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Azoospermia: Treatment, Procedure, Cost and Side Effects

Last Updated: Oct 06, 2021

What is Azoospermia?

Azoospermia is a medical condition which many men in which a complete absence of measurable amount of sperm within the ejaculated semen. Among all men, it occurs in about 1% of the population and about 15% of men with issues of infertility suffer from this condition. The problem may be either that you are having issues that keep your testicles from producing sperm or that the sperms are being stopped from getting out from your body.

How common is azoospermia?

The percentage is about 1% of all men and 10%-15% of impotent men have azoospermia.

What percent of men have azoospermia?

In men, azoospermia influences about 1% of the male populace and might be seen in up to 20 % of male infertility circumstances.

Is there hope for Azoospermia?

Studies have shown that the help of advanced medical treatments and a healthy lifestyle, can help an individual to cure Azoospermia. Depending upon the type and severity one can overcome infertility caused by Azoospermia.

In case of obstructive Azoospermia ( blockage of sperm due to any physical abnormality), surgery like microsurgical or endoscopic reconstruction is recommended and on the other hand, nonobstructive Azoospermia ( no production of sperm due to internal or external factors), medication, change in lifestyle habits and physical exercise will help the person to regenerate sperm and increase its fertility.

So, yes, couples can conceive in the case of Azoospermia.

Types of azoospermia:

Azoospermia is of three types:

  1. Pre-testicular causes (non-obstructive):

    The thing that keeps the testicles from making sperm is the low production of sex hormones. It can be caused by:

    Kallmann syndrome: Hereditary (inherited) disorder carried on the X chromosome, set apart by low degrees of gonadotropin-discharging hormone (GnRH) and lost the smell. GnRH animates the pituitary organ to discharge hormones that oversee the contraceptive organs.

    Disorders of the nerve center or pituitary organ: It can be caused by radiation medicines or certain prescriptions, particularly those utilized in chemotherapy.

  2. Testicular causes (non-obstructive):

    This condition can be detected if there is a defect in the structure or working of the testicles. Can be brought about by:

    1. Anorchia
    2. Cryptorchidism
    3. Sertoli cell-just syndrome
    4. Spermatogenic capture
    5. Klinefelter's Syndrome: one conveys an additional X chromosome (making his chromosomal cosmetics XXY rather than XY). The outcome is regularly barrenness, alongside the absence of sexual or physical development, and learning troubles.
    6. Tumors
    7. Responses to specific prescriptions
    8. Medical procedure
    9. Varicocele
    10. Mumps orchitis
    11. Radiation medications
    12. Ailments, for example, diabetes, cirrhosis, or kidney disappointment

  3. Post-testicular causes (obstructive):

    Two reasons that keep sperms from being conveyed into the seminal liquid are; Problems with ejaculation or a check in the conceptive tract. This condition can be seen in about 40% of men with azoospermia and can be brought about by:

    • Ahindrance or missing association in the epididymis, vas deferens, or somewhere else in the conceptive framework
    • Inborn reciprocal absence of the vas deferens (CBAVD): A hereditary deformity where the vasa deferentia are missing during childbirth. The hereditary change that causes CBAVD is likewise unequivocally connected with cystic fibrosis and men with CBAVD have a high danger of being a bearer of cystic fibrosis. Female accomplices of men with CBAVD ought to have a quality change investigation to check whether they are likewise a bearer to decide the danger of having a kid with cystic fibrosis.
    • Disease
    • Development of a blister
    • Damage
    • Vasectomy (evacuation of all or part of the vas deferens with the medical procedure)

What causes azoospermia?

We are aware of numerous potential causes, including some hereditary conditions, for example, Klinefelter's disorder, medicinal medications, for example, chemotherapy or radiation, recreational medications, for example, a few opiates, and anatomical anomalies, for example, varicoceles or nonappearance of the vas deferens on each side.

Maybe the clearest reason would be a vasectomy, which keeps sperm from joining different liquids in the discharge. By and large, however, azoospermia is likely because of components we don't completely see, for example, hereditary conditions, poor testicular improvement as a hatchling/kid or natural poisons.

Can you develop Azoospermia?

Even though most of the cases of Azoospermia are caused by underlying medical conditions and genetic disorders. Some cases have shown medication side effects and bad lifestyle choices may also cause Azoospermia. Here are some reasons that may cause the development of Azoospermia:

  • Radiation therapy and toxins:

    Medical procedures like chemotherapy or radiation treatment have been used under the plan of cancer treatments to kill cancer cells in various parts of the body. Even though the treatment shows successful results, its side effects may impair individual sperm production due to excessive exposure to chemicals.

    Other than radiation therapies, exposure to Heavy metals and fumes of other industrial toxins related to pesticides also harms an individual overall sperm production. Prolonged exposure to any of the chemicals can trigger Azoospermia.

    If you are planning to reproduce, it is advisable to cryopreserve or freeze your sperm before undergoing chemotherapy or radiation treatment.

  • Medications:

    Prolonged consumption of several medications like spironolactone, sulfasalazine, cimetidine, antibiotics, nifedipine, and colchicine can harm an individual sperm count, as they can imbalance the levels of testosterone.

    In some cases, inappropriate consumption of general hormonal medications can also affect the sperm count, for instance, testosterone is one of the main hormones that are responsible for healthy sperm production; an unsuitable constitution of its artificial supplement can create an opposite reaction in the body that can cause Azoospermia.

  • Drinking, smoking, and drug abuse:

    Studies have shown that excessive intake of alcohol, tobacco, and any illicit drug often imbalance the level of hormones in men making it difficult for them to reproduce. Even though it is a rare cause of Azoospermia, your medical health professional will take it under consideration in case one is suffering from this illness.

How can I get pregnant with Azoospermia?

Apart from the medications and surgical treatments, couples can go for various fertility techniques that are available that may be able to help them conceive naturally. Some of the sperm retrieval techniques may include:

  1. Intracytoplasmic sperm injection (ICSI):

    The process of ICSI involves the injection of single sperm into the center of the egg via a tiny needle, called a micropipette. After the sperm successfully merges with the egg, the fertilized egg or the embryo will be taken to the lab for initial 1 to 5 days to make it stable to transfer into the woman's uterus.

  2. Percutaneous epididymal sperm aspiration (PESA):

    The process of PESA starts by passing a fine needle through the skin into the epididymis ( convoluted duct behind the testis) to obtain the sperm sample which is later sent to a lab to check the presence of healthy sperms which can be injected into the egg via Intracytoplasmic sperm injection (ICSI).

  3. Microsurgical epididymal sperm aspiration (MESA):

    This can be described as a surgical procedure that involves a small incision in the small tube present within the epididymis to look for any presence of sperm. The procedure is generally conducted with the help of a surgical microscope and an adequate amount of local anesthesia. The technique is well recommended in case the passage of sperm is blocked within its path ( obstructive Azoospermia).

  4. Percutaneous testicular sperm extraction (TESA):

    Identical to the process of PESA, the process of TESA also involves passing a fine needle through the skin but instead of taking the sample from the epididymis, TESA takes sample directly from the testes. They also collect small quantities of seminiferous tubules. The sample will be further processed by ICSI.

  5. Testicular sperm extraction (TESE):

    Like MESA, TESE also has a surgical procedure that involves a small incision, but instead of epididymis the traces of sperm are extracted directly from the testes. The procedure is generally conducted with the help of a surgical microscope and an adequate amount of local anesthesia. The process of TESE is recommended when there are no signs of sperm in the epididymis or any other part that is involved in the process of ejaculation (non-obstructive Azoospermia).

  6. In vitro fertilization (IVF):

    The process of IVF is the final step. After the sperm is collected, tested, and prepared, fertilized eggs will also be collected from the ovaries. The sperm then get merged with the eggs through Intracytoplasmic sperm injection (ICSI) and put together for incubation for at least 1 to 5 days. After incubation, the fertilized eggs then later get transferred into the womb to get attached to the lining of the uterus.

After the procedure, it is advisable to preserve some sperm for further use. Most fertility clinics will recommend using fresh sperm rather than the preserved ones for fertilization.

Medical procedures like this do not ensure 100% outcome in the first trial, some of the cases especially the ones associated with Azoospermia may need repeated sperm retrievals. The optimum time gap between retrieval procedures must be around 3 to 6 months.

How to diagnose azoospermia?

The treatment of a patient suffering from problems of infertility begins with a detailed review of previous medical problems, lifestyle, information regarding any drug intake, surgery in the past as well as family history in order to investigate the probable cause of azoospermia. This is followed by a thorough physical examination of the patient. Examinations of blood samples are then done for testosterone and follicle stimulating hormone (FSH).

The next step involves analysis of two semen samples. In the beginning, each of these samples has to undergo a standard semen analysis. If sperms are found to be absent in the earlier test then an additional evaluation is done where the samples are spun in a centrifuge in order to concentrate the small numbers of available sperm that accumulates at the bottom of the test tube. On further laboratory examinations, if 10 or even 1 sperm is found to be present in the pellet then the cause of azoospermia is inferred to be due to reproductive tract obstruction.

However, if from the above medical examinations it is not clear regarding the cause of azoospermia, as to, whether it is due to problem with sperm production or a blockage in the male reproductive tract, then in that case the next step involves assessing sperm production within the testis itself. This is achieved by testis biopsy of the male patient under local anaesthesia. Once the cause of azoospermia is confirmed, the treatment is done thereafter by an experienced physician.


How is the treatment done?

In the context of azoospermia, if sperm are diagnosed to be absent in the ejaculate of the male patient, then it can be inferred that this had occurred either due to blockage the male reproductive tract or due to problem in sperm production. Azoospermia due to blockage in male reproductive tract and problem in sperm production are referred to as obstructive azoospermia and non-obstructive aaoospermia respectively.

Blockage or obstructive azoospermia may arise due to various reasons such as previous infection, prostatic cysts, surgery, injury or congenital absence of vas deferens (CAVD). Except the problem of congenital absence, all other causes of obstructive azoospermia can be cured with the help of microsurgery or endoscopic reconstruction. Patients with problems of blockage can opt for sperm retrieval along with assisted reproductive technology in order to conceive.

However, in cases of non-obstructive azoospermia, the condition can be cured with the help of medical treatment which can assist some men to produce ejaculated sperm (for example, the patients with reversible conditions like Kallman syndrome, varicocele, hyperprolactinemia, etc.). However, in most cases sperm retrieval from the testis of the male patient accompanied with assisted reproduction becomes the only way to have a biological family. The difficulty with non-obstructive azoospermia is that only 50%-60% of the male patients have usable testicular sperm. In addition to this, clinical examinations such as size of the testicles, serum FSH level, biopsy reading and history of the ejaculated sperm are not capable to accurately predict the recovery of sperm from the testis.

Who is eligible for the treatment?

Any male individual who fails to conceive a biological family and is found to have low or no sperm count from a detailed semen analysis is said to suffer from azoospermia and is eligible for such treatment. The other symptoms related to having abnormal sperm involves unusual colour of the semen such as greenish, yellowish, reddish or brownish tinted (probably due to presence of blood), low volume of semen, unusual strong odour of the ejaculate and/or thicker or thinner sperm consistency. A male individual having all such symptoms must immediately for consulting an expert physician.

Who is not eligible for the treatment?

Any male individual who has a healthy sperm count and is capable of conceiving a biological family is not eligible for this treatment.

Are there any side effects?

There are a few unpleasant side effects of the treatment of azoospermia. A few medicines may result in symptoms such as nausea, vomiting, headache, irritability, allergies among people who are hypersensitive to such drugs, liver problems. Some of the hormone based medicines can have side effects like edema, oily skin and even depression. Surgical treatment for azoospermia can lead to side effects such as profuse bleeding or injury to the bladder, kidney, intestines, blood vessels and other body tissues. Subfertility may still remain in some cases, even after the treatment. Without complete treatment, it might not be possible to get a female pregnant. If any of these side effects are seen to occur then the male patient needs to discuss about it with an experienced physician.

What are the post-treatment guidelines?

The post treatment guidelines for patients of azoospermia include taking of prescribed medicines regularly on time, having a nutritious diet plan that can enhance sperm production, having a period of rest for those patients who have undergone surgical treatment.

Only if the cause of azoospermia is congenital, then it cannot be treated effectively. Apart from this, all other obstructive and non-obstructive azoospermia can be cured with medical or surgical treatment. In cases of medical and surgical treatment the full course of treatment should be taken in order to successfully cure the condition. In case a patient has any side effect from the treatment, then he should immediately contact the physician.

How long does it take to recover?

The time taken for the recovery of patients suffering from azoospermia may vary depending upon the cause of this condition. Once the problem is diagnosed to be either obstructive or non-obstructive azoospermia, the treatment is done accordingly. However, cases of congenital azoospermia are irreversible and cannot be treated effectively. All other cases of obstructive as well as non-obstructive azoospermia can be dealt with surgical and medical treatment respectively. It takes about 2 to 3 weeks’ time for this condition to be diagnosed and treated successfully. Once the treatment is done the patient should take rest for a few days as advised by the doctor. Any cases of side effects should be immediately brought to the notice of the physician.

How to treat azoospermia naturally?

To be straightforward there are extremely restricted regular choices for men with azoospermia. Above all else, it is essential to work with a specialist who spends significant time in this condition. Second, the male body requires a wide assortment of supplements to create adjusted hormones and solid sperm.

For men attempting to invert azoospermia, eating a supplement thick entire nourishment diet will be significant. The present current eating routine regularly doesn't sustain the body appropriately and that is the place nourishing supplementation can be valuable in improving sperm generation.

For men who are overweight or hefty with azoospermia, jumping on a health improvement plan will be basic to reestablishing sperm generation.

There is an assortment of herbs that have been appeared to help bolster men's hormonal parity and sperm generation. These herbs might merit considering as a component of a mending plan for azoospermia brought about by non-hereditary, non-obstructive azoospermia. As usual, it is ideal to locate a characteristic human services expert, talented in the utilization of herbal prescription to work with, close by a therapeutic specialist.

Herbs to improve hormonal parity and sperm creation in men:

  • American Ginseng root (Panax quinquefolius)
  • Cordyceps mushroom (Cordyceps sinensis)
  • Maca root (Lepidium meyenii)
  • Saw Palmetto berries (Serenoa repens)
  • Schisandra products of the soil (Schisandra chinensis)
  • Tribulus ethereal parts and organic product (Tribulus terrestris)
  • Significant Note: We don't propose joining any herbs for fruitfulness while additionally taking drugs for richness medications.

Can azoospermia fix itself?

Because of cutting edge medical treatments, men with azoospermia don't need to surrender their expectations of conceiving a kid. Contingent upon the kind of azoospermia, it might be carefully treatable with the arrival of discharged sperm or it might require sperm recovery and helped multiplication to accomplish pregnancy.

Can a man with zero sperm count get a woman pregnant?

The chances of getting your women pregnant decreases with diminishing sperm counts in your semen. A few men have no sperm in their semen by any stretch of the imagination. There are numerous components associated with proliferation, and the quantity of sperm in your semen is just one. A few men with low sperm check effectively father kids.

What is the price of the treatment in India?

The price of treatment of azoospermia in India varies in different places. In metropolitan cities the price of treatment is relatively higher than in other small towns and cities of India. The price range varies from Rs. 45,000 to Rs. 60,000 for the full treatment of this symptom. The cost of treatment also depends upon the cause of azoospermia. For cases of testicular sperm extraction an additional amount of Rs. 50,000 is charged by the infertility clinics.

Are the results of the treatment permanent?

To be honest, the treatment of azoospermia has about 50% chances of success. Problems related to congenital azoospermia are irreversible and cannot be treated effectively. A few cases of non-obstructive azoospermia are reversible can be treated effectively with the administration of medicines. Other cases related to obstructive azoospermia can be treated effectively by surgical methods. However, in most cases, artificial sperm retrieval from the testis of the male patient accompanied with assisted reproduction becomes the only way to have a biological family.

Best Diet for the people suffering from azoospermia:

Pick solid nourishments from all the nutritional categories consistently. Incorporate entire grain bread, oat, rice, and pasta. Eat an assortment of products of the soil, including dull green and orange vegetables. Incorporate dairy items, for example, low-fat milk, yogurt, and cheddar. Pick protein sources, for example, lean meat and chicken, fish, beans, eggs, and nuts. Solicit what number of servings from fats, oils, and desserts you ought to have every day and if you should be on a unique eating routine.

Can alcohol be Azoospermia?

Everyday consumption of alcohol ( more than 60 g a day) will not only affect the sperm count but also alter its size, shape, and motility as alcohol lowers the testosterone, follicle-stimulating, and luteinizing hormone levels in men. Excess alcohol will also raise estrogen levels which also affects the overall sperm production in men.

In the case of Azoospermia, scientists have seen a massive loss in sperm production if the patient consumes excessive amounts of alcohol, especially in the case of nonobstructive Azoospermia. Withdrawal from alcohol will help the patients to increase the sperm count with proper treatment and a healthy lifestyle.

What are the alternatives to the treatment?

The alternative treatment for azoospermia involves ayurvedic treatment. However, there are only very limited natural options of treatment available for patients suffering from azoospermia. The first and foremost thing to be kept in mind is to have a healthy and nutritious diet that enhances more sperm production within the males. Men who are having obesity along with azoospermia must go for weight loss which is highly recommendable for restoring sperm production.

In addition to this, a variety of herbal medicines can be used which helps to boost men’s hormonal balance and production of healthy sperm. These botanical medicines have proved to be highly effective in treating problems related to non-genetic and non-obstructive azoospermia.

Summary: The absence of sperm during ejaculation due to any physical blockage or medical condition is known as Azoospermia. It has often been confused with infertility but in the case of Azoospermia the sperm production happens, it is just blocked.


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Written ByDr. Vikram Gidwani MBBSSexology
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