Sperm Azoospermia, the absence of sperm in the patient’s ejaculated semen, is a condition that requires special care in semen examination for azoospermia. All semen specimens that do not show sperm on microscopic examination should be centrifuged to determine the presence or absence of sperm in the sediment. The diagnosis of azoospermia can only be made if no sperm is found after thorough examination. At least 3 rigorous semen collections and examinations should be performed. Azoospermia is very tricky to treat in terms of infertility, and patients generally feel that they have lost their fertility since then and are unusually depressed. In fact, the ability to have children depends on the specific condition. There are two types of azoospermia. In the case of pseudo-aspermia, the sperm have no way to travel because of an obstruction in the vas deferens, also known as obstructive azoospermia. These patients have no problems with the sperm production function of the testes and can be treated for the site of obstruction, the nature of the obstruction and the degree of obstruction, and some patients are able to have children naturally. For patients with pseudospermia who are unable to have children naturally, they can also achieve the goal of having children through assisted reproductive technology. Another condition is true azoospermia, which actually refers to testicular spermatogenic dysfunction, also known as non-obstructive azoospermia, where drug injury, testicular inflammation, and testicular trauma can cause lesions. If mature sperm can be extracted through testicular biopsy, the same assisted reproductive technology can be used to achieve the desire to be a father. However, if the testicles are congenitally underdeveloped, or if they have completely lost their spermatogenic function due to acquired factors, it is impossible to have a child of your own in this case. What tests are needed for azoospermia? Azoospermia is the most problematic clinical factor causing male infertility, and azoospermia semen examination should be done with special care. All semen specimens that do not show sperm on microscopic examination should be centrifuged to determine if there are sperm in the sediment. The diagnosis of azoospermia can be made only if no sperm is found after thorough examination. At least 3 rigorous semen collections and examinations should be performed. In addition to routine semen examination, the following tests should be performed: Physical appearance of the patient: When examining azoospermia patients, the doctor will pay attention to the development of secondary sexual characteristics, the amount of beard, the presence of external genital deformities, varicocele, cryptorchidism, smoothness of the skin, and the distribution of body hair. Palpation: The doctor will touch the size and texture of the testicles. If the volume of the testicles is less than 10 ml and the texture is abnormally soft, it often indicates spermatogenic dysfunction of the testicles. Then further examine the epididymis for thickening and nodules, the thickness of the vas deferens, the presence of nodules, and the presence of interruptions. This is valuable in diagnosing obstructive azoospermia. If you are not sure whether it is obstructive azoospermia, you can choose to do vasovasography, but since vasovasography is an invasive test, and the test itself can cause secondary obstruction of the vas deferens and anti-sperm antibodies, it is less used clinically nowadays. Seminal plasma biochemical analysis: seminal plasma biochemical examination is helpful in the diagnosis of obstructive azoospermia. Seminal plasma fructose originates from the seminal vesicle gland and is present in the seminal fluid. Low fructose often indicates inflammation of the seminal vesicle gland, androgen deficiency, partial obstruction of the ejaculatory ducts, or incomplete ejaculation. Negative seminal plasma fructose is often indicative of seminal vesicle gland deficiency or ejaculatory duct obstruction. Neutral glycosidase: neutral glycosidase responds to epididymal function and patency. Low neutral glycosidase indicates obstruction of the epididymis and the region of the vas deferens and ejaculatory ducts. Elastase: Elevated elastase indicates the presence of seminal tract infection. Blood test: endocrine level determination, common items such as PSH, T, PRH, LH, E2, and quantitative determination of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone are generally required in patients with azoospermia. If the measured value of FSH is 2 times higher than the upper limit of normal, it often indicates testicular spermatogenic dysfunction. Testicular biopsy: If the testicular biopsy is normal, obstructive azoospermia should be considered first. Pathological examination of the testis can reveal spermatogenic disorders with varying degrees of lesions: for example, hypospermatogenic type, which is characterized by the presence of spermatogenic cells at all levels in the varicocele; spermatogenic block type, which is characterized by the presence of spermatogenic cells, but the number is reduced and they cannot develop into spermatozoa; severe spermatogenic disorders, which can show irreversible changes such as hyaline degeneration of the varicocele and fibrous hyperplasia of the boundary membrane. Chromosomal examination: to determine whether azoospermia is due to congenital causes. Most cases of chromosomal abnormalities, accompanied by other cosmetic abnormalities, and vulvar pseudohermaphroditism, are relatively easy to distinguish. In all cases of azoospermia, chromosomal abnormalities account for no more than 1% of the clinical statistics, so patients need not be nervous and suspicious; most patients with chromosomal abnormalities have a great difference in physical shape from normal males, which is easier to distinguish. microdeletion of the Y chromosome is the second most important genetic factor causing male infertility, and in 1976 the azoospermia factor (AZF) was discovered, which is located on the Y chromosome AZF is located on the distal part of the long arm of the Y chromosome (Yq11) and is divided into three regions: AZFa, AZFb and AZFc. The deletion of any one or more of these regions will lead to sperm disorders, oligospermia, weak sperm, azoospermia and infertility.