Azoospermia

Azoospermia

Treatment for Azoospermia may be possible if the type of Azoospermia and it’s cause can be diagnosed.

Azoospermia is defined as the absence of spermatozoa in the ejaculate or simply absence of sperms in semen or when no sperm is found in semen.

Azoospermia or Nil Sperm accounts for about 20% of all cases of male infertility and in 10-20 % of abnormal Semen Reports.

How do I know my Sperm Count ?

The easiest way to know your sperm count is to undergo a Semen Analysis test. You do not need any written prescription from an Infertility Specialist to undergo a semen analysis test at any pathology.

Routine Semen analysis test at Indore can be done at any standard pathology, however if you wish for Advanced Semen Analysis that uses special microscope to view the sperm morphology you should get it done from an IVF clinic .

My semen analysis report mentions Azoospermia ? What does that mean ?

When no sperms are seen in the semen sample even after centrifugation of the sample, the report mentions Azoospermia. Good andrology labs always confirm the absence of sperm by centrifuging the entire sample and checking each drop to confirm the diagnosis.

NilSpermTreatmentIndore

How is Azoospermia diagnosed ?

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.

 

What is the difference between Cryptozoospermia and Azoospermia ?

During the analysis of the semen sample where no sperms were seen initially, the lab technician will centrifuge the sample and test each drop of the sample to confirm presence of occasional sperms. If a few sperms are found in the centrifuged pellet of the sample, then such samples are reported as cases of Cryptozoospermia.

However if no sperms are seen even in the centrifuged sample,  the diagnosis of Azoospermia is confirmed. 

What is the difference between Non Obstructive Azoospermia  (NOA) and Obstructive Azoospermia (OA) ?

The next step for a lab technician is to determine the type of Azoospermia. Your IVF doctor may order for 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 Azoospermia and Non-Obstructive Azoospermia.

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).

What does Fructose test mean ?

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. If fructose is not present in the semen sample then it is a case of Fructose Negative Azoospermia or Obstructive Azoospermia.
 
This is only performed if no sperm is seen the in the entire sample.
 

Obstructive Azoospermia 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

Azoospermic samples that are fructose positive may be case of 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.

What is the treatment of Azoospermia?

Depends on the type of Azoospermia, if it is a case of Obstructive Azoospermia, sperms can be surgically retrieved in order to achieve parenthood.

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.

Who is the best doctor for azoospermia treatment or Nil Sperm treatment ?

IVF Specialists who are Male Infertility Specialist are called Andrologist. However, Infertility and the best IVF Specialists are trained in reproductive medicine and can give preliminary treatment for men dealing with Azoospermia or Nil sperm.

Men often find it difficult to talk with female gynecologist to discuss their problem. Our reproductive medicine specialist Dr. Gajendra Singh Tomar is the best IVF specialist in Indore and is a very empathetic listener, which makes treatment for both partners very easy.

This short video shows how Azoospermia Report is confirmed in our Andrology Lab.

You might want to read