Normally, the testicles in a man’s scrotum produce sperms. The sperms flow through the male reproductive system to mix with fluid to form semen. Semen is the thick, white fluid released from the penis during ejaculation. Azoospermia is a major cause of male infertility. In this condition, a man’s ejaculate (semen) has no measurable sperm. Azoospermia may be present at birth or may develop later in life.

There are two types of azoospermia, needing different kinds of treatment:

Obstructive azoospermia: There is normal sperm production, but the reproductive tract is blocked. This means no measurable amount of sperms can get into semen. Obstructive azoospermia accounts for 40% of azoospermia (Wosnitzer and Goldstein, 2014).  

Non-obstructive azoospermia: This type is poor sperm production. Men do not produce enough sperms for a detectable amount to show up in their semen.  This can be due to genetic reasons, radiation or toxins (such as heavy metals, chemotherapy), certain medications, hormonal imbalances, or varicocele.

For obstructive azoospermia, microsurgery may be necessary, a delicate procedure that unblocks the reproductive tract. Often, minimally invasive techniques can be used. Thanks to recent advances in microsurgical approaches (and if necessary in combination with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI techniques) treatment outcomes are often excellent (Wosnitzer and Goldstein 2014). Additionally, sperm quality can be further enhanced by antioxidant treatment (Basar et al, 2006)

For non-obstructive azoospermia, treatment will depend on the identification of underlying reasons. Varicocelectomy is an option when varicocele impairs healthy sperm development. Other times, hormone treatment is advisable.  Lifestyle or medication changes may be necessary. In addition to that, several techniques are in the experimental stage, including spermatogonial stem cell transplantation, the use of adult and embryonic stem cells to develop mature gametes and gene therapy (Vij et al, 2018). Antioxidant treatment for 3 months may provide an additional benefit.

If none of these interventions produce the result desired, sperm extraction presents as an option to help men with very low sperm counts become biological fathers.

References

Başar MM, Kisa U, Tuğlu D, Yilmaz E, Başar H, Cağlayan O, Batislam E. Testicular nitric oxide and thiobarbituric acid reactive substances levels in obstructive azoospermia: a possible role in pathophysiology of infertility. Mediators Inflamm. 2006;2006(3):27458.

Vij SC, Sabanegh E Jr, Agarwal A. Biological therapy for non-obstructive azoospermia. Expert Opin Biol Ther. 2018 Jan;18(1):19-23. doi: 10.1080/14712598.2018.1380622. Epub 2017 Sep 19.

Wosnitzer MS, Goldstein M. Obstructive azoospermia. Urol Clin North Am. 2014 Feb;41(1):83-95. doi: 10.1016/j.ucl.2013.08.013. Epub 2013 Oct 15.