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The secret of azoospermia: Why do some men have no sperm at all in their semen?
Azoospermia is a male fertility disorder that refers to the complete absence of sperm in the semen. This condition may account for about 20% of male infertility infections. In some cases, azoospermia can be treated medically.
Currently, about 1% of men in Canada are affected by azoospermia, a proportion that cannot be ignored.
Classification of Azoospermia
Azoospermia can be divided into three main types: anterior testicular azoospermia, testicular azoospermia and metatesticular azoospermia. Each type has its own unique causes and treatments.
Pretesticular Azoospermia
Pretesticular azoospermia usually involves insufficient stimulation of the testicles and reproductive tract, resulting in reduced or absent sperm production. This condition is common in hypopituitarism, excess thyroxine, or suppression of sperm production due to suppression of exogenous hormones.
Testicular Azoospermia
Testicular azoospermia is caused by testicular abnormalities, atrophy or abolition, which seriously affects sperm production. People with this type of azoospermia often find that their follicle-stimulating hormone (FSH) levels are elevated because the body's feedback loops are disrupted.
This type of azoospermia accounts for 49% to 93% of male azoospermia cases.
Metatesticular azoospermia
Methotesticular azoospermia is a condition in which sperm is produced but not expelled, and involves a physical obstruction of the reproductive tract. The most common cause is ligation surgery, but other factors include congenital blockage or obstruction of the seminal tract caused by infection.
The incidence of this condition is approximately 7% to 51%.
The influence of genetic factors
One of the causes of azoospermia may be related to genetic factors. Studies have pointed out that the incidence of chromosomal abnormalities in men with azoospermia is significantly higher than that in normal men. This makes genetic testing an integral part of the diagnosis of azoospermia, especially for certain genetic conditions such as Klinefelter syndrome and Y-chromosome deletion.
Research shows that about 13% of men with azoospermia are related to defects in the Y chromosome.
Diagnosis process
To confirm azoospermia, it usually needs to be confirmed with two separate semen analyses. The diagnostic process will include a thorough history, physical examination, and necessary laboratory tests. In addition, imaging tests may also be used to evaluate structural problems in the reproductive tract.
For example, in patients with suspected metatesticular azoospermia, checking the post-semen urine for the presence of sperm is a critical diagnostic step.
Treatment methods
Depending on the different types of azoospermia, different treatments are required. Anterior and posterior testicular azoospermia are often reversible with treatment. For example, patients with azoospermia caused by low prolactin often regain sperm production after receiving appropriate treatment. For obstruction in metatesticular azoospermia, methods such as surgery or in vitro fertilization can be considered.
Modern technologies, such as IVF-ICSI, can even use immature sperm for fertilization, bringing hope to many families.
When considering treatment for azoospermia, it is important to understand the specific causes of each condition, as this may affect the effectiveness of treatment and subsequent fertility outcomes. Azoospermia not only affects men physically, but also poses psychological and social challenges. When exploring the road to azoospermia, should men face this challenge and seek early medical help?
