What is Azoospermia (Nil Sperm): Azoospermia is called when there is no sperm in semen. This type of semen disorder is found in approximately 3% of infertile men i.e. absent sperm. You should know that testis has two separate functions
(i) Production of normal sperms in semen which needed for pregnancy & normal fertility.
(ii)The other function of testis is production of male hormones i.e. testosterone & others. So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.
To conceive a child, a male's sperm must combine with a female's egg. The testicles make and store sperm, which are ejaculated by the penis to deliver sperm to the female reproductive tract during sexual intercourse.
The most common issues that lead to infertility in men are problems that affect how the testicles work. Other problems are hormone imbalances or blockages in the male reproductive organs. In about 50% of cases, the cause of male infertility cannot be determined.
A complete lack of sperm is the cause of infertility in about 10% to 15% of men who are infertile. When a man does not produce sperm, it is called azoospermia . A hormone imbalance or a blockage of sperm movement can cause azoospermia.
In some cases of infertility, a man produces less sperm than normal. This condition is called oligospermia. The most common cause of oligospermia is varicocele, an enlarged vein in the testicle.
Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. It is associated with very low levels of fertility or even sterility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations. If this is the case, then one or both of two conditions may be present-
* There is problem with sperm production.
* There is a blockage such that sperm production, although normal, cannot reach the ejaculate
How sperms develop: When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle, from first stage to final stage of normal mature sperms is of three months. Thus to produce normal sperms testis should have normal sperm producing germ cells & normal regulating hormones. Any major hindrance in the development of these spermatozoa will lead to absent sperm production resulting into nil sperm..
Causes of Nil Sperms: The various causes of nil sperm are as follows :
Hormone disorder : The various endocrine (Hormone) disorder leading to azoospermia are as follows
(i) Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.
(ii) Obstruction in the outflow of semen (Sperms) from testis to outside through urethral opening. Many times the production of sperms in testis is absolutely normal but these sperm are unable to come out due to obstruction in the out flow tract leading to absent sperms in the semen. The various causes of obstruction are absent vas deferens, absent seminal vesicle, posttraumatic, post surgical ligation of vas deferens. After some infections, as chlamydial, gonococcal urethritis. It may also be due to post tubercular epididimo-orchitis. The sperm may also not come out of testis if the are imotile due to any of the following causes as imotile cilia syndrome, kartagener syndrome cystic fibrosis & many other rare diseases.
(iii) Absence of germ cells in testis also called sertoli cell only syndrome. In this there are no germs cells i.e. sperm forming cells in the testis. For you knowledge, I wish to inform you that in testis germ cell come to testis from neural cord area of the body during neural cord area of the body during development of fetus. So in some fetuses this migration of sperm cells do not occurs leading to testis only having testosterone forming & sertoli cells. Thus this condition is called sertoli sell only syndrome it is a developmental defect.
(iv) Maturation Arrest (. Spermatid arrest): of primary spermatocytes to secondary spermatocyte, spermatids or to mature spermatozoa. Due to may local, systemic, hormonal growth factor deficiency or due to idiopathic factor. The various paracrine hormones and growth factors are essential for normal development i.e. maturation of one germ cells to multiplication of ultimately production of multiple mature, normal & motile sperms. Many other factor as infection, varicocele, drugs, chemotherapy may also lead to maturation arrest. The other causes may by developmentally defective germs cells & spermatocyte. So that they did not have inherent capacity of developing into a mature & motile sperms.
4) Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)
5) Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.)
Varicocele decreases sperm productions by elevating temperature of the testis, may produce higher levels of nitric oxide chemical in the testis which blocks sperm production, varicocele damages sperms directly & lastly varicocele decrease the oxygen supply to testis.
6) Drugs (e.g. spironolactone, alcohol, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
7) Presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia
9) Environmental toxins
10) Viral orchits
11) Granulomatous disease as tuberculosis, sarcoidosis of the testis
12) Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease
13) Neurological disease as myotonic dystrophy
14) Development and structural defects, Germinal cell aplasia, sertoli cell only syndrome, Cypt-orchidism
15) Androgen resistance
16) Mycoplasma infection
17) Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm count.
18) Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the sperm forming germ cell in the testis.
19) Environmental Assaults: Over exposure to environmental assaults (toxins, chemicals, infections) can cause nil sperm either by direct suppression of sperm production or on the hormone. Some chemicals that affect sperm production men are: Oxygen-Free Radicals, Estrogen emulation pesticidal chemicals (DDT, aldrin, dieldrin, PCPs, dioxins, and furans), plastic softening chemicals like Phthalates, hydrocarbons (ethylbenzene, benzene, toluene, and xylene)
20) Exposure to Heavy Metals: Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm production and may cause nil sperms in otherwise healthy men. Trace amounts of these metals in semen seem to inhibit the function of enzymes contained in the sperms, the membrane that covers the head of the sperm.
20) Radiation Treatment: Over-exposure to radiation & xrays affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production, and, in severe circumstances, may never recover.
21) Misuse of substances: There are a number of banned substances that can have potentially lethal effects on sperm production. Taking anabolic steroids, for example, to increase performance in sports such as weight lifting, can dramatically alter both the motility and the health of the spermatozoa. Other banned substances, such as cocaine, marijuana and heroin can reduce sperm production & may make a man infertile.
22) HGH Deficiency
Diagnosis of Cause of Nil Sperm Count
For correct diagnosis of cause of nil sperm count, we need detail history & physical examinations then certain relevant investigations are required.
History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of nil sperm count. So we first try to find out cause. We take detailed history, thorough drug history, and general physical examination, examination of testis, epididymis & testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.
Investigation & Diagnosis: For completes diagnosis of causes of azoospermia (nil sperms) one or more of the following tests may be required as:
1) Complete male hormone profile: This profile includes all the male hormone tests which affect testicular development, growth & other genital organ development as well as genital functions. L.H., F.S.H., Testosterone, prolactins, thyroids test,
2) Antisperm antibody
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Fine Needle Testicular Biopsy of the testis to look for evidence of spermatogenesis & testicular structure.
8) Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype (chromosome analysis)
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when needed
17) Immunobead test
18) MRI head, Hemogram, test for systemic diseases.
19) Olfactory test is done to find out kallman's syndrome
At our center facility for all the above tests are available.
Treatment of Nil Sperms:
After the finding out cause of azoospermia treatment is started depending on the cause found.
The various treatments are as follows:
Understanding of NIL sperms (Azoospermia) by Modern Medicine fails to impress most patients. Only AYURVEDIC MEDICINES HAVE PERMANENT CURE FOR NIL sperms (Azoospermia).WE AT Dr.S.K.Jain’s Burlington Clinic (P) Ltd Lucknow in valueable guidance of Dr.Saransh Jain Have Permanent Cure.
At Dr.S.K.Jain’s Burlington Clinic (P) Ltd Lucknow we have done extensive research in causes of infertility in men and treatments for the same. We have developed and refined herbal remedies for both oligospermis and azoospermia which have been very successful in curing hundreds of men over the decades.
A varicocele is an abnormal tortuosity and dilation of veins of within the scrotum. It can be surgically treated - which might help fertility in some cases.
At our center we have facility for all the testing & treatment facility required for nil sperm count to achieve pregnancy.
Response of Treatment: By above treatment many patients are cured in three to four months times. But if we diagnose that this problem is not curable in such cases we tell the patient that your problem is incurable & suggest them other available options as test tube baby, ICSI, AIH etc..