By Ernest Omoarelojie
One in every four couples, one suffers from infertility which may result from many factors including blockage along the reproductive tract, hormonal problems, ejaculation problems or issues with testicular structure or function. In Nigeria, as it is in most African countries, accusing fingers are often pointed in the direction of the woman. But facts have emerged and are emerging that indeed, the man may, often time, be the culprit.
Findings have indicated that there are many issues that may arise to impair the man’s reproductive system, so much so that he is unable to impregnant a woman, let alone father a child. One of the causes has been identified as Azoospermia, a condition that describes the absence of sperm in an average ejaculation. In which case, even if the affected man has no challenge with ejaculation, there is however, no swimmers, as sperms are often referred to, in the flow, to fertilize the female egg onward conception.
According to the World Health Organization, WHO, an average ejaculation contains normal sperm count which must be in the region of 15 million or more. In effect, men with the number or more do not have challenges fertilizing female eggs. However, those with less concentration are medically known to have Oligozoospermia or simply Oligospermia because though they are challenged in terms of their ability to impregnant a woman, their sperm counts are still measurable. But the case is worse with Azoospermia where there is no sperm at all in the ejaculation concentrate.
Two forms of Azoospermia have been identified. The first is the Obstructive Azoospermia while the second is the Non-obstructive type. While the first involves a condition in which the man produces sperm inside the testicles but cannot release same because it is blocked somewhere along the reproductive duct from being released to fertilized the female egg.
Going further, absence of the Vas Deferens or CAVD, the duct leading from the testicles to the penis is the most recognized cause of Azoospermia. It is such that even if the testicles produce sperm, there is no channel through which it can get to the penis onward the female reproductive channel to fertilize her egg. It is generally taken that most men with the condition also come with cystic fibrosis gene.
The Non-obstructive Azoospermia refers to the condition in which the man produces no sperm at all. The reason is often described as Idiopathic or have no known causes. However, it could also result from abnormality of the chromosomes, including Klinefelter syndrome, pitiruary dysfunction resulting in low hormone production and certain surgery like prostate removal or bilateral repair. However, both Obstructive and Non-obstructive Azoospermia may have rare underlying genetic causes impairing either sperm production or transit.
Azoospermia can also result from medical conditions, including diabetes, which can cause reversal of the flow of semen or retrograde ejaculation. In addition, cancer patients undergoing radiation or chemotherapy may develop Azoospermia given that both treatments can destroy sperm producing cells. Prior to such treatments, patients are advised to see an Oncho-fertility expert.
There are other medical conditions that could result in Azoospermia. This includes injuries to the scrotum can harm the testes or epididymis in ways that could result in sperm production or transportation challenges. More so, excessive use of testosterone can also result in temporary or in some instances, permanent Azoospermia.
Diagnosing Azoospermia does not come with obvious symptoms. The only exception is men with hormone levels. For instance, males with Klinefelter syndrome will have such features as enlarged breast tissue, low energy levels, small genitals and above average height. In the main, Azoospermia can also be diagnosed when, on two separate occasions, a man’s sperm sample reveals no sperm when examined under a high-powered microscope following a spin in a centrifuge. However, it is important that healthcare providers take the patient’s medical history, including past fertility success or failure and family history of birth defects, mental retardation, reproductive failure or cystic fibrosis.
Azoospermia is most commonly diagnosed when a couple discovers they are unable to conceive. However, an analysis of the semen is the only way to determine whether this condition is present.
When diagnosed, Azoospermia cases may be referred to a urogist for further analysis to establish whether it is Obstructive or Non-obstructive. In which case, there may be need for blood test for follicle stimulating hormone, FSH, and testosterone. A genetic test may also be recommended or required to confirm the diagnosis. However, if the FSH is elevated and the testicle is small and soft, it is typically a case of non-obstructive Azoospermia. If the FSH, testosterone, and testis are all normal but the ducts are missing or swollen with sperm that can’t get out, the diagnosis may be obstructive azoospermia.
Obstructive azoospermia due to congenital missing ducts can be treated by sucking out sperm microsurgically through what is referred to medically as sperm aspiration and using the suck out sperm to fertilize a partner’s eggs retrieved by in vitro fertilisation, IVF.
Overall, avoiding sexually transmitted diseases or early treatment of genital infections may lower the risk of Azoospermia. Freezing of sperm is recommended for men receiving cancer treatments given the possibility that the treatment can compromise future sperm production.
Generally, treatment of Azoospermia depends on the cause. Whatever the case is, genetic testing and counselling are often an important part of understanding and treating azoospermia. However, surgery is recommended to unblock, reconstruct or connect abnormal or never developed tubes in the case of Obstructive Azoospermia while a patient may be given hormone treatments, including follicle-stimulating hormone, FSH, human chorionic gonadotropin, HCG, clomiphene, anastrozole and letrozole, in the case of Non-obstructive Azoospermia. But if living sperm are present, they can be retrieved from the testes, epididymis or Vas Deferens for assisted pregnancy procedures such as IVF with intracytoplasmic sperm injection, ICSI.
Care for Azoospermia is dependent on the cause. For instance, surgery may become an option for Obstructive variety that results from sexually transmitted infection complications or a hernia repair that injured the Vas Deferens.
But if the cause of Azoospermia is genetic, thought to be something that could be passed on to children, healthcare provider may recommend genetic analysis of the sperm before considering assisted fertilisation procedures. That is because there are no known ways of preventing genetic problems that cause Azoospermia. However, if it is not a genetic, a lifestyle changes may be recommended as it may help lessen the chance of Azoospermia.