Low sperm count

What is azoospermia?

Azoospermia is the term used to describe a complete absence of sperm in the ejaculate (semen) or the failure of formation of spermatozoa.

What are the causes?

Azoospermia may be due to a number of factors. The three major causes for lack of sperm production are hormonal problems, testicular failure, and varicocoele.

1. Hormonal problems
   
   Pituitary hormones stimulate the testes to produce sperm. If these hormones are absent or decreased, the testes will not produce sperm in the optimum numbers. Androgens or steroids, taken either by mouth or by injection for body building, lowers the production of hormones necessary for sperm production.
   
   
2. Testicular failure
   
   This generally refers to the inability of the testicle to make adequate numbers of mature sperm. The failure may occur at any stage in sperm production for a number of reasons. The testicle may completely lack specific cells (the seminiferous epithelium) that divide to become sperm or the sperm may not be able to complete their development. The latter may be caused by genetic abnormalities, hormonal factors, or varicocoeles.
   
   
3. Varicocoele
   
   Varicocoeles are dilated veins in the scrotum (comparable to a varicose veins in the leg), which become dilated, and blood does not drain properly. This allows extra blood to pool in the scrotum, which has a negative effect on sperm production. This condition is the most common reversible cause of male infertility and may be corrected by surgery.

How is it diagnosed?

During the physical examination, the doctor may check the size and consistency of the testicles. The doctor may also measure levels of follicle stimulating hormone (FSH) and testosterone hormones.

Chromosomal evaluations and testing for Y-chromosome abnormalities can reveal a genetic basis for the absence of sperm. This may be the case in up to 10 percent of men with azoospermia.

An examination of the scrotum and epididymis may reveal signs of scarring from an old infection or congenital absence of the vas deferens (CAVD), the tube that connects the testicle to the ejaculatory ducts. CAVD is not all that rare; it is frequently seen in men who carry the cystic fibrosis (CF) genetic abnormality but do not have the disease.

A rectal examination determines whether there is prostate tenderness, which may imply scarring and blockage of the ejaculatory stream. If the ejaculate volume is low, the doctor will perform an ultrasound examination to look for a complete obstruction of the ejaculatory ducts. Finally, a biopsy of the testicle may indicate normal sperm production and confirm the diagnosis of blockage in the epididymis, vas deferens or ejaculatory ducts.

What is the treatment?

After a thorough evaluation is made, the doctor can determine whether hormone treatment (rarely beneficial), microsurgical correction of a blockage, or retrieval of sperm for in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) might offer the possibility of success.

ICSI is an acronym for Intracytoplasmic Sperm Injection. It is a form of Assisted Reproductive Technique wherein under high magnification the sperm is introduced within the cytoplasm of the egg. ICSI involves injection of a single sperm in to single egg in order to get fertilization. If there has been failure of IVF more than twice, those having low sperm count with low motility, and azoospermia, ICSI can be attempted with sperm collected surgically.

Most men facing semen analysis fear the diagnosis of azoospermia. They should be aware that the diagnosis does not necessarily mean that the testes produce no sperm or can never be made to produce sperm and that they will never have a biological child. Accurately diagnosing azoospermia is a complicated process, but one that is clearly necessary before treatment begins.