What is Azoospermia (No Sperm)?

The number of couples who want children and have difficulty conceiving is increasing day by day. The situation of not being able to get pregnant for a year despite unprotected intercourse is called "infertility" or "sterility". When infertility is diagnosed, it is necessary to examine the factors originating from women and men. More than half of infertility is due to men. Azoospermia, that is, no sperm in the semen, constitutes only 1% of infertility cases.

10-15% of male-related infertility is related to azoospermia, which is 'no sperm in the semen'. Azoospermia can have more than one cause. Some causes can be treated and fertility can be achieved, but some cannot be corrected and alternative solutions should be sought. Our aim is to find quality and live sperm cells and create embryos using in vitro fertilization to enable couples to have babies. In the last 15 years, a decrease in normal sperm values ​​has been observed worldwide. According to the European Association of Urology, values ​​​​of 15 million sperm/ml and above are considered normal.

What is Azoospermia?

The condition of not having any sperm in the semen (ejaculate, pre-ejaculate) that comes out during ejaculation in the male reproductive organs is called "azoospermia". It is very difficult for men diagnosed with azoospermia to have children naturally, because fertilization cannot occur because there is no sperm. Azoospermia can occur due to many different reasons. In some cases, azoospermia can be treated, while in some cases treatment is not possible and in this case pregnancy can be achieved using methods such as in vitro fertilization.

What should be the normal spermiogram values?

Sperm formation begins during puberty. Sperm count and process are important for fertility. Normal sperm count is 15 million/cc and above. Sperm count and motility can be affected by many diseases and conditions. Men with 'oligospermia', i.e. 'low sperm count', have a sperm count of less than 15 million/cc. In azoospermia, there is no sperm in the semen. The presence of semen, i.e. pre-ejaculate, does not indicate that there is sperm. When a sperm analysis is performed, no sperm may be found in the semen.

Causes of No Sperm in Semen

Azoospermia, the condition of no sperm in the semen, can usually be based on two main causes: Obstructive type and Non-obstructive type.

Obstructive Type Azoospermia refers to the condition in which sperm production occurs in the testicles but the produced sperm cells cannot be expelled through the ducts. When there is a blockage in the ducts that make up the reproductive system, such as the epididymis and vas deferens, sperm cells cannot mix with the semen. This blockage can be due to many different causes:

• Previous infections
• History of inflammation
• Trauma or injury
• Cyst formation
• Nerve damage
• Permanent birth control surgeries (vasectomy), during which the vas deferens duct is cut and sperm is prevented from exiting

Some genetic diseases: For example, cystic fibrosis gene mutation can lead to the absence of the vas deferens duct or blockage of the duct due to thick secretions.

In the case of obstructive azoospermia, there is a possibility of having children through methods such as in vitro fertilization, but it is difficult to have children naturally unless the underlying causes of this condition are treated.

Non-obstructive Azoospermia refers to the condition in which sperm production in the testicles is insufficient or no sperm is produced. This condition is usually caused by disorders in the structure or function of the testicle. We can list these causes as follows:

Genetic Causes: Klinefelter syndrome: In this case, a man's chromosome number is different from normal as XXY, which can lead to lack of sexual maturity, physical problems and learning difficulties.

Kalman Syndrome: This genetic disease is associated with olfactory disorders and can cause infertility if left untreated.

Y Chromosome Deletion: Deficiencies in the Y chromosome, which is responsible for sperm production, can cause infertility.

Hormonal Disorders:

• Hypogonadotrophic Hypogonadism
• Hyperprolactinemia
• Androgen Resistance.
• Retrograde Ejaculation:
• In this case, semen may re-enter the bladder.

Causes of Testicular Azoospermia:

A history of undescended testicles (cryptorchidism): The testicles may not have descended into the scrotum or may have been intervened late, in which case the testicles are affected by body temperature and the sperm in them may lose their vitality.

• Absence of testicles (Anorchia).
• Sertoli Cell Syndrome Only: The testicles cannot produce sperm.
• Mumps affecting the testicles (Mumps orchitis).
• Tumors, cancer.
• Torsion of the testicles: The testicle turning around itself, resulting in the interruption of blood flow to the testicles and gangrene.
• Some drugs or treatments: May affect sperm production.
• Radiotherapy and chemotherapy.
• Chronic diseases: Such as kidney failure, cirrhosis, diabetes.
• Varicocele: Varicocele is a dilated vein, and having varicocele in the testicles can negatively affect sperm production by causing the testicles to be at high temperature.

What Should Be Done When Azoospermia Is Detected?

If there are no sperm cells in the semen, a detailed medical history should be taken from the patient. Factors such as past febrile illnesses, undescended testicles or surgeries performed on the testicles, medication use, cancer treatment history, occupation, chemical exposure, smoking and alcohol use should be questioned. Then, the patient should be examined and hormone tests should be performed. If the underlying cause cannot be found, a goal-oriented approach should be adopted and in vitro fertilization should be utilized. The experience and quality of the gynecologist, urologist and embryology laboratory are very important in the success of azoospermia treatment.

What are the Symptoms of Azoospermia?

Male infertility shows its first symptoms when the couple cannot have a child despite unprotected intercourse for a year. This situation can lead to various emotional problems in men such as depression, sadness and feelings of failure. At this point, it is recommended to consult a specialist such as a psychiatrist and receive therapy if necessary.

In the case of azoospermia, this condition should be suspected in the presence of certain symptoms. These include symptoms associated with decreased testosterone production: fatigue, lack of sexual desire, depression, weight gain, and apathy. In addition, although not specific to azoospermia, the following symptoms should also be noted:

• Decreased sexual desire
• Loss of body hair
• Swelling around the genitals or a lump in the scrotum
• Tenderness in the genitals
• Abnormal discharge from the penis

If you or your partner notice any of these symptoms, it is important to see a specialist for evaluation. In particular, it may be helpful to seek the help of a urologist who specializes in male infertility or reproductive endocrinology.

How is Azoospermia Detected?

A spermiogram is a sperm test that analyzes the sperm in the semen given by the man through the ejaculation method and examines the presence, mobility and vitality of sperm. After the semen sample is taken, it is subjected to special processes in a laboratory environment, centrifuged and then examined under a microscope. Azoospermia can be diagnosed after the sperm test, but it would generally be more accurate to perform two sperm tests at two different times for this diagnosis. In addition, additional tests such as genetic tests, hormone tests, urinalysis and testicular biopsy can be performed to assist in the diagnosis and treatment process. After determining the cause of azoospermia, it is important to consult a specialist urologist for treatment planning.

Azoospermia Treatment

Azospermia can occur due to many diseases. Some disease conditions can be treated, but others cannot. The evaluation of the gynecologist and the examination of the urologist are very important

Since the causes of azoospermia and no sperm in the semen vary from person to person, the urologist must first take the patient's detailed medical history to find the cause. Previous surgeries (especially on the testicles), infections, and genetic predisposition of the patient are important. Then, the patient's physical examination should be performed by the urologist.

If the underlying disease causing azoospermia is known, this disease should be treated first. If there is a blockage in the ducts, these blockages can be opened with surgery.

If sperm excretion from the testicles due to nerve damage cannot be achieved, drug therapy or surgery can be performed for the nerve damage.

If the LH (Lutein-producing hormone) and FSH (Follicle-stimulating hormone) hormones secreted from the pituitary gland and involved in sperm production decrease, sperm production can be achieved with hormone therapy.

However, if there is an untreatable cause or if the cause of azoospermia cannot be found, sperm can be collected from the patient with a surgical method (sperm production can be achieved).

In men who do not have any sperm in the spermiogram (sperm test) and are diagnosed with azoospermia, sperm can be obtained surgically since the goal is to have children. However, the patient should first be examined by a urologist and then a decision on surgery should be made. The urologist will decide on the treatment method according to the patient's condition and sperm count. TESA (Testicular sperm aspiration), TESE (Testicular sperm extraction), Micro-TESE, PESA, Microinjection, MESA methods can be used for sperm production.

In the Micro-TESE method, the testicular tissue removed by surgery is examined in detail under a microscope and tissues with sperm production potential can be detected. After Micro-TESE, approximately 50-60% of patients have sperm. In patients with sperm, an embryo is created with the in vitro fertilization method or the sperm can be frozen for future use, i.e., a ‘sperm freezing’ procedure can be performed. In patients where sperm cannot be found with the Micro-TESE method, this tissue can be examined in detail or the Micro-TESE procedure can be tried again after 6 months.

Although not proven, ‘stem cell therapy’ is promising in men who cannot find sperm despite all treatments.

Tests applied in the treatment of azoospermia
A sperm test, namely a spermiogram test, is required to diagnose azoospermia. Azoospermia should be diagnosed by performing spermiogram tests at least at 2 different times. The tests that may be requested after azoospermia is diagnosed are listed below;

• Blood hormone tests (FSH, LH, Prolactin; testosterone..)
• Genetic tests
• Ultrasound to detect abnormalities in the reproductive system (transrectal ultrasound, ultrasound of the testicles or doppler ultrasound)
• Brain imaging (if pituitary disorders are suspected)
• Biopsy of the testicles (if necessary)

How Can Azoospermia Be Prevented?

When we consider the causes of azoospermia, it is not possible to protect against genetic diseases, however;

• Infections such as mumps and their effects should be protected,
• Early intervention and treatment should be provided in the presence of undescended testicles in the newborn,
• In case of varicocele in the testicles, a urologist examination should be performed and surgery should be performed if necessary,
• Radiation and chemical substances should be avoided,
• Smoking should be avoided,
• Medications that may harm sperm production should be avoided,
• Environments that will expose your testicles to high temperatures should be avoided,
• Activities that will harm your reproductive organs should be avoided.

What Does Cryptozoospermia Mean?

In patients diagnosed with azoospermia, sperm cells can be detected in rare cases with consecutive spermiograms (taking samples twice on the same day). These sperm cells can be frozen and used in in vitro fertilization treatment. This condition, called cryptozoospermia, refers to the occasional presence of sperm cells in patients with azoospermia.

In order to detect these rare sperm cells, patients need to have sperm tests done at intervals and carefully examined in laboratories. Instead of a simple spermiogram, detailed tests should be performed in experienced laboratories to correctly detect cryptozoospermia conditions.

What is Varicocele Treatment?

Varicocele is ‘vasodilation’. Vasodilation means high temperature. When this vasodilation is seen in the male reproductive organ (testicles), it can impair sperm function, number and quality due to high temperature. Azoospermia disease can be treated after varicocele surgery and sperm number and quality can increase.

Azoospermia Treatment Prices

Azospermia is a condition that causes male infertility and prevents conceiving if left untreated. The cost of azoospermia treatment depends on many variables, so it is difficult to specify an exact value. Since azoospermia is based on various causes, treatment options also vary. For example, in addition to surgical interventions such as microTESE, medications that may be recommended may also affect costs and may require a different cost calculation for each couple. The correct approach is to evaluate each couple's condition separately and determine the most appropriate treatment plan based on scientific data. In this way, the treatment process is managed in the most effective and appropriate way. Associate Professor Çiğdem Yayla Abide provides quality and the best service with the expert urologists she works with in her team, and applies treatment and in vitro fertilization methods.

Azospermia is a condition that causes infertility in men and means that there is no sperm in the semen. This condition may reduce the couple's chance of conceiving a child and may require treatment. Factors such as genetic diseases, hormonal imbalances, and varicocele may cause azoospermia. Treatment options may vary depending on the individual situation and in some cases, surgical intervention may be necessary. Sperm can be obtained with methods such as MicroTESE and in vitro fertilization can be used to have children. However, since each patient's situation is different, the treatment plan should be personalized. It is important to work with an expert team during the treatment process.

Frequently Asked Questions About No Sperm (Azospermia)