With the decline in sperm concentration over the past 50 years, it’s no wonder why more and more men experience fertility issues. Azoospermia, or the complete absence of sperm in the semen, is the most severe sperm problem which affects 15% of infertile men.
If you’re struggling to conceive as a couple, this condition might be the cause. Here we focus on treatment for azoospermia and how to increase your chances of becoming a dad.
The zero sperm shock
Many men with fertility problems do not have the opportunity to see a specialist in male (in)fertility and, therefore, the issue remains not fully investigated and counselled.
Another problem is that male factor infertility is not widely understood and is surrounded by many cultural biases. Infertility in men is often perceived as “weakness” or “lack of masculinity”.
Therefore, discovering that your swimmers are not in sufficient numbers or are not present at all in the ejaculate may come as a surprise.
Azoospermia in short
Zero sperm count in the ejaculate is referred to as azoospermia. Azoospermia may be caused by a variety of diseases or conditions and is often associated with infertility.
Sometimes there aren’t really any symptoms you’d notice. Men with azoospermia may not have any difficulties with sexual activity, and their semen may look normal to the naked eye. The only way to find out whether you have azoospermia is through fertility evaluation.
Taking the first step: semen analysis
The first step to determine whether there is zero sperm is to undergo semen analysis testing.
Semen analysis is the most common male fertility test. To perform a clinical sperm test, you need to collect a sperm sample in a sterile plastic container and give it to the diagnostic laboratory for examination. In the lab, the sample will be examined under a microscope to evaluate the sperm’s count, movement and shape. The semen is also checked for infections.
The semen analysis test can also be purchased over-the-counter (available at most pharmacies) and used at home. However, at-home options give only a partial answer to the problem.
If your test result shows a zero sperm count, you will probably have to perform the test twice as semen parameters can fluctuate. The repeat test is normally performed three months after the initial test.
After reviewing your full medical history, further testing may be recommended, including:
- Physical examination
- Hormone tests (e.g. testosterone, follicle-stimulating hormone)
- Genetic testing
- X-rays or ultrasound of the reproductive organs (e.g. problems with the shape and size, tumours, blockages, inadequate blood supply)
- Imaging of the brain to identify disorders of the hypothalamus or pituitary gland
- Biopsy of the testes (collecting issue from the testicles for laboratory examination)
Diagnosis: the two types of azoospermia
Depending on what’s causing the sperm problem, there are two types of azoospermia: obstructive and non-obstructive.
Obstructive azoospermia is caused by a blockage (obstruction) of the male reproductive system, although sperm production is completely normal. Causes of obstructive azoospermia include vasectomy, infections, genetic conditions like cystic fibrosis, anatomic abnormalities and unknown causes.
Non-obstructive azoospermia is a result of impaired sperm production and subsequent lack of mature sperm in the semen. Causes of non-obstructive azoospermia include genetic conditions like Y chromosome deletion (missing gene(s) in the Y chromosome), radiation and toxins, medications, hormone imbalances and varicocele.
Azoospermia treatment options
Azoospermia may be the worst diagnosis you ever got and the hardest thing to accept and cope with. The good news is that you can have zero sperm count and still have biological children. With the help of assisted reproductive technology, and sometimes with the help of other treatments, some men with azoospermia can have genetic children.
If your azoospermic problem is a result of an infection/inflammation of the testicles, prostate, or reproductive tract, the infectious disease should be treated first before proceeding with other treatments.
Surgical repair is considered in cases of blockages, severed (or missed) connections, varicoceles and retrograde ejaculation.
If surgery corrects obstructive azoospermia and sperm levels are normal, natural conception may be possible. However, if sperm levels are still abnormal after surgery, other options will be considered.
If the problem is caused by hormonal imbalance, it can be treated using medication or fertility (hormonal) drugs. Hormone therapy can stimulate sperm development. This allows healthy sperm cells to be extracted via a testicular biopsy and used for fertilisation in IVF treatment.
In vitro fertilisation (IVF) can be successful with very low numbers. We only need one sperm to fertilise an egg. Chances of fertilisation are highest with ICSI (injection of single sperm cells into each egg), a procedure performed at EuroCARE IVF as part of IVF — at no extra cost.
Pregnancy with non-obstructive azoospermia can be achieved through the use of surgical sperm retrieval method (e.g. TESE, microTESE) and IVF with intracytoplasmic sperm injection (ICSI). This treatment is only effective if a man produces viable sperm.
Treatments for obstructive azoospermia may include surgery of the obstructed semen ducts and surgical sperm retrieval (e.g. TESE, micro TESE) combined with intracytoplasmic sperm injection (ICSI).
PGD & PGS testing
PGD (preimplantation genetic diagnosis) technology improves the likelihood of a successful pregnancy and birth for patients at risk for passing on an inherited genetic disease to their child(ren).
If you are of advanced age, you may want to consider PGS (preimplantation genetic screening) to check the embryos for chromosomal abnormalities before embryo transfer.
A condition called testicular failure is common in men with azoospermia. It is caused by the inability of the testicles to produce sperm and the male hormone testosterone. For men diagnosed with this condition, IVF with sperm donation is usually advised.
Our IVF specialists advise men to get their sperm checked — whether you want to have kids now or in the future.
Age is a major factor that causes a natural decline in sperm count and quality. Luckily, there are simple steps you can take to prevent infertility. One of those steps may be to freeze sperm while you’re still young. Frozen samples are thawed and used in future IUI or IVF treatments to attempt conception.
Male infertility and mental health
Infertility may have a huge psychological toll on men diagnosed with reproductive disorders. In fact, many men reported that it was the most upsetting experience of their lives. Men with infertility are prone to feel anxious or depressed as those diagnosed with cancer, hypertension, or recovering from a heart attack. The distress may be especially severe for those going through multiple rounds of fertility treatment.
Many patients cope on their own or they seek support from friends, family or online support groups. Some may need additional help, and that is perfectly fine.
Here are some ways to find the support you need to deal with the issue:
- Counselling (especially counselling with an infertility specialist)
- Psychotherapy (such as interpersonal therapy which focuses on improving relationships or resolving conflicts with others, or cognitive behavioural therapy which identifies and changes unhealthy patterns of thought or behaviour)
- Relaxation techniques (such as mindfulness meditation, deep breathing, guided imagery, yoga)
- Medications (e.g. antidepressants, anti-anxiety medications)
Improving health before conception
Although some things are out of your control, there are several lifestyle changes you can make to improve your chances of becoming a dad. These include:
- Sleep enough hours (cutting back on sleep can lower testosterone levels and decrease sperm count)
- Avoid smoking, including e-cigarettes, weed and any products that contain nicotine
- Eat a balanced diet
- Consider doing a sperm DNA fragmentation test
- Consider a scrotal ultrasound and consult with a urologist or infertility specialist
- Get your hormones checked
- Do genetic testing
- Take supplements (antioxidants may improve sperm count and quality)
- Avoid exposure to environmental toxins
Let us help you navigate your infertility journey!
Azoospermia is a common male fertility issue which may cause significant distress in many men. No sperm in the semen does not necessarily mean nothing can be done. In fact, the majority of our patients struggle with sperm issues.
That’s why we at EuroCARE IVF have developed multiple treatment approaches to achieve pregnancy, even in the most difficult cases. Before you think it might be a game over for you, explore the available treatment options for you and your partner. Schedule a FREE online video consultation with our infertility specialist now!