When it comes to talking about infertility, there are still many people that think of it as a primarily female issue. This is far from true and thinking like this may actually hurt your chances of getting pregnant. When you don’t look into the health and fertility of both the male and female, you can miss out on treatment options that could help you conceive. If you and your partner have been trying to get pregnant for over six months, it might be time to start considering testing for both male and female infertility. Because of the lingering social stigma surrounding male factor infertility, it can be harder to find resources on possible causes and treatments. However, once you talk to your doctor about male fertility, you can start to determine what is causing your infertility. Then, you can figure out the best way to treat it. For males that are trying to conceive, a low sperm count is one of the most common causes of infertility. For some men, it goes even farther than that. Azoospermia is a medical condition that means that you have no sperm at all in your semen. This diagnosis may sound scary, but it doesn’t have to mean that you won’t be able to conceive.
What is azoospermia?
About 10-15% of men experiencing male factor infertility experience some form of azoospermia, making it one of the most significant causes of male factor infertility. There are two different types of this condition and each has its own unique causes and treatment options.
Obstructive azoospermia means that your sperm production is normal, but that you have a blockage somewhere between your testes and your urethra that prevents your sperm from reaching the semen during ejaculation. Men experiencing obstructive azoospermia often notice a reduced semen volume when they ejaculate. Obstructive azoospermia is often the easiest type of azoospermia to treat and, after treatment, men with obstructive azoospermia tend to see improvements in sperm count and overall fertility.
The other type of azoospermia is called nonobstructive azoospermia. This means that your sperm production is reduced to the point that sperm cannot be detected in your semen. In some cases, it can mean that your testes aren’t producing sperm at all. Even if this is the case, you still have options. In fact, many causes of nonobstructive azoospermia can be reversed or treated.
What can cause azoospermia?
Like many factors that can contribute to infertility, the cause of your azoospermia may be traced to a variety of genetic, physical, and environmental causes. Some of these causes are easily treated, or may even be preventable, while others can require more extensive testing or surgery.
Common causes of obstructive azoospermia can include:
- Vasectomy or prostatectomy
- Cystic Fibrosis
- An obstruction or missing connection somewhere in the reproductive system, including the epididymis and vas deferens
- Infection in the reproductive tract, including the prostate and testicles. These infections may include venereal diseases such as chlamydia.
- Testicular injury or trauma
- Growth of cysts in the reproductive tract
Some common causes of nonobstructive azoospermia are:
- Side effects of certain medications and drugs, especially chronic use of narcotics
- A history of testosterone replacement therapy
- Radiation and chemotherapy—These can cause hypothalamus or pituitary disorders that affect the production of sperm.
- Varicoceles—Varicoceles occur when the veins in your scrotum become enlarged.
- Genetic abnormalities.
- Diabetes, cirrhosis of the liver, and kidney failure.
- Kallmann syndrome—This genetic disorder causes low levels of gonadotropin-releasing hormone (GnRH), making it harder for the pituitary gland to secrete the hormones needed for healthy functioning of the reproductive organs.
- Testicular conditions, including a complete absence of testicles (anorchia) and testicles that haven’t dropped into the scrotum (cryptorchidism)
- Testicles that fail to produce fully mature sperm cells (spermatogenic arrest)
Knowing the causes of azoospermia may help you treat or prevent the condition. For example, if possible, you should avoid exposure to radiation and activities that could injure your reproductive organs while trying to conceive. Additionally, research the side effects of any medications that you are taking and make sure that they won’t impair your sperm production.
How do I know if I have azoospermia?
Though some of the conditions that can cause azoospermia may have physical symptoms, the condition itself will not affect your overall health in a noticeable way. If you have been struggling to conceive and suspect that any of the above factors may be negatively impacting your sperm production, ask your doctor for a semen analysis. Your physician can test your sperm for a variety of characteristics, including your sperm count (the concentration of sperm in your semen). Your doctor will probably recommend two rounds of semen analysis tests to positively confirm if you have azoospermia. If you do find an absence of sperm in your semen, the next step is to find out why.
Your physician will look at your medical history, including medications, surgeries, injuries, and even childhood illnesses. They will also look at lifestyle factors that may affect your sperm production, as well as any family history with azoospermia. Additional tests, including bloodwork and imaging tests such as MRIs, may also be used to determine the cause of your azoospermia.
Your physician may monitor your hormone levels, specifically those of follicle-stimulating hormone (FSH) and testosterone. FSH and testosterone work together to regulate sperm production in the testes. Low levels of testosterone and high levels of FSH can indicate reduced sperm production.
Once you find out what is causing the lack of sperm in your semen, you can start discussing your options, including treatment methods and assisted reproductive technologies.
Can azoospermia be treated?
Being diagnosed with azoospermia doesn’t have to decrease your chances of conceiving biologically. Many causes of azoospermia are reversible and can be fixed with various levels of treatment. For example:
- Hormone treatments may be possible if abnormal FSH or testosterone production of is the cause of your azoospermia. However, you should not try testosterone replacement therapy without talking with your physician, as this can actually decrease your sperm production even further.
- If medication or recreational drug use is causing azoospermia, removing that cause may be enough on its own to help your testes start producing sperm regularly again.
- In cases of obstructive azoospermia, treatment often involves creating a pathway for sperm to reach the semen. This can be done through surgical removal of the obstruction or reconstruction of the obstructed ducts. After this pathway is created, many men experience increased sperm counts.
If you remove the factor that’s causing your reduced sperm production, your sperm count should noticeably increase in about two months. It’s true that you produce up to several million sperm each day, but it takes about 64 days for sperm to mature enough to be released during ejaculation. So, if you suspect that you’re doing something that could lower your sperm count, it’s important to make changes as soon as possible.
If your testes are producing living, healthy sperm, retrieving that sperm for use in assisted reproduction, such as in vitro fertilization, may be an option. This procedure can be performed alone or as part of a testicular biopsy. Most commonly, sperm retrieval is performed by inserting a needle through the scrotum to collect sperm from the epididymis. However, sometimes a small incision may be needed, depending on your medical condition and doctor’s recommendations.
If you have nonobstructive azoospermia, genetic testing and counseling are often recommended to diagnose the cause of your condition, as well as determine the presence of any genetic risks that could potentially be passed on to your children. However, even if the cause of your azoospermia is genetic there is still a chance that you will be able to conceive biologically, either naturally or through assisted reproductive technologies.
Getting an azoospermia diagnosis doesn’t have to be a bad thing. Knowing the cause of your male factor infertility means that you’re one step closer to finding the treatment that can help you conceive. Your physician will work with you to either fix or reverse the reason for your low sperm count, or to collect your sperm to be used in assisted reproductive methods. Opening communication with your physician about your azoospermia is the best way to increase your chances of getting pregnant.