Normal semen is the seed for conceiving the next generation, but the appearance of azoospermia has ruined the dream of daddyhood for men.
Azoospermia is an important cause of male infertility. It refers to the presence of semen ejaculation during sexual intercourse, normal semen volume, and no sperm found after more than three semen examinations. Generally speaking, azoospermia can be divided into two types: one is that although the testes still produce sperm normally, the sperm cannot be discharged due to obstruction of the vas deferens, which is called obstructive azoospermia. The other type is non-obstructive azoospermia, where the testes are unable to produce sperm due to spermatogenic dysfunction;
The actual fact is that you will find a lot of people who have been in the business for a long time. In fact, it is crucial to recognize the cause of azoospermia!
The treatment of azoospermia, first need to be diagnosed by what causes, and then according to their own causes and then symptomatic treatment: 1.
1, cryptorchidism is a major factor leading to azoospermia, because the testes are the only place to produce sperm, cryptorchidism is the testes are not to the scrotum where they should be, staying in the abdominal cavity because the temperature is much higher than the scrotum, there is no way to generate sperm, and azoospermia occurs, this situation can be treated through surgery. The earlier the cryptorchidism is treated, the better the result will be.
2. Testicular injury or torsion caused by trauma, spermatic cord torsion, etc., or trauma from hernia repair surgery or prostate surgery can also affect testicular function and lead to sperm production disorder. This condition is mainly a matter of prevention and timely and effective measures.
3. Congenital absence of vas deferens, trauma to vas deferens, ligation. Or infection with gonococcal tuberculosis and some other bacterial infections can cause epididymal and vas deferens obstruction. This is a condition where the testicles have suffered an acquired injury that violates their sperm-producing function, and there will be no sperm or very little sperm. In such a case, the key is prevention. Once the infection factor is found, the cause should be eliminated in time to prevent the disease from aggravating.
4, endocrine disease pituitary hyperfunction or hypopituitary tumor adrenal hyperfunction or hypo hyperthyroidism or hypothyroidism can affect sperm production and cause azoospermia. Endocrine and other related measures should be taken for treatment.
5. The testes that cannot produce sperm are reduced in size, soft in texture and inelastic. In contrast, the testes of obstructive azoospermia are normal in volume, full and elastic.
Basic supportive treatment for azoospermia.
The causes of azoospermia are many and complex. Azoospermia can be cured, but the treatment options for azoospermia differ from patient to patient because of their physical condition and the cause of the disease. Once a patient has a sperm abnormality, they should choose to go to a regular professional hospital for examination and diagnosis to clarify the cause and treat the problem. In addition to timely treatment, azoospermia patients should also develop the following good habits.
1, relaxed mood. Mental stress also has a negative impact on the growth of sperm, so men should properly relax themselves.
2, regular checkups. Pathogenic infections are also an important factor in male infertility, and one should visit the physician frequently to receive examinations related to chlamydia and prostate.
3, regular exercise. Excessive obesity in the male body can lead to an increase in temperature in the groin, which damages the growth of sperm and thus leads to infertility. Therefore, weight control within the standard range can improve the quality of sperm.
4, less to sauna, steam bath. High temperature steam baths directly harm sperm and also inhibit sperm production.
5, eat more green food. Green vegetables contain vitamin C, vitamin E, zinc, selenium and other components that are conducive to sperm growth.
6, quit smoking and alcohol. Data show that smoking and alcohol consumption are the most important factors in the decline of sperm quantity and quality.
Azoospermia treatment methods
1, drug treatment: general azoospermia treatment, the use of drug treatment is not effective.
2, surgical methods: If the azoospermia patient has normal spermatogenic function of one testicle, but the vas deferens is obstructed; while the other testicle is atrophied and the vas deferens is open, a trial testicle removal on the diseased side and autotransplantation of the healthy side testicle can be performed. If the testes and vas deferens are normal but the epididymis is diseased, vasectomy with testicular anastomosis is feasible.
3. For obstructive azoospermia in good condition, different surgical procedures are performed according to the site of obstruction.
If it is in the epididymis, microscopic vasectomy with epididymal anastomosis can be performed;
If the obstruction is in the vas deferens, a microscopic vas deferens anastomosis can be performed;
If the obstruction in the vas deferens is congenital or long, testicular or epididymal sperm extraction + ICSI can be performed;
If the obstruction is in the seminal vesicle, transurethral vesiculoscopy can be performed.
4. In case of non-obstructive azoospermia, our department (Northwest Women’s and Children’s Hospital, Shaanxi Provincial Women’s and Children’s Hospital Reproductive Center Male Department) has successfully carried out microscopic testicular sperm retrieval, which is the earliest and most effective in the northwest region, giving the majority of azoospermia patients a chance to have their own children!
5. If patients feel that azoospermia is non-obstructive azoospermia or chromosomal abnormalities and need to perform sperm donor treatment, they can do so in our department (Shaanxi Provincial Human Sperm Bank). The reservoir is abundant and can be done on a drop-in basis!
Finally, a solemn reminder to all patients and friends.
To treat azoospermia, be sure to choose a regular hospital, do not just choose a small clinic, which will only get more complicated the more treatment.
Azoospermia patient consultation important tips
Patients with azoospermia who have mature sperm on testicular biopsy can solve their fertility problems through IVF technology.
If there is no mature sperm, fertility can only be achieved by using sperm from a sperm bank. Medication is generally considered ineffective. In small testes, if follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels are high, this often indicates that the lesion is in the testes, in which case, if there is no sperm in the semen, there is usually no sperm in the testes either, and fertility is usually achieved by using sperm from a sperm bank; if follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels are low, this often indicates that the lesion is in the brain, and chorionic gonadotropin and uropoietin can be used. and uropoietin.
Some patients can achieve fertility. We followed up 70 such patients and found at least 11 who had become pregnant.
The general principles of treatment of azoospermia are
Azoospermia can be diagnosed by the absence of sperm on microscopic examination of semen sediment after two centrifugations, and azoospermia patients are generally ineffective with drug therapy. In azoospermia, there may be sperm in the testes, in which case they can be removed for ICSI (single sperm injection, a technique of IVF);
If there is no sperm in the testes, artificial insemination can only be done using someone else’s sperm. Azoospermia with varicocele is not very interesting to perform high level ligation of spermatozoa.
If the testicular biopsy or puncture results in no mature sperm, then only other people’s sperm can be used. The Beijing Municipal Sperm Bank is at the Research Institute of the National Family Planning Commission, No. 12, Dahuisi Road, Haidian District.
We generally believe that testicular volume is less than 6 ml and FSH (follicle stimulating hormone) is 2 times higher than the upper limit of normal, the possibility of finding sperm in the testes is smaller; and vice versa is greater. However, when performing testicular puncture it should be noted that if there is no sperm at one point of puncture, a bilateral multi-point puncture biopsy should be performed.
Because testicular sperm production is unbalanced, just as the earth has plains, deserts, and oases in the desert; it is a very important thing for the patient to have a testicular biopsy.
Because there is or is not a direct decision on whether the patient will take his own sperm for fertility purposes using IVF technology or have to use sperm from a sperm bank for donor insemination, which is, frankly, a big deal whether he is the biological father of his offspring.
Therefore a testicular biopsy should be performed with multiple points of puncture if necessary, and strictly speaking a bilateral map testicular puncture biopsy should be performed to get enough specimens for laboratory use.
Methods of testicular biopsy.
1, testicular open meatus biopsy
It was first performed and is still commonly used. The operation is simple, safe, complete, and convenient for the pathologist to make a diagnosis. The disadvantage is that it is slightly traumatic and the area of sampling is limited, which cannot completely reflect the spermatogenic function of the whole testis.
2.Testicular open microsurgical biopsy
It is a new method developed in recent years. It is especially suitable for patients with poor spermatogenic function of the testis. During the operation, the white membrane of the testis is incised, the testicular tissue is separated and observed under the microscope, and selective biopsy is performed on the tissues with normal shape and structure, and the sperm detection rate is higher for patients with partial regional insufficiency of the testis.
3.Percutaneous testicular aspiration biopsy
Percutaneous testis biopsy requires the use of a specialized puncture gun (Tru-Cut), which needs to be performed under local anesthesia and can be used to evaluate the histological and cytological manifestations of the testis. Due to the large blindness of puncture, it can easily lead to epididymal or testicular artery injury. In addition, the specimens obtained by puncture are small, containing only 3-6 tubular structures per needle of tissue. For patients with obstructive azoospermia, this method can be chosen to obtain testicular sperm for ICSI.
4.Transcutaneous testicular fine-needle aspiration biopsy (special aspiration needle)
There is also percutaneous testicular fine needle aspiration biopsy (ordinary butterfly needle)
Fine-needle aspiration biopsy is less risky and less painful. The extracted tissue needs to be evaluated with the help of a flow cytometer. Open biopsy is still the preferred method of examination for diagnostic purposes. This method is often used to obtain testicular sperm for use in ICSI.
Percutaneous epididymal puncture aspiration
Percutaneous epididymal sperm aspiration (PESA ), PESA is a relatively simple procedure that requires no incision, is easily repeatable, is inexpensive, and can be performed under local anesthesia.
Procedure: fix the testis and fix the epididymis with the thumb and index finger. A 21-gauge butterfly needle is selected and followed by a 20 ml syringe. The needle is inserted into the epididymal envelope, and the needle can be inserted a little deeper, then the syringe is aspirated while the needle is slowly withdrawn until there is fluid aspirated. repeated puncture aspirations are sometimes required if sufficient spermatozoa are to be obtained. the epididymal fluid aspirated by PESA is very small and a large number of blood cells can be mixed with it. If this method is unsuccessful, other methods may be chosen.
The use of testicular biopsy was first reported in the late 1930s by Professors Hotchkiss and Engle of Cornell Medical Center, New York Hospital, USA. The original purpose of testicular biopsy was to identify obstructive azoospermia and primary varicocele insufficiency. It is mainly indicated in patients with azoospermia who have normal testicular size (>15cc), normal testicular texture, palpable vas deferens and normal serum FSH levels.
The purpose of testicular biopsy is to find out whether the spermatogenic function of the testes is normal. The biopsy allows direct examination of testicular tissue and is the “gold standard” for determining testicular function. Testicular biopsy is a simple surgical procedure that can be performed in an outpatient operating room, and local anesthesia is sufficient. The procedure takes about 5-10 minutes. Depending on the patient’s condition, a unilateral testicular biopsy or a bilateral biopsy can be performed.
A small amount of testicular tissue is cut during the procedure, preserved in a special preserving solution called Bouin’s fluid, and then sent to the pathology department, where the tissue is stained and examined by a pathologist under a microscope.
Due to the local anesthesia administered during the procedure, the patient does not feel any particular pain. For a few days after the procedure, the patient may experience a mild dull pain, which can be relieved with a small amount of analgesic medication if necessary.
Because testicular biopsy is, after all, a surgical procedure, most doctors use it as the ultimate test and only perform it as a last resort. Before you decide to perform a testicular biopsy on a patient, you should first consider whether the results will change the original treatment plan and whether there is a less invasive alternative.
Testicular biopsy is particularly indicated for patients with azoospermia. Patients with oligospermia do not require a testicular biopsy, and in these patients, the biopsy results are often normal. This is not surprising; after all, the patient has sperm present in the semen, and these sperm are clearly produced in the testes.
In the past, doctors took only a small piece of tissue for pathology during a testicular biopsy. Today, however, we all know that biopsy tissue taken from one site alone does not truly reflect the entire testis. Within the testis, sperm production is not uniformly consistent; some areas will have vigorous sperm production, while others will have poor or even no signs of sperm production. In particular, in patients with non-obstructive azoospermia, spermatogenesis is even more heterogeneous due to testicular insufficiency. This means that in order to understand the true spermatogenic status of the testes, the doctor needs to take samples from at least 4 different areas of the testes and send them separately for examination.
Azoospermia, one of the major causes of male infertility, is very harmful.
Some men say that azoospermia does not make a man infertile. In fact, the harm of azoospermia is much more than that, for male friends, sometimes azoospermia brings other harm, more terrible than infertility: azoospermia patients are most obviously caused by changes in male hormone levels, the most important when it comes to testosterone that is androgenic changes!
Testosterone plays a vital role in a man’s life: 1.
1. The effect of testosterone on infants:
In the first week of life, the concentration of testosterone begins to rise in young male infants and remains at the same concentration as puberty for several months. Testosterone has an important role in the formation of the male penis and scrotum.
2. The effect of testosterone on adolescent males:
Testosterone is a type of androgen, and male sexuality is related to androgens. When the testicles begin to secrete androgens during puberty, male sexual behavior begins to sprout and enhance.
It produces adult body odor; skin and hair become more oily, acne; pubic hair and armpit hair; growth increases dramatically, accelerating bone growth; penis grows; libido and erection increase; voice becomes low; facial subcutaneous fat decreases; throat nucleus grows; muscle strength and quality increase, etc.
3, the effect of testosterone on adult men:
There are four main effects of testosterone on adult men: maintaining muscle strength and quality; maintaining bone density and strength; maintaining libido and the number of erections; refreshing and improving physical performance.
What are the risks of low testosterone for men?
The main hormones related to male reproductive function are gonadotropin-releasing hormone (LH) secreted by the hypothalamus, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone (TES) secreted by the anterior pituitary gland. They are the “Big Five” of fertility, working in close collaboration with each other. For example, FSH can “order” the epithelial cells of the varicocele to promote the development and maturation of sperm; LH is an enabler that stimulates the secretion and synthesis of testosterone in the testicular mesenchyme. Testosterone has direct or indirect physiological effects on all systems of the body. Testosterone deficiency will lead to a series of pathophysiological changes in bones, muscles, fat, blood, cardiovascular and other tissues and organs, as well as emotional and cognitive functions, and sexual function.
1, testosterone is too low, seriously affect the quality of male sperm, resulting in a decrease in the number of sperm, the formation of oligospermia, in serious cases can lead to azoospermia; resulting in a decrease in sperm motility, the formation of weak sperm, and less sperm, azoosperm, weak sperm will affect male fertility, leading to infertility, so if testosterone is low men should go to the hospital for treatment in a timely manner!
2, the impact of testosterone on bones: recent studies abroad and in our department have shown that patients with androgen deficiency are more likely to have reduced bone mass and osteoporosis. The reason for this is the decrease in testosterone, accompanied by a decrease in biologically effective testosterone and an increase in sex hormone binding globulin can increase the rate of bone density loss by more than three times.
3.The effect of testosterone on muscle tissue: The decrease of serum free testosterone can make men have less progressive muscle mass, less muscle strength, easier fatigue and less ability to perform daily activities;
4, testosterone for the impact of fat: testosterone levels can be reduced, leading to an increase in visceral fat, weight gain, mainly abdominal obesity;
5, the impact of testosterone on mood and cognition: bioactive testosterone level has an important regulatory role on mood and cognition, if the endogenous testosterone is too low, it can lead to anxiety, insomnia, memory loss, thinking response and mental retardation in men.
6, the impact of testosterone on sexual function: testosterone can regulate libido and erectile function through the central and local tissues, and plays a decisive role in male libido, androgen deficiency can lead to a significant decrease in libido and erectile dysfunction (ED);
7, testosterone on the cardiovascular system: testosterone can induce coronary artery and aortic diastole, and when serum testosterone is reduced, coronary artery sclerosis, triglycerides and high-density lipoprotein are more likely to occur;
8, the effect of testosterone on red blood cells: testosterone can directly stimulate the bone marrow stem cells and through the kidney synthesis of erythropoietin to increase the number of red blood cells and hemoglobin level, testosterone deficiency can lead to anemia.
Therefore, all patients, based on the principle of prevention before illness, should follow up for a long time, at least once every six months or once a year to review the “five sex hormones”, if there are abnormalities in time to seek medical advice is the best policy! You should also pay attention to the weight change, abdominal circumference and hip circumference ratio, which can simply provide your basic health status.