Azoospermia

Azoospermia is defined as the absence of spermatozoa in the ejaculate or simply absence of sperms in semen.

Azoospermia accounts for about one fifth of all cases of male infertility and in 10-20 % of abnormal Semen Reports.

The preliminary diagnosis of azoospermia needs to be followed by:

  • Confirming the diagnosis of Azoospermia
  • Determining whether it is Obstructive or non-obstructive
  • Assessing for the presence of correctable causes
  • Offering appropriate ART methods for conception

As a standard practice, one single report of Azoospermia cannot be considered conclusive and semen analysis has to be repeated. An abstinence of 2-3 days is recommended before repeating the test.

The World Health Organization has given guidelines for performing semen analysis before labeling a sample as Azoospermic. Please ensure these guidelines have been followed at the lab where this test is being performed. The guideline is available here for the purpose of reference: World Health Organization. WHO laboratory manual for the examining and Processing of Human Semen, 5th Edition.

If the diagnosis is confirmed, the next step is to determine the type of Azoospermia. Few additional tests like S.FSH, S.Testosterone, Ultrasound of testes may be prescribed to come to this conclusion.

There are 2 main types of Azoospermia: Obstructive and Non-Obstructive.

Obstructive Azoospermia

Obstructive Azoospermia means that sperms are being produced in the testes but fail to come out. In Obstructive Azoospermia, generally the testes are normal sized and FSH levels are normal. The semen sample typically does not contain Fructose ( Lab Report shows Fructose Negative).

Fructose is a source of energy that provides vitality and mobility to sperms.
The Fructose Test determines if fructose is present in the semen sample. This is only performed if no sperm is seen the in the entire sample.

This type is very easy to treat with either surgical reconstruction or surgical sperm retrieval using procedures such as TESA, TESE and then performing ICSI and IVF.

Obstructive Azoospermia has very good prognosis and pregnancy rates.

Non-Obstructive Azoospermia

Non-obstructive azoospermia means that sperms are not being produced in the testes as a result they are absent in the ejaculate. In this type, size of testes is usually reduced and FSH levels are either very high or very low. Such samples usually have normal volume and contain fructose (Lab report shows fructose positive).

Non-Obstructive Azoospermia can be because of multiple causes ranging from genetic to infectious to hormonal reasons. It is therefore important to diagnose the cause by carrying out further investigations like Hormone Studies (Blood Investigation), Ultrasound etc.
The prognosis of non-obstructive azoospermia will depend on the cause.

Testicular Biopsy is a definitive way to differentiate between Obstructive and Non-Obstructive Azoospermia and also identifies the subtype of non-obstructive azoospermia like Sertoli Cell only syndrome, Maturation arrest etc. The exact type and its implications will be best explained by the treating Andrologist.