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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.
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..
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.)
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
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)
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.
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:
finding out cause of azoospermia treatment is started depending on the
Correction of the Cause: First of all we try to find out the primary cause of nil sperms by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.
1) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually sperm count normalizes in three month time with proper hormone treatment.
2) Gonadotropin Therapy: Gonadotropins are most potent natural stimulators of sperm production in the testis. Once we start gonadotropin therapy, these gonadotropins stimulates the sperm producing cells in testis. Under the stimulating influence of gonadotropins dormant sperm forming cells which were not producing any sperms, they start dividing & produce multiple immature sperm cells with in three to four weeks. These are further matured in next two to three month into mature sperms under the influence of gonadotropin treatment. Thus in more than 90% cases sperm production can be normalized in three to four months time if it is started in properly selected cases of nil sperms. Gonadotropin therapy is most successful of all the available treatment for nil sperms till now. In many cases of nil sperm count, when all other treatment has failed even in those cases gonadotropin therapy is effective. Thus treatment of nil sperms with gonadotropin results in pregnancy soon.
6) Gonadotropin-releasing hormone (Gn-RH) analogs
7) Growth hormone therapy in many cases where somatropin deficiency is found
8) In cases of Antisperm antibody induced cases treatment is sperm washing followed by intrauterine insemination, steroid use or intra-cytoplasmic injection of sperms (ICSI).
8) Growth Factor, Mineral & Micronutrient Therapy
9) Free Radial Scavengers: These are drug to reduce the free damaging oxidative radical in the testis. For your information every minute lot of oxidant radicals are generated inside the testis which damages sperm forming cells. These special antioxidant drugs scavenge these damaging oxidative free radicals thus leading to production of normal sperms by the testis. In many study these free radical scavengers have been found to be very-very effective in normalizing sperm count.
10) Coenzyme ubique: These drugs improve the nutritional status of the testis. Thus sperm forming cells get enough nutrient which helps in fast generation of sperms in good number with good motility & fertilizing capacity.
11) carnititine supplimentation increases the production of sperm, with normalization of sperm count in three months.
13) Bromocriptine. This medication is for men who has elevated levels of prolactin, then this hormone rise decreases the sperm production
14) Correction of thyroid hormone
15) Correction of congenital adrenal hyperplasia
27) Certain Newer Drugs has been found very effective
28) Surgery: Depending on the surgery may
be a treatment option for nil sperm count due to blockade of the tract
from testis to the tip of pennis (i.e. obstructive azoospermia).
Surgery is also the treatment of choice for significant varicocele.
Similarly surgery may be one of the treatment options for many
29) But there are many cases of azoospermia in
which inspite of best treatment sperm production either does not
improves or is impossible. In these cases we do fine needle testicular
biopsy in which sometimes we may get some normal sperms or even
spermatids. These spermatocytes or sperms are then injected in ovum
leading to formation embryo. These embryos are ten transferred into
uterus leading to achievement of pregnancy.
31) Test tube baby is also delivered with our efforts by use of intra-cytoplasmic sperm injection (ICSI), then transfer of embryo to uterus of mother.
32) Semen Bank: Facility for good quality sperm is semen bank in also available. At our center we have facility for all the testing & treatment facility required for low sperm count to achieve pregnancy.
33) Assisted reproductive technology (ART)
The most common forms of ART include:
a) In vitro fertilization (IVF). This is the very effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a sperm from sperm bank in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization.
b) Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if blockage is present.
c) Intracytoplasmic sperm injection (ICSI). This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure.
34) Varicocele ligation
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
consultation & treatment (by appointment / or online) click How
to Consult Us
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