Azoospermia (nil sperm count) is an uncommon yet severe fertility concern in men. Out of 100 infertile men, about 10 to 15 men experience infertility due to this condition only.
This article is a comprehensive guide that will talk through this condition, its types, causes, symptoms, diagnosis, treatments and preventions. The article also intends to lay out the condition and the right approach for couples to advance towards its treatment and still be able to have a child with the condition.
What exactly is Azoospermia?
As a man reaches an orgasm, his penis releases a thick, white fluid called semen. This semen also contains sperm cells that produce in the testicles and combine with the semen at the time of ejaculation.
Azoospermia (nil sperm count) is the condition where there is an absolute absence of sperm in a man’s ejaculated semen. Though this condition is quite uncommon in men, it affects about 1 percent of the overall male population and contributes to almost 10-15 percent of male infertility cases.
You would not probably have heard of “nil sperm count”, but would have heard of “low sperm count”. Both these conditions are somewhat similar, however “nil sperm count” is an extreme case where semen contains no sperm at all. People also often assume that having a genetic child is not possible for an azoospermic man, but it is not always so. With reproductive assistance, some azoospermic men can have a genetic child as well.
Aspermia vs Azoospermia
Though they are both different reproductive conditions, azoospermia is often misunderstood as aspermia. One is the absolute absence of sperm in the semen, however the other condition aspermia is absolute absence of semen in the ejaculation.
When a man ejaculates, he releases semen and contains sperm (that is produced in the testicles). However in the case of aspermia, when a man ejaculates, there is no release of semen at all. The condition is therefore also called dry ejaculation and also contributes to male infertility.
How many types of Azoospermia are there?
There are primarily two common types of this condition in men.
Obstructive azoospermia is classified as post-testicular. It is when your testicles are producing sperm as normal but some blockage or ejaculation dysfunction obstructs the sperm from combining with semen and ejaculating upon orgasm.
Non-obstructive azoospermia is classified as pre-testicular or testicular. It is pre-testicular when your testicles are healthy but are not capable of producing sperm due to poor levels of hormones responsible for the production of sperm in the testicles. And, it is testicular when there is a functional or structural abnormality in the testicles due to:
What are the common Azoospermia causes?
Causes of Azoospermia (nil sperm count) differ with the type of the condition, whether it is obstructive or non-obstructive. Common causes are:
- A blockage in epididymis or vas deferens: As the testicles produce sperm, it travels from the epididymis to vas deferens where it mixes with semen in the seminal glands and ejaculates on orgasm. Any blockage in epididymis or vas deferens will prevent the sperm from reaching seminal glands.
- A vasectomy: A vasectomy is a medical procedure that a man can undergo if he chooses to not have children. It involves cutting and sealing the vas deferens tube to prevent sperm from entering the semen on ejaculation. Vasectomy is reversible.
- Retrograde ejaculation: It is an ejaculation dysfunction in which the semen falls back into the bladder rather than releasing from the penis on orgasm.
- Past surgeries: Certain surgeries such as testicular or scrotal surgeries, groin hernia repairs, prostate surgeries, and surgeries for rectal or testicular cancer may prevent the sperm from ejaculating by creating obstruction.
- Inflammation of one or both testicles, epididymis or urethra: Orchitis (inflammation of testicles), epididymitis (inflammation of epididymis), and urethritis (urethra) may obstruct the sperm to enter the seminal glands and ejaculate on orgasm.
- Groin strain: A groin strain or pull is often an injury caused while sprinting, cycling, skating, and playing certain sports. Groin muscle becomes pulled and might affect the reproductive function including sperm production as well.
- Genetic abnormalities such as Klinefelter syndrome, Y-microdeletions, and Kallmann syndrome: Klinefelter syndrome is a genetic anomaly in which a man has an extra X chromosome. Y-microdeletions is another anomaly that disturbs sperm production in men. And, Kallmann syndrome causes delayed or no puberty. All these genetic anomalies affect sperm production.
- Treatments such as radiation therapy or chemotherapy: Radiation therapy to the reproductive organs or around them can lower testosterone levels and affect sperm production. Chemotherapy damages sperm cells.
- Hormone imbalances: Your brain and testicles are responsible for producing certain hormones that create sperm. If these hormones are imbalanced, sperm production will be affected too.
- Certain medications: Certain medications such as alpha-blockers, antidepressants, 5-alpha-reductase inhibitors, narcotics, beta-blockers and anti-epilepsy medicines affect sperm production.
- Varicocele: It is the condition when veins in the scrotum swell. It affects sperm production as a result of increased temperature and poor blood and oxygen supply in the testicles.
How to find out if you have Azoospermia?
Azoospermia (nil sperm count) is not generally associated with any noticeable symptoms or signs. However, in some cases, a man may experience other related reproductive disorders that might hint at the condition.
- Difficulty in getting and/or maintaining an erection
- Poor sex drive
- Discomfort, swelling or pain or development of lumps in one of both testicles or around the testicle area
However, most men do not find out about nil sperm count until they start to experience pain or discomfort in or around the testicles. Or, until they are planning for a child but are not able to induce conception. Though the above mentioned conditions may hint at azoospermia, proper diagnosis will be required to confirm the condition.
How is Nil sperm count diagnosed?
Commonly, doctors diagnose nil sperm count through a semen analysis test. A man will be asked to submit his sperm samples, keeping in mind that he has refrained from ejaculating at least 2-5 days prior to ejaculating for the sample. This refraining time frame is considered important so that his testicles could get sufficient time to produce the sperm.
However, except for a semen analysis test, doctors can order other tests to confirm the condition as well. These tests include:
- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) test
- Testosterone assessment
- Genetic screening
- Screening of reproductive organs through x-rays or ultrasounds
Available Azoospermia treatments and their cost
Treatment of azoospermia (no sperm count) and its cost depends on the cause of the condition. After a proper diagnosis, a doctor may consider one of the following treatment approaches.
Obstructive azoospermia treatments
If the condition is developed due to an obstruction, a blockage, one of the following appropriate surgical options can be considered to remove the blockage.
- Microsurgery: If the obstruction is in epididymis or vas deferens, microsurgery can be performed to unblock or reconstruct affected tubes.
- Endoscopic surgery: If the obstruction is in the ejaculatory duct, endoscopic surgery can be performed to repair the blockage.
Even if surgical unblocking or repairing is not possible, sperm extraction can be done from the testicles, epididymis or vas deferens for assisted conception treatments such as IUI (intrauterine insemination) and IVF (in-vitro fertilization). This extraction technique is called microscope-assisted testicular sperm extraction (microTESE) which involves sperm mapping and microscopic extraction.
Non-obstructive azoospermia treatments
If the condition is developed due to your body’s inability to produce sperm, one of the following options can be considered to restore sperm production.
- Hormone therapies: Poor sperm production can be improved with the help of certain hormones such as clomiphene, follicle-stimulating hormone (FSH), luteinizing hormone (LH), anastrozole, and human chorionic gonadotropin (hCG).
- Varicocelectomy: Varicocele is when veins in the scrotum swell. Varicocelectomy is a surgical procedure to repair varicoceles and restore male fertility.
Can Nil Sperm Count be prevented?
Though it is not possible to prevent azoospermia caused by a blockage or that is genetic, some cases that happen due to certain medicines and injuries can be prevented. Make sure that:
- You restrain from doing physical activities that might cause injuries, strains or pulls in the reproductive organs or around them.
- Discuss pros and cons of the medicines you are prescribed. Certain medicines impair sperm production.
- Having your reproductive organs exposed to radiation can impair sperm production, avoid that.
- Having your testicles exposed to high temperature for longer periods such as for steam baths can impair sperm production, avoid that.
The bottom line
However azoospermia (no sperm count) is a rare condition in men, it is severe and affects a male’s ability to induce conception and have a genetic child. Where in cases of oligospermia (low sperm count), a man can still have a genetic offspring with clinical conception assistance, having absolute absence of sperm in semen makes a man completely infertile.
The condition may occur due to several obstructive or non-obstructive causes, there are effective treatments available for them already. There are surgeries to remove obstruction, medicines to restore sperm production and other techniques such as sperm extraction to retrieve sperm and help a couple to have a child through IUI or IVF treatment.