Becoming a father has never been considered a challenge, but it is when man contributes to attributes of infertility. The incidence of male infertility is no new, in fact, it’s increasing with the emergence of poor and stressful lifestyles. Often, a complete lack of sperm production or issue in delivering sperm during ejaculation could be one of the reasons behind male infertility. The condition is known as Azoospermia.

Azoospermia is quite different from a similar term, ‘low sperm count,’ which could also affect male fertility. Azoospermia is referred to as having ‘no sperm count.’

What is azoospermia?

A condition in which there’s no measurable sperm found in a man’s semen during ejaculation is known as azoospermia. A hormone imbalance or a blockage of sperm movement can cause azoospermia. 

What are the symptoms of azoospermia?

It’s challenging to experience any symptoms of azoospermia until one may put effort into conceiving and get unsuccessful. Other signs related to hormonal imbalances or genetic chromosomal conditions may occur, which include:

• Low sex drive
• Erectile dysfunction
• Swelling, lump, and discomfort around the testicles
• Decreased hair on the face and body

However, these signs may indicate the underlying causes of disrupting fertility in males. 

What causes azoospermia?

Various conditions, including genetic disorders or reactions from chemotherapy, radiation, recreational drugs, and anatomical abnormalities such as varicoceles or absence of the vas deferens on each side, could be the reason behind azoospermia. 

Vasectomy is the most apparent cause of azoospermia in men, which prevents sperm from joining other fluids in the ejaculate. Generally, the factors contributing to the condition remain idiopathic, like genetic conditions, poor testicular development as a child, or exposure to toxins.

Types of Azoospermia

Most men have nonobstructive azoospermia making it a common type of azoospermia. Severe spermatogenesis defects often occur due to primary testicular failure or dysfunction, leading to cause non-obstructive azoospermia.

There are mainly two types of azoospermia:

• Obstructive Azoospermia

A type of azoospermia where sperm is produced but blocked from reaching the ejaculate means no measurable amount of sperm in the semen. This blockage can be found in the epididymis, vas deferens, or elsewhere along the reproductive tract. The blockage may occur due to injury, infection before surgery, or a genetic abnormality.

• Non-obstructive Azoospermia

As discussed, non-obstructive azoospermia is not produced at all due to the structure or function of the testicles. It can occur due to hormonal causes, past infections, injury, twisting of the testicles, congenital or genetic abnormalities, or a varicocele. 

Diagnosis – Testicular Sperm Aspiration (TESA) 

 In Kenya, we are equipped to diagnose Azzospermia through the advanced diagnostic method, TESA (Testicular Sperm Aspiration). During the procedure, a fine needle is passed into the testicles under anesthetic. A tiny amount of tubules is removed from the seminiferous tubules (a network of small tubes inside the testicles where sperm are produced). These tubules are then processed in the laboratory and checked for the presence of sperm, which can either be used to fertilize eggs or frozen.

In TESA, sperm retrieved from the seminiferous tubules is less mature and less motile than sperm found in ejaculated seminal fluid. There is a specialized form of IVF, ICSI (Intracytoplasmic sperm injection), which is required to achieve fertilization with retrieved sperm. 

Ways of Treatments for Azoospermia in Kenya

There are different ways to treat different types of azoospermia. 

Obstructive Azoospermia

In this, hormonal medications or treatment may help initially if the underlying cause is low hormone production. Other ways could be performed through surgery or non-invasive procedures where reconnecting or reconstructing tubes and ducts that restrict the sperm flow. 

Non-obstructive azoospermia

There is a possibility that non-obstructive azoospermia may not respond to medical treatment. However, that doesn’t implies that one cannot achieve pregnancy after the diagnosis. IVF (in vitro fertilization) or ISI (intracytoplasmic sperm injection) have changed the response to the condition. People can successfully conceive their biological child through such procedures, even if there are few sperm present in men’s testicles. 

We advise taking a consultation with a fertility specialist to receive counseling and a better understanding of the outcome. 

FAQs

• Are all cases of azoospermia have the same problems?

Ans. No, every man diagnosed with azoospermia has their own condition. Even with a similar volume and a similar pH, it may have different consequences.  

• What is a normal range of sperm count?

Ans. The normal range for the number of sperm per milliliter is between 15 million to 100 million. Below 10 million are considered poor, while a sperm count of 15 million or more may be acceptable (if motility and morphology are normal). 

• Can my partner get pregnant if I have Azoospermia? 

Ans. It’s tricky until you get diagnosed by a fertility specialist. When no sperm is found in the ejaculation, there is a chance (about 50%) that sperm in the testicles can be retrieved using IVF. We advise not to give up, as a handful of sperm in a man’s testicle can make a successful pregnancy.