Azoospermia treatment
Azoospermia is the inability to count the number of sperm in the man's semen, in other words, the absence of sperm. Azoospermia constitutes an important group among the causes of male infertility.
Azoospermia can occur due to occlusive reasons as well as non-occlusive reasons. Azoospermia is seen in 1% of all men and 10% of men who cannot have children.
What causes azoospermia?
Genetic diseases, damage to the pituitary gland, radiation, undescended testicles, testes that cannot produce sperm, Klinefelter syndrome, mumps, tumors, previous surgeries, varicocele and obstructions in sperm ducts are the most common causes of azoospermia.
What are the signs of azoospermia?
The most common symptom is male infertility. It occurs when couples consult a doctor when they cannot have children despite having regular sexual marriages for a period of time. Apart from this, azoospermia can be suspected in the form of low sexual drive (decreased libido), lack of hair and body hair, ossification problem and small testicles. All these symptoms are not specific to azoospermia and are among the signs that can be seen in men who cannot have children.
Is azoospermia well diagnosed?
The diagnosis is made by performing sperm analysis in a suitable laboratory. To conclude the diagnosis of azoospermia, it is necessary to repeat the test at least one more time after the initial analysis. Sometimes, transient azoospermia can be seen secondary to toxic agents, environmental factors, infections and iatrogenic conditions. It is thought that some of the bodybuilders, protein powders and energy drinks used among teenagers may also be associated with azoospermia. The chance of finding sperm can be increased by taking consecutive semen samples on the same day. After the diagnosis of azoospermia is made, diagnostic tests are performed to understand the cause.
How is azoospermia treated?
Azoospermia treatment is based on the cause. Obstructive causes (obstructive) are found in approximately one-third of azoospermic men, and non-obstructive causes (non-obstructive) are found in two-thirds. If the cause of azoospermia is a blockage, treatment is performed to relieve this blockage. The causes of obstructive azoospermia are very diverse. It is usually seen due to the presence of obstruction in any of the channels in the male reproductive system. In some cases, these channels are not formed congenitally.
Such obstructions may occur as a result of tuberculosis, gonorrhea or other inflammatory diseases that have been previously experienced. In addition, bleeding after injuries to a semen duct or testicular area also causes flow in these ducts.
If there is a blockage in the channels carrying sperm, this can be corrected surgically. If there is a structural defect or failure to develop in the channels, it is restructured. Varicocele surgery is performed in cases of azoospermia caused by varicocele (excessive enlargement of the vessels leading to the egg).
After the operation, it is possible to form natural sperm cells. However, sometimes it is not possible to reach healthy sperm cells after the operation. In this case, it is possible to have a child with the in vitro fertilization method. Various surgical interventions are in question in the treatment of infertility in men who develop due to obstruction.
The causes of non-occlusive azoospermia are various genetic diseases, undescended testis, chemotherapy, radiation therapy, infection, trauma. In this type of azoospermia, a surgical method called microTESE is used to obtain sperm. Apart from this method, there are applications such as gene therapies, cell cultures and stem cells that may be hopeful for future treatment.
Various hormone tests are performed to find the cause in azoospermia patients without obstruction. Chromosome analysis is also done. The process of taking a piece of the testis, which was used for diagnosis in the past, is not preferred much nowadays.
The aim of the treatment of these patients is to bring the hormones to their normal physical levels. By reducing the excess hormones and increasing the few hormones, hormonal balance is tried to be achieved and new sperm cells are tried to be obtained. In addition to oral drug treatments, there are also hormone drugs that can be administered like injections.
In cases where no response can be obtained with all these treatments, a surgical search for sperm from the testicles is performed. If sperm can be obtained during this treatment, it is either frozen or transferred to the female egg during the same process and in vitro fertilization is initiated.
With the correct diagnosis, appropriate treatment and necessary surgical interventions, patients with azoospermia are also able to have children.