Total Pageviews

Thursday, 6 March 2014

Azoospermia


When a man goes for a semen test, the one thing that he dreads the most either consciously or subconsciously is an abnormal result. It is impossible to fathom the blow to a man whose sperm test shows no sperms. The immediate reaction is that of despair and disbelief, of denial and anger.

The process starts in the millions of sperm producing tubules in the testes where special cells called Spermatogonia multiply and after a maturation process (that takes nearly 72 days) form sperms. The newly formed sperms are stored in a structure called Epididymis. During ejaculation the sperms are brought up and mixed with fluids secreted by the prostate and the seminal vesicles. This final fluid is semen. 

The condition where there is a total absence of sperms in the semen sample (checked on two occasions) is called Azoospermia. This condition is present in approximately 1% of all men and 10-15% of infertile men. This condition can either happen because there has been a damage or insult to the sperm production mechanism or because the sperms are being produced but unable to come out through the ducts and into the ejaculate (due to an obstruction or an anomaly in the ducts). 

Sperm production is under hormonal control and some endocrine conditions may impair sperm production. These are potentially correctable with medicines. In case of an obstruction, technology is available that involves retrieval of sperms from the testes and the couple can undergo IVF using these sperms. Where the sperm production machinery has started failing due to a disease or an insult (such as chemotherapy or radiation therapy), it may still be possible to use the few sperms that are present in the testes. In those men where there is no sperm production whatsoever, using donated sperms is the only option. This can be decided by an andrologist after appropriate hormone tests and a testicular biopsy to assess the situation.


3 comments:

  1. Dear Madam Doctor,
    There is an opinion that though testosterone levels are low, if FSH is in range, azoospermia can be corrected by medicines. Your opinion please.

    ReplyDelete
    Replies
    1. Typically in testicular failure FSH levels are higher than normal and testosterone levels are lower than normal. However, in some patients FSH can still be within range so we cannot plan management based on any one test. The best course of action can only be decided on after proper clinical examination and appropriate investigations.
      The failure of the sperm production machinery when it happens after puberty is not a rapid process. It occurs over a period of time during which the sperm count slowly decreases. There is a time when the sperms have disappeared from the semen but there are still some present in the testes and these can be used to procreate. As a fertility specialist, my focus is on identification of these men so that they do not lose out on a chance at having their own biological child.

      Delete
  2. Thank you, Ma'm!

    ReplyDelete