Azoospermia is commonly referred to as the absence of sperm in the semen. The medical definition is “azoospermia is when no sperm is found in the ejaculated semen for three consecutive times. It is one of the most serious and difficult to cure diseases in male infertility. Azoospermia accounts for about 15-20% of male infertility patients.
The cause is complex and can be summarized into two main categories according to its etiology: one is the impaired function of the testes to produce sperm, that is, the testes themselves cannot produce sperm, called non-obstructive azoospermia; the other category is the testes can produce sperm normally, but the pipeline system to transport sperm is not open to cause sperm can not be ejected with the semen, called obstructive azoospermia.
In addition, azoospermia must be distinguished from ejaculation and retrograde ejaculation. Non-ejaculation is the absence of semen ejaculation after intercourse, while retrograde ejaculation is the entry of semen into the bladder, and azoospermia is the presence of semen ejaculation after intercourse, but no sperm in the semen.
Common etiologies are as follows.
① Disorders of sperm production.
Congenital anomalies such as absence of testes, cryptorchidism, testicular dysplasia.
Testicular atrophy due to testicular trauma, trauma to the vas deferens artery, testicular torsion, mumps combined with orchitis, etc.
Endocrine diseases such as hypothalamus and pituitary gland hypofunction. Certain chromosomal abnormalities: such as Crohn’s disease, Kallmann’s syndrome, etc.
Radiation therapy: The destruction of testicular spermatogenic epithelium by radiation therapy is irreversible.
Drug effects: Certain drugs such as immunosuppressants like cyclophosphamide, aminopterin, colchicine, etc. can also cause irreversible damage to the spermatogenic epithelium.
②Sperm transport disorder: i.e. sperm can be produced in the testes, but due to obstruction of the sperm transport duct, sperm cannot be ejected out of the body with semen. The causes include
Congenital vas deferens, trauma to the vas deferens, ligation.
Obstruction of the epididymal duct due to gonorrheal, tuberculous epididymitis, and epididymal prostate tuberculosis.
Obstruction of the ejaculatory duct opening.
The diagnosis of definitive azoospermia is relatively simple. If no spermatozoa are found after three consecutive semen centrifuges, the diagnosis of azoospermia can be made.
There is a well-established diagnostic procedure for diagnosing obstructive and non-obstructive azoospermia. It includes semen volume, PH value, seminal plasma biochemical examination, and finally testicular biopsy. Vasectomy is now rarely used as it is believed to cause further damage to the vas deferens.
How to treat?
The traditional treatment for non-obstructive azoospermia can be done by spermopoietic drugs to improve the local blood flow and nutritional status of the testes, or to improve the spermatogenic function of the testes, but the efficacy is mostly unsatisfactory.
2.At present, the most commonly used drugs such as: vitamin E, Schilkhorn, L-carnitine, and proprietary Chinese medicines such as: Wu Zi Yan Zong Wan, spermatogenic capsule, etc.
3, the current new breakthrough in the treatment of non-obstructive azoospermia is the application of microsurgical sperm extraction, which may bring good news to these patients. The specific method: taking part of the testicular tissue under the microscope may reveal the presence of a small amount of sperm, preserving the sperm can be used to artificial fertility techniques, namely IVF, to enable such patients to have their own children. The disadvantage is that the cost is high and the success rate is low.
4. The treatment of obstructive azoospermia is mainly surgery or assisted reproduction techniques. The fundamental purpose of surgery is to clear the blocked vas deferens so that the sperm can be expelled with the semen to achieve natural pregnancy. Methods: Microsurgical methods are mainly used such as: microscopic end-to-end vasectomy, which has a success rate of up to 90%; epididymal vasectomy has a success rate of about 70%. The advantage is that natural pregnancy is possible.
5.Assisted reproductive technology is to remove the sperm and the woman’s egg by puncture, and to perform in vitro single sperm follicular injection, and then in vitro cultivation into a fertilized egg and implantation into the woman’s uterus, to achieve the purpose of fertility, its success rate is about 30%. The disadvantages are the high cost, low success rate, and the possibility of passing the paternal Y chromosome abnormality to the male in the offspring.