Azoospermia

Azoospermia means that there are no sperms. This can be due to 2 reasons.

1. Obstructive azoospermia – There is normal sperm production but no sperms in the ejaculate as the duct is blocked

2. Non Obstructive azoospermia – The sperm production in testis is absent or minimal . Hence there is no sperm in ejaculate

• It is a blockage which could be anywhere in the vas. 
• Azoospermia could be because of surgical closure called vasectomy. 
• The vas could be absent by birth as in cystic fibrosis or obstruction may occur because of infection. 
• It is to be understood that in all these cases sperm production is occurring in a normal way. However the sperm is not present in ejaculate. 

There are two modes of treatment:

Either a surgical repair of duct is done to open it. This may often not be successful in cases of infection where duct is badly destroyed. It may also not be an option where there is absence of duct by birth. 

Another option is to retrieve the sperm surgically from the testis and do an intracytoplasmic sperm injection (ICSI). This entails that the female partner is stimulated with injections and eggs are removed by a transvaginal needle. These eggs are then injected with testicular sperm to yield an embryo which is deposited in the uterus. This process is in Vitro Fertilization (IVF).

• Commonly azoospermia can occur with testosterone injections which are used for muscle building. 
• Narcotics could also cause a decreased sperm production. 
• There could be genetic causes like in Klienfelter syndrome 
• Radiotherapy and chemotherapy could lead to azoospermia. 
• Sometimes local causes like a large varicocele or trauma to testis can cause it. 
• Causes in the brain like tumours can lead to decreased stimulus for sperm production. Undescended testis by birth can be a cause even after surgical correction.

Life style change is recommended specially weight loss and cessation of smoking. 

Any drug causing azoospermia is to be stopped. 

Hormonal therapy maybe needed for sperm production in these azoospermic men. 

There are injections in the form of hCG and FSH. They stimulate the brain to in turn release hormones which cause sperm production. 

Sometimes surgical therapy for varicocele is required. 

Finally if nothing works surgical sperm retrieval for azoospermia is recommended.

There are various methods of surgical sperm retrieval

1. TESA: Testicular sperm aspiration: Done by needle. The sperm is aspirated
2. PESA: Per cutaneous epidydimal sperm aspiration
3. Micro Tese: In non obstructive azoospermia the testis are opened under the microscope and enlarged image identifies the a few dilated tubules with sperms which otherwise would not have been visible.

The sperms retrieved cannot naturally fertilize an egg and these patients require an IVF- ICSI.