What It Is
The complete absence of sperm in the ejaculate. Azoospermia can be caused by problems with sperm production or problems in the sperm delivery. Either the testes are simply not producing sperm (non-obstructive azoospermia) or they are producing sperm but unable to deliver it in the ejaculate (obstructive azoospermia).
Generally sperm production problems fall into these three categories: (1) hormonal problems (the testicles need pituitary hormones to be stimulated to make sperm. If these are absent or severely decreased, the testes will not produce sperm. Men who take androgens (steroids) either by mouth or injection for body building shut down the production of hormones for sperm production.), (2) testicular failure (the inability of the sperm-producing part of the testicle, the so-called seminiferous epithelium, to make adequate numbers of mature sperm. This failure may occur at any stage in sperm production for a number of reasons and may be caused by genetic abnormalities, which must be screened for), or (3) varicocele (dilated veins in the scrotum, caused by blood that does not drain properly from them. These dilated veins allow extra blood to pool in the scrotum, which has a negative effect on sperm production.
Sperm delivery problems are generally caused either by a problem with the ductal system that carries the sperm, or problems with ejaculation. The sperm carrying ducts may be missing or blocked.
Infertility. A couple does not achieve pregnancy despite repeated unprotected sex at the time of the woman’s ovulation.
How It's Diagnosed/Detected
A semen analysis (an examination of a sample of ejaculate) can quickly show whether or not sperm are present. But accurately diagnosing the cause of the condition (for proper treatment) is more complicated.
How It Affects Fertility (And Pregnancy)
Since sperm are required to fertilize an egg, obviously the absence of sperm makes conception impossible without medical intervention.
The treatment depends on the cause of the azoospermia. If the azoospermia is caused by a varicocele or a physical blockage, for instance, a surgical procedure can often correct the problem (see separate entry for Varicoceles).
If it’s found that sperm is being produced but not delivered to the semen, the sperm can often be harvested via testicular biopsy and used to achieve fertilization with IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection, in which a single sperm cell is injected into an egg for fertilization).
If the condition cannot be corrected, donor sperm may be the only option available for a couple to achieve pregnancy.
Azoospermia does not necessarily mean that a man will never father a biological child. Even if the problem cannot be surgically reversed, sperm harvesting and techniques like ICSI are helping many men with azoospermia to become fathers.
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