Azoospermia is the absence of vital or motile sperm in the male ejaculate, which can be attributed to different causes and disorders and is associated with infertility of the male. Azoospermia may be temporary or permanent, depending on the underlying causes.

What is an azoospermia?

In most cases, there is a disruption in the synthesis, development or dissipation of sperm from the testis (testis). Spermatogenesis (sperm formation) may be temporarily disturbed due to overheating of the testis (hot baths, tight underwear).
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Azoospermia is a fertility disorder (fertility disorder) in which the male ejaculate lacks living or motile sperm (mature sperm).

In a healthy man, the ejaculate has more than twenty million mature sperm per millimeter (sperm concentration), with at least half of the sperm having normal sperm mobility (motility) and sperm morphology (appearance, shape).

In azoospermia, these three criteria (sperm concentration, mobility and morphology) are disturbed and the affected man is considered infertile. In general, a distinction is made between temporary (temporary) and permanent (permanent) azoospermia.

causes

Azoospermia can be attributed to various causes. In most cases, there is a disruption in the synthesis, development or dissipation of sperm from the testis (testis). Spermatogenesis (sperm formation) may be temporarily disturbed due to overheating of the testis (hot baths, tight underwear). Also, the use of drugs (cimetidine), alcohol, nicotine and contact with toxic substances (such as pesticides) or cancer therapy can negatively affect spermatogenesis.

Inflammation of the testicles (orchitis) or epididymis (epidymitis) can also lead to a disorder of spermatogenesis. As a result of a gonorrhea (gonorrhea) related epidymitis, the vas deferens may permanently adhere (occlusive zoospermia).

In addition, orchitis can trigger permanent azoospermia as a result of postpubertal mumps infection. In addition, azoospermia may be genetic (Klinefelter syndrome) or, more rarely (1-8 percent), hormonal disorders (sexual hormone-related disorders).

Symptoms, complaints & signs

Azoospermia generally leads to infertility in a man. This is shown by the fact that the partner can not get pregnant after intercourse, so that the desire to have children of both parties can not be met. However, as a rule, azoospermia does not have a negative impact on the health or life of the person affected, so there is no reduction in life expectancy and, in most cases, no other symptoms or complications.

Azoospermia, however, often causes sufferers and their partners depression or other mental complaints and moods. A tension between the partners can also occur and have a very negative impact on the relationship. Should a tumor be responsible for azoospermia, the further course and the possible complaints and complications depend very much on the exact position and expression of the tumor.

Eventually, this will also reduce the life expectancy of the person concerned. If azoospermia is caused by a high intake of nicotine or alcohol, the high level of consumption usually has a very negative effect on the overall health of the person affected and can also lead to various complaints.

Diagnosis & History

To diagnose and clarify the causes of azoospermia, in addition to a thorough anamnesis, different tests are required. As part of a spermiogram (microscopic sperm analysis), the subject's ejaculate is analyzed for sperm concentration, mobility and morphology.

If less than 20 million sperm per millimeter are detected in the ejaculate, oligozoospermia is present but no sperm are observed, azoospermia. For the explanation of the causes of azoospermia additional investigations are necessary. These include genetic and hormonal tests as well as antibody screening, permeability testing of the spermatic duct (patency) and a testicular biopsy.

In a temporary azoospermia normal spermatogenesis can usually take place again after the elimination of the triggering factors. In permanent azoospermia, which is associated with permanent infertility (infertility), the disease can be psychologically stressful in the presence of a desire to have children, so that a psychological care may be required.

complications

In most cases, azoospermia causes infertility of the patient. This can lead to severe mental health problems, so sufferers suffer from depression and reduced self-esteem. Inferiority complexes can also arise through azoospermia.

Not infrequently, the partners are also affected by the disease. Not in all cases, however, this occurs permanently, so that a cure can occur. Unfortunately, a causal treatment of azoospermia is not possible in all cases. If the person is taking high levels of nicotine or alcohol, it may be due to the disease.

However, it can not be guaranteed that azoospermia will disappear on its own if withdrawal is carried out. Likewise, certain medications can cause this disorder. Overheating of the testes may also be responsible for azoospermia, with azoospermia occurring only temporarily in this case.

If the transport routes are glued, they can be solved with the help of surgical intervention. If complete treatment is not possible sperm can also be taken for fertilization. If the cause of azoospermia is a tumor, it must be treated and removed. Different complications can occur, which mainly depend on the spread of the tumor.

When should you go to the doctor?

If a child wish remains unfulfilled despite regular intercourse over a longer period of time, a doctor should clarify the causes. The physician can then determine if an azoospermia is present and, where appropriate, initiate the appropriate treatment measures. If the prescribed measures and medicines have no effect, this should be discussed with the responsible physician. Perhaps azoospermia is due to another cause which can not be treated.

Sometimes the defect of male sperm is genetic or has been caused by a viral disease. If this is the case, the doctor may refer the affected couple to a specialist in artificial insemination, or suggest alternative options to help them fulfill their wishes.

Should it lead to mental impairment as a result of azoospermia, we recommend talking with a therapist. If physical complaints occur, a doctor must be consulted. If there is no desire for children, azoospermia is unproblematic. A visit to a doctor is then only necessary to get certainty about infertility.

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Treatment & Therapy

The therapy of azoospermia depends on the particular causes of the disease, although not every azoospermia can be successfully treated.

In nearly half of the cases, the causes of azoospermia can not be conclusively clarified. Disorders of spermatogenesis can be minimized in some cases by avoiding alcohol, nicotine or azoospermie favoring drugs.

In hormone-induced azoospermia, hormone preparations can compensate for hormonal imbalances, whereas antibiotics are usually prescribed in azoospermia due to bacterial infections. If azoospermia is based on excessive warming of the testicles, the causes of overheating should be avoided, after a certain period spermatogenesis normalizes.

If the dissipating transport routes from the testicles are glued, in some cases, this disorder can be eliminated in the context of surgery. If azoospermia is based on a spermiogenesis disorder, sperm can be taken from the testicles in 30-60% of the cases in a biopsy and used for subsequent artificial insemination. In the case of occlusive zoospermia, vital sperm can be extracted from the epididymis.

Outlook & Forecast

The prognosis in the case of azoospermia depends on the cause. Thus, in cases where it is genetically determined, there is no treatment option and the man remains infertile. The same applies to cases in which the germ cell-forming organs (testes) are severely damaged or degenerated.

In addition, recoverable causes of azoospermia come into consideration. If necessary, narrowed or glued vas deferens can be repaired surgically. The same applies to obstruction in the testes themselves (near the seminiferous tubules). Hormonal fluctuations, which lead to a disruption of semen production, can often be treated by hormone therapy.

There are also environmental factors that can limit sperm production to such an extent that azoospermia occurs. Here are about alcohol, various drugs, nicotine or too much heat to call. In such cases, normal sperm production can often be achieved through a different lifestyle. The decisive factor here is what is the cause.

Bacterial infections can also hamper sperm production in seminiferous tubules. In such cases, rapid antibiotic therapy can usually prevent the seminal production sites from being permanently damaged.

If azoospermia can not be repaired, the man is infertile. However, in cases in which seeds are still formed (but not delivered), there is the possibility of artificial insemination by directly removing the seeds from the testicles.

prevention

Azoospermia can not be prevented in every case. Nevertheless, some causes can be avoided. Thus, a healthy diet and lifestyle increases the sperm quality without alcohol and nicotine. Inflammation of the testes and epididymides should be avoided by vaccination (mumps) or condoms (gonorrhea).

If treatment measures for a cancer (chemotherapy, radiotherapy) are necessary, it should be considered in advance about a collection and storage of sperm, as there is an increased risk of azoospermia.

aftercare

Finally, if the absence of sperm in the ejaculate can not be resolved, follow-up can only suggest alternatives such as adoption. A doctor usually orders psychotherapy for a major emotional ailment. This is especially the case with genetic causes. These can usually not be fixed.

In about half of all cases, sufferers can contribute to boosting sperm production. The desire to have children can be realized with a healthy lifestyle. The doctor informs about this. Just nicotine and alcohol are considered harmful to sperm production. Patients should therefore absolutely do without these addictive substances.

A minimum of physical activity is also beneficial. Sometimes certain medications also prevent fertile ejaculate. These should then be discontinued or replaced. Finding a cause for missing sperm production can be time consuming. Even after causes have been found, regular follow-up examinations are necessary.

The conversation between doctor and patient is of great importance. The affected person has to provide several times a sample of his semen, which is then analyzed in detail. Further investigations, such as genetic tests, hormone analyzes and imaging techniques, are partially followed. Azoospermia does not lead to any life-threatening complications.

You can do that yourself

Azoospermia, in which the man's ejaculate contains no sperm, develops completely without symptoms and is usually only recognized when there is a desire to have children and the causes are analyzed as to why the woman does not become pregnant.

Special behavior in everyday life is therefore not required. Self-help can only be helpful and effective in certain cases. A very simple self-help is the protection of the testicles from too high a temperature. A permanently elevated temperature of the testicles, which may already result from inappropriate, tight clothing, leads to a reversible azoospermia, which can be resolved by appropriate choice of clothing. There are no data available on the frequency of this form of azoospermia. It is probably a rather rare form.

If the disease is caused by hormonal imbalance caused, for example, by an undesirable side effect of the medication, stopping the medication or substituting it with another drug may cure azoospermia. Medicines that can cause such side effects include certain neuroleptics and antidepressants.

Even in these cases self-help, together with medical advice, can overcome reversible azoospermia. If there is a (physical) blockage of the vas deferens, no adjustment is required in everyday life, and there is no self-help known that could solve the problem.

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