Azoospermia is characterized by the total absence of sperm in the semen. It is estimated that between 1-2% of the male population has been diagnosed with the condition.
In most cases, azoospermia occurs due to an obstruction in the vas deferens, responsible for carrying sperm from the epididymis (where the gametes mature and gain movement) to the urethra, the channel through which the semen passes. Because of this, the semen ejaculated during sexual stimulation does not carry sperm.
It is one of the main causes of male infertility, with about 20% of infertile men having the condition. Understand more about azoospermia and how it impacts man's fertile potential.
WHAT ARE THE TYPES OF AZOOSPERMIA?
There are two types of azoospermia: excretory (obstructive) and secretory (non-obstructive). Check out the characteristics of each group below:
​
Secretory (non-obstructive) azoospermia
Non-obstructive azoospermia results from processes that cause the testicles to fail to produce sperm. This testicular failure can, due to intrinsic processes, lead to hormonal changes—especially in the hormone FSH; or even when there is change in the testicles due to external factors.
​
Excretory (obstructive) azoospermia
In this case, obstructive processes occur in the vas deferens that prevent the semen from leaving. The patient has adequate sperm production (evidenced by testicular biopsy), but they do not reach the semen due to obstruction of the seminal tract.
WHAT ARE THE CAUSES OF AZOOSPERMIA?
The main causes of azoospermia they are:
​
Secretory (non-obstructive)
Endocrine changes;
Cryptorchidism, when one or both testicles do not descend into the scrotum;
Radiotherapy and chemotherapy, performed in the treatment of cancer;
Klinefelter's Syndrome, genetically oriented syndrome;
Y chromosome microdeletion;
Testicular infections (eg, mumps);
Trauma, which can be caused by accidents or injuries in the region.
Habits that are harmful to health, such as smoking and excessive consumption of alcoholic beverages and marijuana.
​
Excretory (obstructive)
Agenesis of the vas deferens and/or seminal vesicles;
Obstruction of the ejaculatory duct;
Retrograde ejaculation;
Urogenital infections, which can obstruct the semen-conducting channels;
Scrotal, inguinal or pelvic surgery (inguinal herniorrhaphy, vasectomy).
​
It is important to note that, in some cases, the origin of azoospermia it is idiopathic, that is, with no known cause. Therefore, periodic follow-up with a physician specializing in andrology is essential to make an early diagnosis.
WHAT ARE THE SYMPTOMS OF AZOOSPERMIA?
Unlike other male disorders, azoospermia it has no specific symptoms that help to alert the patient.
​
Overall, the main indication that the patient may have the condition is marital infertility. Infertility needs expert investigation to determine whether the difficulty in getting pregnant comes from female factors, male factors, or both.
HOW IS THE DIAGNOSIS CARRIED OUT?
Physical examination is the first method used when diagnosing the condition, especially when the patient's testicles are atrophied or shrunk. The andrologist physician, to complement the investigation, may request a spermogram.
​
According to the result of the spermogram, the doctor may request, to confirm his diagnosis, a histological evaluation of the patient's testicles. If there is an absence of spermatogenesis at different stages, the diagnosis of azoospermia.
WHAT ARE THE AZOOSPERMIA TREATMENTS?
The treatment chosen by the andrologist will depend on each case, respecting the patient's medical history and general health. See more details below:
​
Treatment of excretory (obstructive) azoospermia
In this case, the treatment indicated by the andrologist will aim to clear the seminal tract by specialized surgery. The surgical technique is chosen according to the patient's diagnosis.
​
Treatment of secretory (non-obstructive) azoospermia
The treatment of this type of azoospermia it is directly linked to the causes of the condition, and the physician must diagnose the patient and treat him according to the disease.
​
In cases where such methods are not applicable, the treatment consists of recovering sperm in the testicles by surgery, using a microscope, in order to recover sperm while preserving the integrity and function of the testicles. For this, the andrologist must use the microsurgical method of obtaining sperm by testicular biopsy (micro TESE).
​
Microsurgical Reconstruction
This procedure helps the patient diagnosed with azoospermia (absence of sperm) to overcome marital infertility. It is a surgery indicated when the condition was not caused by a vasectomy, that is, when the obstruction of the vas deferens has other causes than the vasectomy.
​
The surgical technique is also indicated for cases of azoospermia caused by congenital anomalies or as a consequence of inguinal hernia surgery performed in childhood.