Male infertility: Causes, treatment of obstructive, non-obstructive Azoospermia | Health


Infertility is not a problem experienced by women alone but by men too, which is not often talked about where genetic reasons apart, modern life and its stresses are responsible for male infertility and around 1% of the male population and around 15% in infertile men suffer from Azoospermia, which is a condition in which there are no sperms in the semen. Sometimes the male spouse is unwilling to undertake a fertility evaluation because he is not ready to accept this however, male infertility can be brought on by a number of things, such as hormonal imbalances, physical problems, semen infections, lifestyle habits and more.

Male infertility: Types, causes, diagnosis, treatment, prevention of obstructive and non-obstructive Azoospermia (Photo by Nik Shuliahin on Unsplash)

Azoospermia is a condition when there are no sperm in the ejaculate (or semen) after an orgasm and as per the reports, Azoospermia is an uncommon but severe form of male infertility that affects 1 in 100 people in general and up to 1 in 10 men who have fertility problems.

Types:

In an interview with HT Lifestyle, Dr Deepthi Bawa, Consultant Gynaecologist, Laparoscopic and Hysteroscopic Surgeon, Consultant Reproductive Medicine and IVF at SPARSH Hospital in Bangalore, shared, “Azoospermia is of two major types – Obstructive Azoospermia (OA) and Non-Obstructive Azoospermia (NOA). Atleast 2 centrifuged samples taken at different times should show absence of sperms to report it as azoospermia. In OA, the absence of sperm is due to blockage in the reproductive tract and NOA is a condition where sperms are not present in the semen as sperm production is impaired or abnormal.”

Dr Manu Gupta, Senior Consultant Urology and Andrology at Sir Ganga Ram Hospital and First Step IVF in Delhi, elaborated –

  • Obstructive Azoospermia: In this condition there will be normal sperm production in the testis but inadequate sperm flow due to an obstruction anywhere between the testicles and the urethra. This disorder may be brought on by various factors such as an injury, an infection, an inflammation of the reproductive tract or genital tract surgery (for a hernia or hydrocele).
  • Non-Obstructive Azoospermia: It is an issue with the testis’ ability to produce sperm. The exact cause is typically unclear; however it could be due to genetic or chromosomal defect, radiation, chemotherapy, an infection during adolescence, or hormonal imbalances.

Causes of Azoospermia

Dr Deepthi Bawa revealed, “There are pretesticular, testicular and post testicular causes. Pretesticular usually called secondary testicular failure and are endocrine related like FSH/LH/Growth hormone deficiency, pituitary insufficiency or hyperprolactinemia. These are diagnosed by doing hormonal tests. Testicular leads to primary testicular failure and directly related to growth of sperms. Can be chromosomal / genetic abnormalities/ varicocele/ testis injury due to infections or drugs/ radiation/ chemotherapy/ systemic disease like liver, kidney issues and sometimes unknown. Post testicular causes are due to blockages either in ejaculatory duct/congenital/post vasectomy/infection/nerve damage.”

Diagnosis:

Dr Manu Gupta highlighted, “Semen analysis would be necessary to verify the sperm counts, followed by a physical examination of the male reproductive area to check for any pain or anomalies. To determine whether there are any hormone-related issues that could be the root of Azoospermia, hormone levels (FSH, LH, and testosterone) are also tested.”

Treatment of Obstructive and non-obstructive Azoospermia

Dr Deepthi Bawa suggested, “Hormonal assay, transrectal ultrasound, scrotal scan, chromosomal tests are usually done to find any treatable cause of azoospermia. Testicular aspiration (TESA) or PESA (percutaneous epididymal sperm aspiration are done to detect any viable sperms directly from testis or epididymis. These sperms are used to do ICSI as part of fertility treatment.”

According to Dr Manu Gupta, “There is a widespread misconception that persons with azoospermia are unable to conceive biological children. Recently, in fact, we have heard of situations when the male spouse was informed that, since he is incapable of generating sperm, he cannot have a biological child and must instead use donor sperm or adopt a child. And to our dismay, the patient was not even fully examined and was declared as infertile.”

Self-awareness is therefore crucial. Even if a patient has obstructive azoospermia, he can still have children. Since the sperms are formed in the testis they can be extracted using a quick and painless procedure known as Percutaneous Epididymal Sperm Aspiration (PESA) or Testicular Sperm Aspiration (TESA). Here, a needle is used to extract sperm from the testis. Nearly all patients successfully retrieve their sperm. These sperm can subsequently be used to inject the patient’s wife’s eggs using the IVF-ICSI procedure.

It was once believed that patients with Non-Obstructive Azoospermia would find it difficult to have a biological child, but thanks to medical advancements and cutting-edge techniques like Micro Dissection Testicular Sperm Extraction (Micro TESE), it is now possible to obtain sperm from patients with Non-Obstructive Azoospermia.

Micro TESE, is a surgical treatment to obtain sperms that can be used in IVF-ICSI procedure. Micro-TESE is a safe procedure when performed by qualified medical practitioners. Being a daycare procedure, you can usually go home the same day.

It is always advisable to eat a balanced diet and maintain healthy lifestyle. If you are trying for a long time and unable to conceive, seek help from a qualified and knowledgeable fertility specialist as well as an andrologist. In case you are diagnosed with Azoospermia don’t panic because treatment is available.

Prevention tips for Azoospermia

Dr Deepthi Bawa advised, “Don’t get into activities that could injure the reproductive organs; do not expose yourself to radiation; be aware of risks and benefits of medications that could harm sperm production and avoid exposure of testes to hot temperatures. If diagnosed with sperm absence, consult a fertility expert to understand more about Azoospermia, the types, causes and treatments available.”



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