A semen test reveals the absence of sperm, which we call azoospermia cited. As one of the most difficult to treat infertility, azoospermia had caused profound suffering to patients and numerous problems to doctors.” Failure to find a single sperm in the ejaculated semen for three consecutive times is called azoospermia.” Azoospermia accounts for about 15-20% of male infertility patients and has a wide range of causes, which are summarized into two main categories. One is the dysfunction of the testes themselves, called primary azoospermia or non-obstructive azoospermia. The second is normal testicular spermatogenesis, but due to obstruction of the vas deferens, sperm cannot be discharged from the body, known as obstructive azoospermia cited.
Azoospermia is a condition in which no sperm are found in multiple semen examinations (usually more than 3 times). This disease is one of the causes of male infertility. Testicular biopsy, spermography, and endocrine hormone release assay can be performed if necessary to assist in identifying obstructive azoospermia or congenital azoospermia.
Common causes of testicular spermatogenic dysfunction include azoospermia. The testes are the only place where sperm are produced, and without them, sperm production is not possible. Since
Since there are no testicles, there is no therapeutic value and there is no need to take any medication at all; bilateral cryptorchidism. In this case, the testicles do not reach the scrotum where they should be, and stay in the abdominal cavity because the temperature is much higher than the scrotum, so there is no way for sperm to be produced, and azoospermia can also occur. This condition can be treated surgically, and it should be noted that the earlier the treatment, the better the results; congenital varicocele hypoplasia (also called Kline-Felter syndrome), which is also a developmental cause, although there is no problem with the location of the testes, there is the same problem with sperm production.
In reality one should avoid all factors that increase the temperature of the testicles; consume cottonseed oil. The oil contains a component called cotton phenol, which can inhibit sperm production, so people use it for male contraception, but if men who intend to have children eat too much, a reduction in sperm can occur, or even disappear. If you eat too much cottonseed oil, it is difficult to return to normal after you stop; varicose veins. This condition can seriously affect the blood supply to the testicles, which in turn affects the sperm production function of the testicles, and can also occur a large number of sperm reduction or even will disappear. Timely surgery or medication (for mild cases) can be expected to restore the reproductive function of most patients.
Causes
1. Endocrine diseases, hyper- or hypopituitarism, pituitary tumors, hyper- or hypoadrenalism, hyperthyroidism or hypothyroidism, etc.
2.Congenital testicular abnormalities.
3, testicular lesion itself. Such as testicular trauma, inflammation, torsion and testicular vascular lesions.
4.Hereditary diseases. Such as autosomal or sex chromosomal abnormalities, Kernicterus syndrome, etc.
5.Blocking of the vas deferens.
6.Radiation injury and drugs damage the testicular spermatogenic cells causing azoospermia.
Predisposing factors
1, congenital varicocele hypoplasia: It is a cause of the patient’s development, the location of the testes is not abnormal, however, there is a problem with the production of sperm. If this disease is found in time, the condition is not too serious, there is hope for a cure.
2, genital injury: external factors lead to testicular torsion, injury, spermatic cord torsion, or because of hernia repair surgery or prostate surgery trauma, etc., can also affect the function of the testes, resulting in patients with sperm production disorders.
3, radiological factors: if in the presence of powerful radiation or electromagnetic waves, will have a great impact on men, which can only do a good job of prevention.
4, testicular local high temperature: long time sauna, hot inflammatory bath, or due to other factors caused by the testicular temperature becomes high, will affect the production of male sperm. Most of the patients in such cases have symptoms such as less sperm or too much sperm death, and people need to pay attention to avoid all the factors that can make the testicular temperature rise.
5, varicose veins: this situation will seriously affect the blood supply to the testes of men, thus affecting the sperm production function of the testes of men, and also lead to a large number of sperm reduction or disappearance, the timely treatment of such patients most patients can restore the fertility function.
6, hypogonadism: this kind of patient is rare in the clinic, only a few people will appear such phenomenon.
Pathological classification
Azoospermia can be divided into 2 categories.
Sperm
I. Causes of sperm duct obstruction type azoospermia: It is due to obstruction of the vas deferens, so that the sperm can not be discharged from the body. The common causes are.
1, congenital vas deficiency, trauma to the vas deferens, ligation.
2, gonorrheal epididymitis, epididymal prostate tuberculosis and caseous necrosis.
3.Ejaculatory duct obstruction.
4.The testes that cannot produce sperm have reduced volume, soft texture and lack of elasticity; while those with obstructive azoospermia have more normal testicular volume, fullness and elasticity.
Second, the causes of spermatogenic disorders azoospermia: male sperm duct non-obstructive type is due to testicular spermatogenic dysfunction, unable to produce sperm. Common etiologies.
1, congenital anomalies such as orchid-less malformation, cryptorchidism, testicular dysplasia.
2. Testicular atrophy due to testicular trauma, vas deferens artery trauma, testicular torsion, mumps combined with orchitis, etc.
3, long-term use of chemical drugs or radiation disease, etc.
4.Endocrine disorders such as gonadal and pituitary hypofunction.
5, vitamin A, C, E and B complex deficiency.
In identifying which type of azoospermia a patient belongs to, the first step is to take a medical history and physical examination, paying special attention to the development of secondary sexual characteristics and reproductive organs, from which the presence or absence of endocrine dysfunction can be determined.
Testicular volume is measured. Generally, the testicular volume of normal Chinese adults is 12-25 ml, and those with testicular volume less than 10 ml are usually accompanied by spermatogenic dysfunction. Thickening, nodularity and hardening of the epididymis when examined means obstruction; an enlarged and swollen epididymis indicates obstruction at its distal end.
Azoospermia
Measurement of follicle stimulating hormone in the blood is very important in the differential diagnosis of azoospermia.
A lower than normal blood FSH level is usually pre-testicular, and an elevated blood FSH level is considered to be primary testicular failure. In post-testicular azoospermia, blood FSH levels are generally normal. When FSH is significantly elevated, the testes are definitely in irreversible or severe spermatogenic impairment.
For pre-testicular i.e. hypogonadal and/or pituitary dysfunction causing testicular hypofunction, hormone replacement therapy can be used. For testicular azoospermia, only those patients who do not have elevated FSH have any hope of treatment. For post-testicular azoospermia, local obstruction of the epididymis and obstruction of the upper vas deferens can be surgically removed. However, nowadays, with the improvement of assisted reproduction measures and the increasing maturity of IVF technology, second-generation IVF can be accomplished through sperm extraction from the epididymis or testes.
Etiology
Common Causes
1. Absence of spermatogenic cells. Many azoospermic men have vas deferens containing only pedunculated cells. There are many reasons for this, including administration of cytotoxic drugs, radiation, or some factor in the fetal period.
2. Primary testicular insufficiency. This may be due to genetic defects, undescended testes, physical damage to the testes, or testicular insufficiency caused by pubertal mumps, which affects fertility.
3.Endocrine disorders. Commonly include: hyper or hypo pituitary function, pituitary tumors, hyper or hypo adrenal function, hyperthyroidism, hypothyroidism, etc., all of which can affect sperm growth and cause azoospermia to occur.
4, obstruction of the vas deferens. The first major factor that causes azoospermia is obstruction of the vas deferens. Obstructive azoospermia can be caused by congenital epididymis or other parts of the vas deferens (including the vas deferens) that are not fully developed. Some of these cases appear to be hereditary.
Clinical factors
1. Disease factors.
The appearance of azoospermia is related to a number of male diseases, which can easily trigger the disease when such diseases constitute pressure on the vas deferens. The cause of azoospermia may also be due to some diseases that compress the internal spermatic veins, so leading to sperm duct obstruction type and sperm duct non-obstruction type azoospermia.
2.Life habits.
The reason for the high incidence of azoospermia in young people is related to the high blood supply in the scrotum. The experts of Hangzhou Guangren Hospital pointed out that the sexual function of young adults is more vigorous, if standing for a long time, it is easy to increase the abdominal pressure, which is one of the azoospermia pathogenesis traps.
3, environmental factors.
The appearance of azoospermia and male survival environment is also related. If men often work and live in a radioactive, high temperature, toxic gas environment, will make the testicular sperm cells are damaged, in serious cases, will cause azoospermia.
Western medicine
Classification of azoospermia
Non-obstructive NOA; testicular spermatogenesis disorder, which cannot produce sperm or produces only a very small amount of sperm, resulting in the absence of sperm in the semen. It can be specifically subdivided into.
(1) Genetic disorders: autosomal or sex chromosome abnormalities that affect testicular sperm production, such as Klinefelter’s (K) syndrome.
(2) Congenital testicular abnormalities: abnormal testicular development or abnormal testicular position can cause sperm production disorders.
(3) Testicular lesions: such as testicular trauma, inflammation, torsion and testicular vascular lesions.
(4) Endocrine diseases, hyper- or hypo-pituitary function, pituitary tumors, hyper- or hypo-adrenal function, hyperthyroidism or hypothyroidism can affect spermatogenesis and cause azoospermia.
(5) Severe systemic diseases and malnutrition can cause azoospermia.
(6) Radiation injury and drugs, especially cytotoxic drugs, can cause damage to testicular spermatogenic cells, which can lead to azoospermia in severe cases.
Azoospermia
Obstructive OA: The absence of sperm in the semen is caused by obstruction of the vas deferens. The patient has normal secondary sexual characteristics, libido and sexual function, normal testicular development and sperm production, but no sperm discharge due to obstruction of the vas deferens. Etiology includes.
① congenital malformations, commonly ectopic epididymal head, atresia of the epididymal duct, absent or rudimentary vas deferens.
(2) Infection with gonococcus, tuberculosis and some other bacterial infections, which can cause obstruction of the epididymis and vas deferens.
(iii) obstruction caused by cysts at the epididymis compressing the epididymal ducts.
(4) Injury that causes obstruction of the vas deferens.
Causes and lesions of obstructive azoospermia.
Composition of the vas deferens: testicular output tubules → head, body and tail of epididymis → vas deferens → ejaculatory duct → urethra.
Causes of vas deferens obstruction.
Congenital factors: Congenital abnormalities in any part of the entire vas deferens tract from the testes to the ejaculatory ducts can be caused, commonly in the epididymis.
(1) Epididymal dysplasia abnormal position of epididymal head with atrophy of epididymal body tail, atresia of epididymal duct, obstruction of epididymal collaterals and epididymal vas deferens collaterals, and epididymal cysts.
(2) Vas deferens hypoplasia with congenital bilateral absence or atresia of the vas deferens.
(3) Dysplasia or absence of seminal vesicles.
(4) Prostatic and ejaculatory duct hypoplasia congenital atresia or stenosis of the ejaculatory duct.
(5) Mullerian duct or mesonephric duct cysts.
Acquired factors: Reproductive tract infections, severe testicular, vas deferens, prostate, and seminal vesicle specific and non-isogenic infections can lead to obstructive azoospermia. Epididymal infections are common, with gonococcal infections being the most frequent, often invading the tail of the epididymis and rarely the head. Obstructive azoospermia caused by tuberculous infection is difficult to restore its fertility by recanalization surgery; trauma, injury during vulvar and inguinal surgery and postoperative scar compression as well as trauma to the scrotum and perineum can lead to obstruction of the vas deferens and ejaculatory ducts. Vasectomy; tumors, tumors of the epididymis, spermatic cord, seminal vesicles and prostate, such as invasion or compression of the vas deferens or ejaculatory ducts.
Commonly described as the following causes.
(1) Some individuals are born without the ability to produce sperm, an abnormality that is found in the study of chromosomes and genetics, or azoospermia that is known through biopsy. It can also be detected by multiple semen examinations.
(2) The inability to produce sperm due to testicular inflammation is mostly due to mumps, and other infections can also cause this condition.
(3) Obstruction of the pathway through which sperm pass, resulting in ejaculation of semen without sperm, for example, gonorrhea sometimes causes obstruction of the vas deferens.
(4) Absence of testicles or cryptorchidism, epididymal cysts or injury.
(5) Decreased ability of the testes to produce sperm due to advanced age. However, it varies from person to person, and some people still have fertility in their 70s.
(6) Other factors, such as nutritional disorders, industrial hazards, radiation exposure, febrile diseases, allergic reactions, and bad habits such as smoking and alcoholism.
Traditional Chinese Medicine
Azoospermia is also divided into true azoospermia and pseudospermia. Some patients with true azoospermia have no conscious symptoms, have a normal sex life, and are infertile for many years after marriage and are found to have no sperm on examination or testicular biopsy. However, there are also those who are unable to produce sperm due to prolonged illness or kidney deficiency, or those who have obstruction of the vas deferens and have sperm that cannot be discharged, which can be treated with medication and have certain effect. It is also difficult to cure testicular tuberculosis and testicular atrophy.
1, kidney sperm deficiency: the evidence is seen in the thin volume of semen, sexual desire is reduced or normal, the face is less florid, fatigue, dizziness and tinnitus, frequent urination, light tongue and thin first, the pulse is sunken and weak. The treatment is to tonify the kidneys and fill the sperm, the formula is used to produce medulla yodan (ginseng, maitong, flesh put on rhizome, yam, shamrock, rehmannia, mulberry, deer antler, wolfberry, turtle board gum, cuscuta, angelica, purple river car, fish john).
2, sperm channel blockage: evidence of full of qi and blood, young and strong, testicles of normal size and texture, less abdominal distension and pain, or no feeling, or a ferry yellow like gonorrhea, dark tongue with yellow coating, pulse string count. The treatment is to clear heat and silt to clear the ligaments, the formula is to use Tongkou and blood circulation soup plus reduction (red peony, angelica, peach kernel, safflower, Chuan Niu Knee, Wang Bu Liu Xing, Lu Lu Tong Yin Hua, dandelion). Or it can be combined with external application. In case of drug-induced azoospermia (e.g. Radix et Rhizoma), appropriate treatment after stopping the drug may also have the possibility of cure.
Examination and diagnosis
Examination methods
1.Endocrine examination: serum FSH (follicle stimulating hormone), LH (luteinizing hormone), PRL (prolactin), T (testosterone), DHT (dihydrotestosterone) can help to identify whether it is primary or secondary testicular failure.
2. Obstructive testing: Seminal plasma neutral a-glucosidase and seminal plasma fructose can be detected, as the former is produced by the epididymis while the latter is produced by the seminal vesicles. The difference in the concentration of the two is detected, combined with changes in semen volume and PH value (normal semen discharge volume is 2 – 8
The PH value is 7.2-8.0, of which the seminal vesicle fluid accounts for 70%, and the PH value of seminal vesicle fluid is alkaline) can determine whether there is obstruction, whether the obstruction is in the epididymis, vas deferens, or in the seminal vesicle or ejaculatory duct.
Testicular biopsy: Testicular biopsy can clearly diagnose the spermatogenic status of the testes. Because of its invasive nature and other factors, the World Health Organization is cautious about it. It is recommended to be performed only in azoospermic patients with normal testicular volume and normal blood FSH.
Diagnostic methods
The examination of azoospermia patients includes 3 main aspects: detailed history, physical examination and laboratory tests.
1.Detailed medical history. Taking a detailed medical history to understand the patient’s past history of fertility, age of sexual maturity and history of congenital diseases can help to clarify the diagnosis and find potential causative factors, and also help to determine whether the patient has OA or NOA. For example, a history of loss of smell or visual imbalance suggests that the patient may have pituitary lesions; a history of epididymitis, inguinal or scrotal surgery suggests the possibility of OA; a history of cryptorchidism or spermatic cord torsion and chemotherapy suggests the possibility of NOA; in addition, some drugs can also cause azoospermia, including alcohol, alkylating agents, allopurinol, proprotein synthesis steroids, cimetidine, cocaine In addition, some drugs can also cause azoospermia, including alcohol, alkylating agents, allopurinol, anabolic steroids, cisplatin, cocaine, colchicine, gentamicin, neomycin, furantoin, spironolactone, salicylic acid azoosulfadiazine, tetracycline, etc.
2.Physical examination. Physical examination plays an important role in finding potential causative factors of azoospermia. Through examination of the patient’s whole body, we can understand the patient’s hormone level, previous surgical history, and the presence of abnormalities such as small volume of the gau, testicular mass, epididymal nodes, vas deferens, and spermatozoal hemorrhage. Through anal diagnosis, the condition of prostate and seminal vesicles can be understood.
3.Laboratory examination
(1) Semen examination. The result of semen examination is the basis for the diagnosis of azoospermia. Generally, 2 specimens of semen are collected after 2-3 d of abstinence. The amount of semen volume also has an important significance (normal >1.5mL). In clinical examination, the main reason for low semen volume is incomplete semen collection, therefore, it is routinely required to collect 2 specimens.
(2) Endocrine examination. For patients with azoospermia, serum FSH and T should be examined first, and if the values of both are normal, further endocrine examination is not necessary. If the T value is lower than normal, LH and prolactin should be examined. Currently, some scholars believe that inhibin B is produced by the testicular support cells and can reflect the spermatogenic function of the testes more directly than FSH, so inhibin B should also become a routine test for male infertility patients.
（In 1996, Van and Assche reported that 13.7% of patients with azoospermia had karyotype abnormalities. Since then, researchers have been performing chromosomal examinations in patients with azoospermia. The purpose of genetic examination is twofold: firstly, it can diagnose some genetic disorders such as Klinefelter syndrome, chromosomal translocations, inverted mutations, etc.; secondly, it can restore fertility in some infertility patients by sperm extraction technique and intracytoplasmic single sperm injection technique. If the patient has chromosomal abnormalities, then such abnormalities may be passed on to the next generation.
(4) Testicular biopsy . Testicular biopsy can help to distinguish OA from NOA and also detect some potential lesions of the testis, such as intertubular germ cell tumor and Frank’s seminoma. There are two main methods of testicular biopsy: scrotal excisional biopsy and puncture biopsy. The former is more damaging to the testis, but a larger amount of tissue can be obtained, which is conducive to H{correct pathological diagnosis; the latter is easy to operate and less damaging to the testis, but less tissue is obtained, which may affect the diagnosis. Some researchers found that in patients who underwent bilateral testicular biopsy, 28% of patients had inconsistent testicular findings on both sides. Therefore, when conditions permit, the gauntlet biopsy gun should be sampled bilaterally whenever possible so as to avoid errors.
Genetic factors
Ninety percent of male infertility is caused by spermatogenic disorders, which clinically manifest as azoospermia or oligospermia. About 15% of patients with azoospermia or oligospermia have chromosomal abnormalities that manifest as tiny deletions on the long arm of the Y chromosome, and these deletions are also known as azoospermia factors.
Azoospermia
If genetic tests are not performed, sperm with the relevant genetic deletion may be injected into the egg, and if a boy develops in the future, he may grow up to be an azoospermic or oligospermic patient. This can lead to new troubles and misfortunes for future generations. To avoid this, genetic tests, especially azoospermia factor tests, should be performed on patients with unexplained azoospermia or oligospermia.
The azoosperm factor test can not only clarify the cause of the disease and avoid invasive tests such as testicular biopsy or some ineffective treatments, but more importantly, it can avoid passing on defective genes to the next generation.
Genetic factors are the main factors causing male infertility, among which chromosomal abnormalities are closely related to the occurrence of azoospermia and severe oligospermia. Spermatogenesis is controlled by many genes that are expressed in an orderly fashion, and aberrations in the number of chromosomal structures can affect the function of these genes, which in turn can affect spermatogenesis. The most common karyotype causing azoospermia is 47,XXY. 47,XXY azoospermia is caused by an increased dose of genes involved in sex determination on the X chromosome, which affects the coordinated expression of the “regulatory string pattern” of sex determination. There are also many genes on some autosomes that affect sperm production, which can lead to oligospermia and azoospermia when translocations cause gene breakage or deletion. Homosomal chromosomes relate to sexual differentiation and the presence of Y chromosomes and the development of undifferentiated gonads into testes, but when the Y chromosome structure is abnormal, it can produce certain clinical effects in varying degrees. It leads to testicular hypoplasia or malformation of sexual development, resulting in impaired spermatogenesis, which results in reduced or absent sperm production, producing azoospermia or severe oligospermia. Further in-depth studies are needed. Chromosomal abnormalities not only affect sperm production, but on the other hand, even if assisted conception is achieved through assisted reproduction, gametes with unbalanced chromosomes are easily formed, leading to pregnancy failure, so it is evident that chromosomal examination in patients with oligospermia and azoospermia is necessary and should not be neglected.
In 1976, Tiepolo and Zuifaidi first proposed that there are multiple genes on the Y chromosome involved in the spermatogenesis process. Over the years of research, a region of key fertility-related factors, called the AZF region, was found to exist on top of the male-specific Y chromosome. It is now believed that there are four subregions of spermatogenesis (AZFa, AZFb, AZFc, AZFd) on the AZF region, each containing loci that play different roles in the development of male germ cells at different times, and deletion of the loci may cause patients to exhibit oligospermia, hypospermia or azoospermia, leading to infertility.
It is generally accepted that proximal deletions of the Y chromosome (involving AZFa and AZFb) manifest severe spermatogenic disorders with a predominantly supportive cell syndrome, while distal deletions of the Y chromosome (involving AZFd and AZFc) may leave an island of normal spermatogenic areas. In patients with azoospermia, AZF gene testing is generally not performed again in patients with small testes on examination or in patients with testicular biopsies that still have no sperm. In conclusion, chromosomal and AZF testing can be performed to comprehensively evaluate genetic defects in male infertility, thus better explaining the cause of pathogenesis, providing genetic counseling and guiding clinical treatment.
Clinical performance
1. No sperm in semen routine for more than 3 times.
2. Immunological examination can clarify whether immune infertility is present
3. Vasectomy can clarify whether there is obstruction in the sperm duct and its obstruction site.
4.Testicular ultrasound can detect the general lesion of testis, and testicular biopsy can provide a more definite basis for diagnosis and treatment.
5.Azoospermia can be diagnosed when semen is examined after centrifugation and sedimentation and no sperm is found 3 times.
6.On physical examination, the testicular volume is less than 10 ml and the texture is abnormally soft, suggesting poor testicular function.
7.Most patients are found to have azoospermia when they come to the hospital for infertility examination because they have been married for many years and are unable to conceive their wives without taking contraceptive measures.
Disease examination
In the outpatient clinic, when the test reveals the absence of sperm, it should be repeated to determine if there is an error in the test. If no sperm is found in the patient’s semen on multiple tests, this is a diagnosis of azoospermia. It should be noted that the patient’s semen is no different from that of a normal person, and there is nothing abnormal about his or her sexual process, sexual pleasure, or ejaculation process, except that the semen does not contain any spermatozoa.
Once it is determined to be azoospermia, further tests are required, not that it means that fertility is lost from then on. Clinically, azoospermia is divided into two main categories: one is caused by the testes’ own sperm production dysfunction, which is equivalent to not having a processing plant to produce products, so there is no product supply; the other is that the testes’ sperm production function is normal and can produce qualified products, but due to the obstruction of the vas deferens, the sperm produced by the testes cannot be discharged out of the body, this condition is called obstructive azoospermia.
If the disease is detected in time and the condition is not very serious, there is still hope for treatment; viral orchitis caused after mumps, as well as gonorrhea, syphilis, testicular tuberculosis, etc. This is a condition in which the testicles have suffered an acquired injury that violates their sperm-producing function, and there will also be no sperm or very little sperm. In such a case, the key is prevention, and once the infection factor is found, the cause should be eliminated in time to prevent the disease from aggravating; genital injury. External injuries resulting in testicular damage or torsion, spermatic cord torsion, etc., or trauma from hernia repair surgery or prostate surgery can also affect testicular function and lead to sperm production disorders. This condition is mainly a matter of prevention and timely and effective measures; radiation exposure. Sperm are very fragile and will be decimated if they are in the presence of powerful electromagnetic waves and radiation. The cause of this disease is only good prevention; testicular local high temperature. Frequent and prolonged scalding baths, sauna, or other factors causing elevated testicular temperature can affect sperm production, although this is mostly the case with less sperm, excessive sperm death, etc.
The main causes of obstructive azoospermia are: congenital bilateral vas deferens; genital duct injuries, such as unrepaired urethral injuries, surgical misuse of the spermatic cord and not detected and repaired in time; inflammatory diseases of the reproductive system such as epididymitis, epididymal tuberculosis, prostatitis, and seminal vesiculitis can cause obstruction of the vas deferens; benign tumors of the seminal vesicles such as seminal cysts, etc.
Disease diagnosis
The diagnosis of azoospermia can be confirmed if no spermatozoa are found in the semen after centrifugation and microscopic examination of the sediment for 3 times, but further clarification of the etiology is needed.
During physical examination, pay attention to the development of secondary sexual characteristics and external genitalia development. If the testicular volume is less than 10 ml and the texture is abnormally soft, it often indicates poor testicular function, and palpation should pay attention to the epididymis and vas deformities, nodules, etc. Endocrine examination, serum FSH (follicle stimulating hormone), LH (luteinizing hormone), PRL (prolactin), T (testosterone), and DHT (dihydrotestosterone) can help to identify primary or secondary testicular failure.
Ultrasound of the testes can detect gross testicular lesions, and testicular biopsy can provide a more definitive diagnosis and treatment.
Causes infertility
1.Sperm production disorder
Sperm production disorder is an important cause of azoospermia, and is also the cause of male infertility caused by azoospermia. The main causes of sperm production disorder are: congenital anomalies such as an orchid deformity, cryptorchidism, and testicular hypoplasia. X-rays are also used to treat testicular atrophy caused by testicular trauma, vas deferens artery trauma, testicular torsion, mumps combined with orchitis, etc. Endocrine disorders such as gonadal and pituitary hypofunction.
2.Sperm transport obstruction
Sperm transport obstruction causes sperm death and thus male infertility, and also indirectly, male infertility caused by azoospermia. The causes of sperm transport obstruction are: congenital vas deficiency, trauma to the vas deferens, ligation. Gonorrheal epididymitis, epididymal prostate tuberculosis with caseous necrosis. Ejaculatory duct obstruction. Testes that cannot produce sperm are reduced in size, soft and inelastic, while those with obstructive azoospermia have more normal, full and elastic testes.
Testicular spermatogenesis disorders are the most common factors of spermatogenesis disorders, mainly include: azoospermia; cryptorchidism; congenital varicocele hypoplasia; orchitis; testicular tuberculosis; genital injuries: testicular injury, spermatic cord torsion radiation exposure; excessive local temperature of testicles; consumption of cottonseed oil varicocele and hypogonadism. Vas deferens obstruction: congenital bilateral vas deferens defect; genital duct injury; genital duct inflammation: epididymitis, epididymal tuberculosis, prostatitis, seminal vesiculitis, etc.; benign tumor of seminal vesicles: seminal cysts, etc.
Precautions
1. It is important to reduce some common radiation exposure in life. Sperm is very fragile, if in the presence of powerful electromagnetic waves, radiation, will be extinguished. The cause of the disease is only good prevention.
2, life and work attention to avoid genital injuries. External injuries leading to testicular injury or torsion, sperm cord torsion, etc., or due to hernia repair surgery, prostate surgery trauma, etc., can also affect testicular function, resulting in sperm production disorders. This situation is mainly a matter of prevention and timely adoption of effective measures.
3, in life and work to avoid producing local high temperature of the testicles. Frequent and prolonged scalding baths, saunas, or other factors that cause elevated testicular temperature can affect sperm production, although most of such cases are less sperm, excessive sperm death, etc. Avoid all factors that increase the temperature of the testicles.
4. The usual condition varicocele. This condition can seriously affect the blood supply to the testicles, which in turn affects the sperm production function of the testicles, and also occurs when there is a large reduction in sperm or even can disappear. Timely surgery or medication (mild cases) can be expected to restore the reproductive function of most patients.
5, in daily life to minimize the consumption of cottonseed oil. The oil contains a component called cotton phenol, this component can inhibit sperm production, so people use male contraception, but if men who intend to have children eat more, it will happen sperm reduction, or even disappear. If you eat too much cottonseed oil, it is difficult to return to normal after you stop.
Disease risk
1. Damage to the kidneys.
Azoospermia causes men to have weakness of the spleen and stomach, as well as a deficiency of essence and blood. It causes deficiency of kidney essence and endangers male fertility.
2, causing blockage of the vas deferens.
Due to the occurrence of injury. The spermatozoa cannot be discharged normally, which may lead to the injection of wind poison into the symphysis or the absence of sperm.
4, leading to testicular sperm production failure.
This is usually due to congenital testicular dysplasia, as well as testicular trauma or inflammation, which interferes with the temperature regulation of the scrotum.
5, affect the normal sex life of men.
As testosterone is an androgen in men, it is secreted by the interstitial cells of the testes and is used to maintain the spermatogenic function of men, as well as the secondary sexual characteristics and control the physiological effect, etc. If abnormalities occur, it will affect the normal sex life of men.
Common misconceptions
1, no semen ejaculation that is azoospermia? The main reason for not ejaculating is not reaching orgasm or retrograde ejaculation, and retrograde ejaculation can be identified by centrifuging the urine after “ejaculation” to find sperm or fructose measurement.
2, semen test without sperm is azoospermia? After the general microscopic examination of no sperm, it needs to be determined by centrifugation of semen again to determine the results of a single test with errors, and clinical diagnosis requires at least 2 to 3 centrifugal microscopic examinations to confirm the diagnosis of azoospermia, and also to exclude retrograde ejaculation. In this case, the technician’s own operation level and responsibility is also one of the influencing factors.
3, direct testicular biopsy for azoospermia patients to clarify the cause? Some hospitals perform testicular biopsy directly for azoospermia patients instead of preferring epididymal puncture. For patients with obstructive azoospermia in whom sperm can be found by epididymal puncture, direct testicular biopsy is relatively more damaging and may lead to postoperative hypospermia.
4.For patients with ejaculatory duct obstruction direct surgical treatment? Even if the diagnosis is clear, it is still necessary to perform an epididymal puncture to confirm the presence of sperm before surgery, so do not operate blindly and cause unnecessary waste.
5. For patients with vas deferens on one side but with good testicular spermatogenic function, and patients with vas deferens on the other side but with low testicular spermatogenic function, one side of the epididymis – contralateral vas deferens anastomosis is feasible.
6, inactive sperm can not be ICSI . ICSI technology requires live sperm for fertilization, but the sperm obtained by puncture or biopsy may be inactive sperm. However, this does not mean that ICSI cannot be performed, but requires an experienced technician to determine whether the sperm is dead or alive. Some assisted reproduction facilities have limited technicians who believe that inactive sperm means that ICSI cannot be performed or that they cannot determine whether the sperm are dead or alive, leaving many couples without a chance to have children.
Diet therapy
1., yam, white rice, sugar, water. Peel the fresh yam and cut into pieces, cook until seventy years old, add rice and cook into porridge, then add sugar and cook for a few moments.
2. 1 kg of sesame seeds, white rice, honey and water. Just add honey after boiling. This porridge can benefit the liver and kidneys, laxative and wuzu hair, more beauty effect.
3, animal kidneys: eating animal kidneys has the effect of tonifying the kidneys and benefiting the essence, is the specific embodiment of the theory of Chinese medicine “to dirty nourish dirty”. Because it is rich in protein, fat, a variety of vitamins and some rare trace elements, so both tonic and strong function.
4.Sea cucumber: it can nourish the kidney and benefit the essence, nourish the yin and strengthen the yang. It is rich in iodine, zinc and other trace elements. It can participate in regulating metabolism and lowering blood lipids. The mucin and other polysaccharide components contained in it have the functions of lowering lipid and anticoagulation, promoting hematopoietic function, delaying aging, nourishing skin and repairing tissues.
5, shrimp: capable of tonic kidney and aphrodisiac, through the breast detoxification. Rich in protein, lipids, minerals, vitamins, calcium, phosphorus is particularly rich, is a good bone, shrimp meat extract also contains immune-enhancing substances.
Prevention
The frequency of azoospermia is 5-20% among infertility patients, which can lead to male infertility and seriously endanger men’s health. Experts point out that the phenomenon of azoospermia can be prevented by abandoning cigarettes immediately, taking medication carefully, avoiding intense running, not taking too long breaks, not abstaining for long periods of time, and getting up at night to urinate.
1, immediately abandon cigarettes: men who smoke more than a pack a day, sperm vitality is always weaker than that of non-smokers. However, after quitting smoking, special care should be taken not to be anxious, because that can cause a drop in testosterone, which can cause a decrease in sperm.
2. Be careful with your medication: medications for depression, malaria and certain sores can affect sperm production. Therefore, when it is necessary to use those drugs, you should seek the advice of your doctor beforehand.
3, avoid intense running: intense running will reduce sperm vitality, so running should be moderate and not too intense, and the possibility of azoospermia will be reduced.
4. Don’t take too long breaks: find something either light or heavy to do. Don’t be lazy, but don’t do too heavy physical work either. Both rest and physical work should be moderate.
5, not long-term abstinence: If the genitals are often congested will make the temperature of the scrotum rise, resulting in reduced sperm vitality. Therefore, you should not be abstinent for a long time.
6, get up at night to urinate: urinating at night is a good habit, it will be good for the production of sperm, so that you reduce the possibility of committing azoospermia.