AZOOSPERMIA

Azoospermia is the condition where there is no sperm in the semen. In other words, semen comes after intercourse, but it does not contain any sperm cells.

What is azoospermia?

It is the situation that a man does not have any sperm in his semen and it can depend on different reasons. Some of these depend on blockage of sperm channels and no sperm production occurs in the testicles. In some cases, sperms cannot be thrown out with the semen because of the blockage in the channels. This situation is called as lack of sperm because of blockage (obstructive azoospermia). In lack of sperm because of blockage situations, small pieces are taken by entering into the channels which are blocked or testicle tissue with a thin injection. The rate of finding sperm within these pieces is close to 100%. In situations which do not depend on the blockage (non-obstructive azoospermia), sperm production does not occur or occurs in a limited amount in certain parts. The underlying reason of non-obstructive azoospermia may be genetic and infections experienced during adolescence period may also play a role. In such a situation, the testicle biopsy is very fruitful in terms of guiding in the treatment.

What are the Azoosperm Types?

Azoospermia is examined in two groups as obstructive and non-obstructive.

• Occlusion-related (obstructive) azoospermia: Along all the channels that allow the sperm to be discharged out of the penis from the testicles where sperm are produced, semen is not ejected due to obstruction anywhere. Congenital deficiencies in a part of the sperm ducts or genital infections cause obstruction. The rate of finding spermatozoa by surgical method is very high in obstructive azoospermia.
• Non-obstructive (nonobstructive) azoospermia: There is no sperm in the semen and no sperm is produced or very few sperm are produced. Non-obstructive causes of azoospermia are Y chromosome microdeletions that cause spermatogenic insufficiency, Klinefelter syndrome, cryptorchidism, chemotherapy, radiotherapy, infection, testicular trauma, torsion, idiopathic, Kallman syndrome and pituitary tumors, briefly genetic and hormonal disorders, radiation and congenital presence of testicles ( undescended testis). Surgical sperm retrieval and microinjection is the only treatment method for azoospermia that is not related to obstruction.

What Are the Symptoms of Azoospermia?

There is no symptom of azoospermia. Usually semen is of normal color and appearance. Diagnosis is made by performing a spermiogram (sperm test). Before taking the test, it is necessary to abstain from sex for 3 days. For example, if the last ejaculation was on Monday evening, the best day to give your semen sample would be on Friday. During this time, the individual should not have sexual intercourse or ejaculate by masturbation.

Causes of Azoospermia

We can examine the causes of azoospermia in 3 main groups:

• Pretesticular causes
• Testicular causes of azoospermia
• Postesticular causes in azoospermia

Pretesticular Causes: The most common reason for the deterioration of sperm production is hormonal problems. Hormones such as FSH, LH, testosterone are responsible for sperm production. Defects in these hormones lead to hormonal causes.

Testicular Causes of Azoospermia: Many factors such as congenital testicular diseases, testis infections, operations, tumors affect sperm production in the testis. Other reasons affecting the absence of sperm in the semen are radiotherapy, chemotherapy and various gonotoxic drugs.

Postesticular Causes in Azoospermia: It is associated with obstruction or dysfunction of sperm transport channels. Postesticular causes cause 40% Azoosperm. It prevents the sperm produced in the testis from reaching the external environment, causing the absence of sperm in the semen.

How is Azoospermia Diagnosed?

Sperm test (spermiogram) should be done by taking at least two semen samples at different times. Sperm is searched in semen samples taken with a microscope. If there are no sperm cells in the semen, the diagnosis of “Azospermia” is made.

*Detecting azoospermia with a sperm test done once is not enough*

What Should a Man Who Has No Sperm Do?

In this case, which is called azoosperm, the chance of having a child still continues. First of all, the underlying causes of sperm formation are examined. These reasons include a previous infection, trauma, drugs that inhibit sperm production, and whether there is a family history of fertility problems. After determining the underlying causes of the absence of sperm, the examination begins. In the examination, the size of the testis, hair growth in the body (hormones), testicular structures, whether there is a varicocele and whether there is a cause for obstruction are investigated. When the diagnosis of azoospermia is made, one should not despair. That’s because most azoospermia is caused by treatable causes.

Analyzes to be Done in the Case of No Sperm Coming

In the case of azoosperm, genetic testing should be done. FSH values are examined in patients with blood analysis. If the FSH value is normal and no sperm is formed as a result of the analysis, the reason for azoospermia is the obstruction in the semen ducts. As a result of the analysis, if the FSH value is high and the semen volume is normal, the rate of testicular dysfunction is high. If the FSH and Testosterone values are low, the reason for the sperm not to come out due to this situation is due to hormonal insufficiency.

With transrectal ultrasound (TRUS), the occlusion site is determined in patients with suspected occlusion in the semen ducts. In addition, as a vasography

The medicated film also helps to show the location of the obstruction in the semen ducts and whether it can be corrected with surgery.

What is the azoospermia success rate?

Since most azoospermia is caused by treatable causes, the success rate is equivalent. Azoospermia disappears when the discomfort that causes azoospermia is treated and eliminated. For this reason, many men can have children naturally.

What are the factors that cause azoosperm?

Azoosperm disease can be congenital or occur later. Certain conditions affect sperm production and function. The common reasons for this are as follows:

• Advanced Male Age: Due to advancing age, especially after the age of 40, there is a decrease in sperm production.
• Nutritional disorder: Poor quality food, obesity and undernutrition affect azoospermia.
• Environmental factors: Prolonged exposure to many environmental factors such as organic solvents, lead paint and radiation can cause low sperm count.
• Hormonal: Psychological problems and stress cause a decrease in testosterone hormone.

Is it possible to detect the diagnosis of azoosperm in advance?

Spermiogram (sperm test) should be done to make the diagnosis. The individual may encounter a situation different from normal in the semen after sexual intercourse before the test. If the semen is much more liquid or darker, even if it observes yellowish or greenish colors, it should be examined immediately.

Is there a cure for azoospermia?

Of course, there is a treatment for azoospermia. First, the diagnosis is made whether the patient has azoospermia. If the patient has azoospermia, the underlying causes are investigated with tests. Azoospermia is treated by hormone supplementation from hormone deficiency. However, if azoospermia is due to the cause of the obstruction, it is treated with a surgical operation.

What is Tese?

TESE is the surgical procedure of obtaining sperm from the testis. Micro tese is preferred in cases of infertility with no sperm in the semen (azoospermia) or immobile sperm.

Tese Surgery

The assisted reproduction method, which is frequently used in the treatment of azoospermia, is the micro TESE method.

In the Micro Tese method, the testis is opened using a microscope and tissue samples are taken. Sperm-forming channels are wider, and sperm-producing channels can be seen clearly thanks to the microscope. The places where the tissue will be taken from the areas where sperm can be found are determined and collected. Sperm screening is performed in the collected tissues. Tissues usually contain sperm. Micro Tese, an assisted reproductive method, allows pregnancy even if the diagnosis of azoospermia is not permanently passed.

What is the success rate in surgery and how is it performed?

There are thousands of structures like a small tube within the testicle tissue. Sperm production continues in different stages in these structures. While there is not any production in some tubules, there may be little sperm in some. The logic underlying the surgical sperm search methods is this. When the pieces taken from different parts of the testicle are examined, sperm cell can be found. In this method that is named as TESE, possibility of finding sperm varies between 25-60% depending on the underlying reason. While the highest success is obtained in hypospermatogenese where sperm production decreases much, the chance is the least in the situations depending on genetic disorders.

Having found sperm in an azoospermia case before does not always guarantee to find sperm in the following trials. But it is mostly successful. Likewise, it is possible to find sperm in a new trial according to biopsy result in people who have not had any sperm before.

When sperm is found once, whether it is found from testicle or semen does not affect the success rates of the microinjection. In other words, the fact that sperm is taken from the semen, channels or directly testicle does not change the pregnancy rates and results.

When sperm is taken from the channels with injection, this process is called as percutan epididymal sperm aspiration (PESA). Taking it from the testicle with injection is called as percutan testicular sperm aspiration (PTSA). Taking it from the testicle with a direct operation is called as testicular sperm extraction (TESE). While PESA and PTSA are applied with the local anaesthesia, TESE is mostly performed with the general anaesthesia.

The process lasts about 15-45 mintures and the person can turn to his/her normal life the following day.

In the event of being unable to find any sperm with the surgery, the method to be used changes according to the biopsy results. If there is no chance of finding sperm in a new trial, applying to sperm banks is the only valid method for now in such a situation. However, because this application is illegal in our country, couples should apply to the centers abroad. On the other hand, it is possible to get hopeful results for a new trial in important part of the patients. In such a situation, a new trial can be applied a few months later.