A male factor is known to be involved in about half of couples having fertility problems. The most severe form of male infertility is a complete lack of sperm in the ejaculate. This condition is known as “azoospermia”. Azoospermia is found in about a fifth of male fertility patients. Among men found to have azoospermia, one of the most commons question asked is, “why did this happen?” In a recent report in the Journal of Urology (April 2015) Crain et al explored the reasons behind azoospermia in 139 male patients evaluated at the Naval Medical Center in San Diego.
Obstructive azoospermia (OA) and Non-obstructive azoospermia (NOA). Obstructive azoospermia can be thought of as normal sperm production in the setting of a blockage. The classic case would be a man who fathered children and then had a vasectomy. Non obstructive azoospermia implies no blockage. Sperm is absent from the ejaculate either because sperm production is absent or is so low that the sperm simply cannot make it from the testis into the ejaculate. In the latter case, sperm can be surgically retrieved from the testicle and used to initiate a pregnancy in the setting of In Vitro Fertilization with ICSI.
In the study population, 29 percent of the patient had obstructive azoospermia. Causes of OA included congenital bilateral absence of the vas (a condition where men are born without the tubes needed to transport the sperm out of the testicles, and other forms of blockage including post surgical, prior trauma, and ejaculatory duct obstruction. There was also a patient with retrograde ejaculation where the sperm are present in the ejaculate, but the ejaculate spills backwards into the bladder.
Of the remaining patients with non obstructive azoospermia, about 62% had conditions where no sperm were retrievable. Other causes included genetic factors, history of undescended testicles, trauma and use of testosterone. (Testosterone use will often suppress sperm production).
Perhaps the most reassuring finding in this study was that of all the patients who presented, more than half had conditions which permitted treatment or sperm retrieval and the pursuit of pregnancy. Given the anxiety associated with the finding of azoospermia, these findings can serve to give some reassurance that there are often solutions or ways to deal with the problem. In my fertility practice, I see a substantial number of patients with azoospermia and I applaud the authors for their efforts in this publication.
