Azoospermia, or the complete absence of sperm in the ejaculate, is unfortunately not as rare as doctors and patients would like. Azoospermia is secretory, excretory and combined.
Types of azoospermia
Secretory azoospermia is when sperm is not produced in the testes at all. This happens with congenital developmental anomalies of the testicles or their complete absence, with cryptorchidism (testicles not placed down in the scrotum) and other abnormalities in the male reproductive system. However, the secretory azoospermia may also be extrinsic - it occurs with inflammation of the testes (orchitis) or their appendage (epididymitis) as a result of infection, hypothermia, radiation, alcoholism, vitamin A and E deficiency, varicocele and others.
Excretory azoospermia occurs with obstruction of the seminal ducts. Although sperm production is preserved in the testicles, doctors diagnose male infertility. Obstruction can be congenital, if there is a disturbance of the development of the genitals, both internal and external, and acquired, due to inflammation or injury of various parts of the reproductive system - from the testicle to the prostate.
Diagnostics
Diagnostics of azoospermia is extremely important for prognosing male fertility. With secretory azoospermia, the chances of having a baby are quite low, and with the excretory one quite high. First of all, it is necessary to conduct a spermogram. If sperm are not detected in the ejaculate, but single immature cells of spermatogenesis are found, then this is a sign of secretory infertility, and there is almost no chance of fertilization. If the ejaculate does not contain any cells related to spermatogenesis at any stage, it is most likely excretory azoospermia. In this case, you need to have a puncture of the testes to determine how high are the chances that they have sufficient amount of sperm to fertilize.
It is believed that fructose present in the ejaculate may be a fairly accurate diagnostic indicator of the type of azoospermia. Thus, a low concentration of fructose on the background of an acid reaction may indicate a congenital absence of seminal vesicles. In such cases, it is recommended to further determine the level of fructose in the seminal fluid and FSH (follicle-stimulating hormone) in the serum. If FSH is 50% higher than the upper limit of normal, it indicates secretory azoospermia.
At detection of an obstructive form of azoospermia the doctor evaluates chances of operative solution of a problem - carrying out of microsurgical intervention. However, the problem is complicated by the fact that with prolonged obstruction of seminal ducts there is a disturbance of sperm production in the testes.
In addition to azoospermia, there are cases when the ejaculate itself is absent. This is called aspermia and is the result of retrograde ejaculation. The sperm are then thrown into the bladder instead of erupting outside. Aspermatism is the absence of orgasm and ejaculation in a man due to some functional or neurological disorders. Both of these conditions are treated strictly individually.
Treatment
Testicle biopsy - a method of surgical diagnosis and treatment of male infertility.
Sperm may be absent in semen (the medical term for this condition is azoospermia) in two cases:
- when the sperm are not produced or mature properly in the testes;
- when sperm (an obstructive form of infertility) from the testicle and appendix do not enter the semen due to obstruction of the seminal ducts.
The causes of obstructive infertility are traumas, vasectomy, surgery for inguinal hernias, the presence of inflammatory diseases of the appendage of the testis or prostate, defects of the seminal ducts, STDs (gonorrhea).
Indications for biopsy:
- azoospermia (absence of sperm in semen);
- sperm collection for auxiliary reproductive technologies;
- suspected testicular cancer.
Types of biopsy:
- PESA - percutaneous (through the skin) aspiration (sampling) of sperm from the epididymis;
- TESA - percutaneous aspiration of the sperm from the testicular tissue;
- MESE - obtaining spermatozoa during open biopsy of the epididymis;
- TESE - obtaining sperm when performing an open testicular biopsy.
- mTESE - obtaining sperm when performing an open testicular biopsy using an optical magnification (microscope).
Aspiration (PESA, TESA) is performed without incision. A special needle with a syringe picks material containing sperm from the testicular tissue or testicular appendage, respectively.
An open biopsy (MESE, TESE) is a minor operation. The procedure is performed painlessly, at patient’s request - under general or local anesthesia with low-traumatic access. The scrotum skin is sewn with a cosmetic seam. The biopsy is performed at the in-patient department. On the same day, the patient may be released home or stay in the hospital for 1-2 days. Within 10 days after surgery, it is recommended to limit physical activity, exclude sexual intercourse.
The sperm that were obtained during the biopsy are frozen. They are further used in the program (ICSI - intracytoplasmic sperm injection). ICSI is an extracorporeal fertilization by the introduction of a single sperm directly into the egg.
Currently, new azoospermia treatments are being developed, but alas, they are undergoing laboratory testing and have not yet been implemented in clinical practice.
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