The concept of azoospermia: to confirm the diagnosis, more than 2 semen analyses must be performed and the semen must be centrifuged and precipitated, and those who still have no sperm found under the microscope must abstain from sex for 2-7 days at the time of semen collection. The semen sent for examination must indeed be semen. The incidence of azoospermia is 19%-30% of male infertility.
1. Classification
(1) pre-testicular sex: refers to the testes themselves function normally, but the testes do not develop or do not produce sperm secondary to hypothalamic and/or pituitary endocrine dysfunction.
(2) Testicular sex: refers to the loss of the ability of the testes themselves to produce sperm due to various causes.
(3) Post-testicularity: refers to the normal ability of the testes to produce sperm, but the sperm transport ducts are obstructed or congenitally absent, for example: epididymal tuberculosis, bilateral epididymitis, bilateral vas deferens combined with absence of seminal vesicle glands, ejaculatory duct obstruction, etc.
2.Etiology
(1) Sperm production disorder of the testes: The testes are the only organ that produces sperm. The testes themselves are impaired in producing sperm
(2) Infectious factors: Mostly due to mumps, other infections may also cause this disease.
(3) Congenital factors: Some people are born without the ability to produce sperm. This abnormality is found in the study of chromosomes and genetics, or is known through biopsy.
(4) 6% of male infertility patients have varying degrees of chromosomal abnormalities, with the rate of chromosomal abnormalities even reaching 10%-15% in azoospermia patients.
(5) Ejaculatory dysfunction: ejaculation and retrograde ejaculation belong to this
(6) obstruction or deficiency of the vas deferens
(7) Decreased ability of the testes to produce sperm due to advanced age.
(8) Other factors: such as nutritional disorders, industrial hazards, radiation exposure, febrile diseases, allergic reactions and bad habits such as tobacco and alcohol addiction.
3.Examination
(1) History taking and physical examination: pay special attention to the development of male secondary sexual characteristics and reproductive organs, measurement of testicular volume, examination of epididymis, vas deferens, etc.
(2) Endocrine examination: observation of FSH, LH, T and PRL in serum
(3) Testicular biopsy: direct examination of the spermatogenic function of the testicular varicocele and the development of interstitial cells
(4) Fructose determination: to identify whether there is vas deferens obstruction
(5) karyotype analysis: used for testicular dysplasia, external genital malformation and azoospermia of unknown origin
(6) Ultrasonography: mainly used for syringomyelia, epididymal hematoma, varicocele, epididymal cyst, epididymal inflammation, etc.
4.Treatment
For pre-testicular and hypothalamic and/or pituitary dysfunction-induced testicular hypofunction, hormone replacement therapy can be used, currently two approaches: one is to use HMG and HCG together, and the other is LHRH
(1) For testicular azoospermia, if FSH is significantly elevated, or if testicular biopsy confirms a severe and irreversible spermatogenic disorder, the options are: artificial insemination by donor sperm, adoption of a child or no child.
(2) Post-testicular azoospermia: Those with confirmed local obstruction of the epididymis and obstruction of the upper end of the vas deferens can undergo surgical operation to release the obstruction.
(3) Assisted reproductive technology: mainly refers to intracytoplasmic single sperm injection technology (ICSI). In cases of vas deferens deficiency or obstruction, long segment vas deferens obstruction, long segment ejaculatory duct dysplasia or hypoplasia and obstruction, where vas deferens reconstructive recanalization cannot be used, epididymal sperm aspiration technique or testicular biopsy can be used to obtain sperm for ICSI to assist conception.