General Info for Azoospermia
If the given sperm sample does not include live sperm cells, we call it azoospermia. In such cases, we repeat the sperm analysis a few days later. We must request additional tests if azoospermia is detected once again. These tests include:
- Testicular ultrasound
- Chromosome analysis
- Microdeletion testing (AZF-a,b,c)
We generally observe azoospermia in 1% of the society and 20% in patients who apply to a hospital for possible infertility. If there are no live sperm cells in the semen, we must definitely do the second test. We make the diagnosis if we are unable to find live sperm cells once again. So, is it possible to have children even if there is azoospermia? Which tests should be performed?
In cases of azoospermia, we observe around 40% congestion in the channel. In such cases, tests related to the cause are required. Congenital absence of channels or congestion of channels due to infections may cause azoospermia. In these cases, we are able to obtain mature sperm cells. It is possible to have children, by retrieving sperms through congested vessels or if there is no channel, microinjection could be performed by obtaining sperms from the testicular tissue.
In cases of azoospermia, we observe around 60% of production malfunction in the testicles. In such cases, it might be harder to obtain mature sperms. These cases include:
- Hypogonadism; that is congenital problems in brain hormones
- Undescended testicle
- Production malfunction following chemotherapy/radiotherapy
- Individuals with Klinefelter’s syndrome
- Individuals with Y microdeletion (AZF-a, AZF-b or mostly AZF-c)
- Those who have had testicular infection called orchitis
- Those who have had testicular surgery
In these cases, live-mature sperm cells might not be obtained in sperm analysis. After this phase, hormones should be monitored and if necessary hormone therapy could be initiated. In cases of azoospermia, several techniques are used to obtain sperms.
TESE: sperm search under microscope by taking tissue samples from testicles
TESA: getting sperms from testicular channels through a needle. We are able to find approximately 30-40% live sperm cells in men by using these methods.
FAQs about azoospermia:
What is Azoospermia?
Many couples around the world suffer from infertility. Almost half of the patients who have consulted a doctor for infertility have low sperm counts. There should be at least 40 million sperms in the sample according to normal ranges. If there is no sperm, we call it azoospermia.
What are the Reasons for Azoospermia?
2 main causes of azoospermia are obstruction of ducts or lack of sperm production. Obstruction is mainly due to cysts, lesions, infections or surgeries. Sperm production problems may be due to varicocele, cryptorchidism, infection, genetic disorders, hormonal problems or idiopathic.
How is Azoospermia Treated?
Firstly, it is important to determine whether the patient has azoospermia. This can be understood by using a method called spermiogram. If no sperm cells are seen after 2-3 spermiograms that are examined every 2 weeks, the diagnosis of azoospermia is made. Initial follow up should include basic hormonal profile, testicular sonography, Y microdeletion analysis and karyotyping. After analysis, treatment model based on the diagnosis should be applied.
Microscopic TESE method is the biopsy of both testicles in order to find mature spermatozoa. By magnifying testicular tissues, biopsy specimens are obtained from testes. Microscopic TESE is almost the most successful biopsy method and may reveal sperms up to 50%.
In most cases there is a sperm. However, in some cases where sperm cannot be found, tissue samples are sent for pathological diagnosis.