizes.

If the outgoing transport routes from the testes are stuck together, this disorder can in some cases be removed as part of a surgical procedure. If azoospermia is caused by a spermiogenesis disorder, vital sperm can be taken from the testes in 30-60 percent of cases as part of a biopsy and used for a subsequent artificial insemination. In the case of occlusive azoospermia, the vital sperm can be obtained from the epididymis.

Outlook & forecast

The prognosis in case of azoospermia depends on the cause. In cases where it is genetically determined, there is no possibility of therapy and the man remains sterile. The same applies to cases in which the organs that form germ cells (testes) are severely damaged or degenerated.

In addition, recoverable causes of azoospermia can also be considered. Narrowed or stuck vas deferens can be repaired surgically if necessary. The same applies to obstruction in the testicle itself (near the seminiferous tubules). Hormonal fluctuations that lead to a disruption of semen production can often be treated with hormones.

There are also environmental factors that can limit sperm production to the point that azoospermia occurs. These include alcohol, various medications, nicotine and too much heat. In such cases, normal sperm production can often be achieved through a different lifestyle. The decisive factor here is what is the cause.

Bacterial infections can also hinder sperm production in the seminiferous tubules. In such cases, rapid antibiotic therapy can usually prevent the semen production facilities from being permanently damaged.

If azoospermia cannot be resolved, the man is sterile. However, in cases in which semen is still being formed (but not released), there is still the possibility of artificial insemination by taking the semen directly from the testes.

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prevention

Azoospermia cannot be prevented in every case. However, some causes can be avoided. A healthy diet and lifestyle without alcohol and nicotine increases the quality of sperm. Inflammation of the testicles and epididymis should be avoided by vaccination (mumps) or condoms (gonorrhea).

If therapeutic measures for cancer (chemotherapy, radiation therapy) are necessary, collection and storage of the sperm should be considered in advance, as there is an increased risk of azoospermia.

Aftercare

If the lack of sperm in the ejaculate cannot be finally remedied, aftercare can only show alternatives such as adoption. A doctor usually orders psychotherapy for severe mental illness. This is particularly the case with genetic causes. These can usually not be remedied.

In about half of all cases, those affected can help to boost sperm production. The desire to have children can be realized with a healthy lifestyle. The doctor will inform you about this. Nicotine and alcohol in particular are considered harmful to sperm production. Patients should therefore absolutely avoid these addictive substances.

A minimum of sporting activity is also considered beneficial. Sometimes certain drugs prevent fertile ejaculate as well. These are then to be discontinued or replaced. Finding a cause for the lack of sperm production can be time consuming. Regular follow-up examinations are also necessary after the causes have been found.

The conversation between doctor and patient is of great importance. The person concerned has to take a sample of their sperm several times, which is then analyzed in detail. Further examinations such as genetic tests, hormone analyzes and imaging procedures are sometimes followed. Azoospermia does not lead to any life-threatening complications.

You can do that yourself

Azoospermia, in which the man's ejaculate does not contain any sperm, develops completely without symptoms and is usually only recognized when there is a desire to have children and the causes of why the woman does not become pregnant are analyzed.

Special behavior in everyday life is therefore not required. Self-help can only be helpful and effective in certain cases. A very simple self-help is to protect the testicles from excessive temperature. A permanently increased temperature of the testicles, which can already result from unsuitable, tight clothing, leads to reversible azoospermia, which can be remedied by choosing the appropriate clothing. No data are available on the frequency of this form of azoospermia. It is probably a rather rare form.

If the disease is caused by a hormonal disorder caused, for example, by an undesirable side effect of the medication, stopping the medication or replacing it with another drug can cure the azoospermia. Medicines 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 everyday life is necessary and there are no known self-help measures that could solve the problem.