We refer to the failure to find sperm on three consecutive routine semen examinations as azoospermia. It is important to note that the clinical need to centrifuge and sediment the semen and then smear it, and no sperm is also found, in order to confirm the diagnosis. in the WHO 5th edition guidelines, this condition in which no sperm is found on plain microscopy, but sperm can be seen after centrifugation is called occult azoospermia, which is actually severe oligospermia.
What can cause azoospermia?
Customarily, we classify azoospermia into two broad categories: obstructive azoospermia and non-obstructive azoospermia, with the former accounting for 55% of azoospermia.
Obstructive azoospermia: That is, the testes have normal function and can produce sperm, but due to obstruction of a certain part of the vas deferens, the sperm produced by the testes is blocked and cannot be discharged from the body. Its common causes include.
1, congenital malformation: such as absence of the vas deferens, abnormal position of the epididymal head, atrophy of the epididymal body, etc.
2, Reproductive tract infection: due to inflammation blocking the vas deferens. Gonorrhea is the most common cause of vas deferens obstruction, and tuberculosis can make the epididymis completely destroyed.
3.Compression of cysts: Cysts compress the vas deferens tract causing sperm to be unable to be discharged. It is common to see epididymal cysts and ejaculatory duct cysts, etc.
4.Injury: The most common is cryptorchidism or hernia repair, which can cause obstruction due to improper technique of clamping or tearing the vas deferens due to scar formation.
Non-obstructive azoospermia: That is, testicular spermatogenesis is dysfunctional and the testes themselves are unable to produce sperm. It can be divided into 3 conditions.
1, there are no spermatogenic cells in the testis cells (spermatogenic cells are the initial state for sperm production, no spermatogenic cells, that is, no seeds), also known as only supporting cells syndrome; 2, although there are spermatogenic cells in the testis, but they are mostly of the fine infantile type and do not transform in the direction of sperm, known as spermatogenic blockage (there are seeds, but the seeds do not germinate and grow); 3, a small amount of sperm can be produced in the testis, but there is no ability to discharge sperm , which is the support cell disorder type.
The common causes of testicular spermatogenic dysfunction are.
1, genetic abnormalities: abnormalities of chromosomes, such as Klinefelter syndrome (Klinefelter), hermaphroditism, etc.
2, congenital abnormalities: such as bilateral cryptorchidism, germ cell dysplasia, support cell only syndrome, etc.
3, endocrine abnormalities: hypogonadism, hyperadrenocorticism, hypothyroidism, too little androgen, too much estrogen, etc.
4, physical and chemical factors: long-term high-temperature environment (scrotal temperature is 1 degree lower than body temperature, this temperature is conducive to sperm production and maturation, high temperature destroys the survival environment of sperm. Common occupations chef, boiler worker, driver, electric I worker, etc.); radioactive irradiation, etc.
5, infectious diseases: mumps testicular infection.
6, the impact of drugs: cytotoxic drugs, such as anti-tumor drugs, some anti-rheumatic drugs, etc.
7, other: severe varicocele.
The treatment of azoospermia is the difficult part of male infertility.
For obstructive azoospermia, if the obstruction time is short, you can try to apply Chinese herbal medicine treatment, there are many patients can appear sperm, can be free from the pain of puncture, and there are even cases of natural conception. If herbal treatment does not work, the site of obstruction can be determined by seminal plasma fructose measurement or vasectomy. If it is a local obstruction of the epididymis or an obstruction of the upper end of the vas deferens, an anastomosis can be performed through surgical procedures and there is hope for recanalization. If the surgery fails, sperm can be obtained through epididymal puncture for in vitro fertilization.
For patients with non-obstructive azoospermia, it is necessary to influence the search for the cause of the disease and to obtain information through chromosomal, AZF genes, sex hormones, and even testicular aspiration pathology to determine the prognosis. For patients with no value for treatment, such as those with significantly elevated FSH, testicular biopsy confirmed severe or irreversible spermatogenic disorders, genetic defects, and support-only cell syndrome, there is little point in treating them and no need to spend a lot of money and time, which ultimately brings sorrowful disappointment, and patients are advised to adopt small children through sperm donation or adoption. For patients with no clear cause, normal sex hormone levels or low gonadotropin should be treated aggressively, and the possibility of obtaining sperm is commonplace.