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{{Short description|Medical condition of a man whose semen contains no sperm}}{{Distinguish|text=aspermia, which refers to the absence of semen in a male}}

factoids

Azoospermia is the medical condition of a man whose semen contains no sperm.JOURNAL, Berookhim, BM, Schlegel, PN, Azoospermia due to spermatogenic failure., The Urologic Clinics of North America, February 2014, 41, 1, 97–113, 24286770, 10.1016/j.ucl.2013.08.004, It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male populationBOOK, Male Infertility Best Practice Policy Committee of the American Urological Association, Practice Committee of the American Society for Reproductive Medicine, 2001, Infertility: Report on Evaluation of the Azoospermic Male, American Urological Association; American Society for Reproductive Medicine, 978-0-9649702-8-1,weblink 2010-06-14, 2018-03-26,weblink live, and may be seen in up to 20% of male infertility situations in Canada.JOURNAL, 20514278, 2010, Jarvi, K, Lo, K, Fischer, A, Grantmyre, J, Zini, A, Chow, V, Mak, V, CUA Guideline: The workup of azoospermic males, 4, 3, 163–7, 2874589, Canadian Urological Association Journal, 10.5489/cuaj.10050, In a non-pathological context, azoospermia is also the intended result of a vasectomy.JOURNAL, Barone, Mark A., Irsula, Belinda, Chen-Mok, Mario, Sokal, David C., the Investigator study group, 2004-07-19, Effectiveness of vasectomy using cautery, BMC Urology, 4, 1, 10, 10.1186/1471-2490-4-10, 1471-2490, 503392, 15260885, free,

Classification

Azoospermia can be classified into three major types as listed. Many conditions listed may also cause various degrees of oligospermia rather than azoospermia. Pretesticular and testicular azoospermia are known as non-obstructive azoospermia, whereas post-testicular azoospermia is considered obstructive.

Pretesticular

Pretesticular azoospermia is characterized by inadequate stimulation of otherwise normal testicles and genital tract. Typically, follicle-stimulating hormone (FSH) levels are low (hypogonadotropic) commensurate with inadequate stimulation of the testes to produce sperm. Examples include hypopituitarism (for various causes), hyperprolactinemia, and exogenous FSH suppression by testosterone. Chemotherapy may suppress spermatogenesis.JOURNAL, 10.1111/j.1442-2042.2010.02484.x, Male infertility in cancer patients: Review of the literature, 2010, Dohle, Gert R, International Journal of Urology, 17, 4, 327–331, 20202000, free, Pretesticular azoospermia is seen in about 2% of azoospermia. Pretesticular azoospermia is a kind of non-obstructive azoospermia.

Testicular

Testicular azoospermia means the testes are abnormal, atrophic, or absent, and sperm production severely disturbed to absent. FSH levels tend to be elevated (hypergonadotropic) as the feedback loop is interrupted (lack of feedback inhibition on FSH). The condition is seen in 49–93% of men with azoospermia. Testicular failure includes absence of failure production and low production and maturation arrest during the process of spermatogenesis.Causes for testicular failure include congenital issues such as in certain genetic conditions (e.g. Klinefelter syndrome), some cases of cryptorchidism or Sertoli cell-only syndrome as well as acquired conditions by infection (orchitis), surgery (trauma, cancer), radiation, or other causes. Mast cells releasing inflammatory mediators appear to directly suppress sperm motility in a potentially reversible manner, and may be a common pathophysiological mechanism for many causes leading to inflammation.JOURNAL, 10.1093/humupd/dmq053, The role of mast cells and their mediators in reproduction, pregnancy and labour, 2010, Menzies, F. M., Shepherd, M. C., Nibbs, R. J., Nelson, S. M., Human Reproduction Update, 17, 3, 383–396, 20959350, free, Testicular azoospermia is a kind of non-obstructive azoospermia.Generally, men with unexplained hypergonadotropic azoospermia need to undergo a chromosomal evaluation.

Post-testicular

In post-testicular azoospermia, sperm are produced but not ejaculated, a condition that affects 7–51% of azoospermic men. The main cause is a physical obstruction (obstructive azoospermia) of the post-testicular genital tracts. The most common reason is a vasectomy done to induce contraceptive sterility.WEB,weblink Practice Committee of ASRM, August 2008, The management of infertility due to obstructive azzospermia, June 14, 2010, March 4, 2016,weblink" title="web.archive.org/web/20160304025750weblink">weblink live, Other obstructions can be congenital (for example, agenesis of the vas deferens as seen in certain cases of cystic fibrosis) or acquired, such as ejaculatory duct obstruction for instance by infection.Ejaculatory disorders include retrograde ejaculation and anejaculation; in these conditions sperm are produced but not expelled.

Unknown

Idiopathic azoospermia is where there is no known cause of the condition. It may be a result of multiple risk factors, such as age and weight. For example, a review in 2013 came to the result that oligospermia and azoospermia are significantly associated with being overweight (odds ratio 1.1), obese (odds ratio 1.3) and morbidly obese (odds ratio 2.0), but the cause of this is unknown.weblink" title="https:/-/web.archive.org/web/20151223094830weblink">weblink JOURNAL, Sermondade, N., Faure, C., Fezeu, L., Shayeb, A. G., Bonde, J. P., Jensen, T. K., Van Wely, M., Cao, J., Martini, A. C., 3, 2012, BMI in relation to sperm count: An updated systematic review and collaborative meta-analysis, Human Reproduction Update, 19, 3, 221–231, 10.1093/humupd/dms050, 3621293, 23242914, The review found no significant relation between oligospermia and being underweight.

Genetics

Genetic factors can cause pretesticular, testicular, and post-testicular azoospermia (or oligospermia) and include the following situations: The frequency of chromosomal abnormalities is inversely proportional to the semen count, thus males with azoospermia are at risk to have a 10–15% (other sources citing 15–20% incidencePadubidri; Daftary (2011). Shaw's Textbook of Gynaecology, 15e. p. 205. {{ISBN|978-81-312-2548-6}}) abnormalities on karyotyping versus about 45 ID/mL) have been correlated with successful microdissection testicular sperm extraction.Ramasamy R, Lin K, Gosden LV, Rosenwaks Z, Palermo GD, Schlegel PN. High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction. Fertil Steril. 2009;92(2):590-3.Serum inhibin-B weakly indicates presence of sperm cells in the testes, raising chances for successfully achieving pregnancy through testicular sperm extraction (TESE), although the association is not very substantial, having a sensitivity of 0.65 (95% confidence interval [CI]: 0.56–0.74) and a specificity of 0.83 (CI: 0.64–0.93) for prediction the presence of sperm in the testes in non-obstructive azoospermia.JOURNAL, 10.1093/humupd/dmq024, Inhibin B and anti-Mullerian hormone as markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies, 2010, Toulis, K. A., Iliadou, P. K., Venetis, C. A., Tsametis, C., Tarlatzis, B. C., Papadimas, I., Goulis, D. G., Human Reproduction Update, 16, 6, 713–724, 20601364, free, Seminal plasma proteins TEX101 and ECM1 were recently proposed for the differential diagnosis of azoospermia forms and subtypes, and for prediction of TESE outcome.JOURNAL, 10.1126/scitranslmed.3006260, Differential Diagnosis of Azoospermia with Proteomic Biomarkers ECM1 and TEX101 Quantified in Seminal Plasma, 2013, Drabovich, A. P., Dimitromanolakis, A., Saraon, P., Soosaipillai, A., Batruch, I., Mullen, B., Jarvi, K., Diamandis, E.P., Science Translational Medicine, 5, 212, 212ra160, 24259048, 13541504, JOURNAL, 10.1186/s12916-017-0817-5, Preclinical evaluation of a TEX101 protein ELISA test for the differential diagnosis of male infertility, 2017, Korbakis, D., Schiza, C., Brinc, D., Soosaipillai, A., Karakosta, T.D., Légaré, C., Sullivan, R., Mullen, B., Jarvi, K., Diamandis, E.P., Drabovich, A.P., BMC Medicine, 15, 1, 60, 28330469, 5363040, free, Mount Sinai Hospital, Canada started clinical trial to test this hypothesis in 2016.WEB,weblink Use of Semen TEX101 to Improve Sperm Retrieval Rates for Men With Non-obstructive Azoospermia, March 8, 2019, clinicaltrials.gov, April 13, 2017, April 13, 2017,weblink live, Primary hypopituitarism may be linked to a genetic cause. So a genetic evaluation may be done for men with azoospermia as a result. Azoospermic men with testicular failure are advised to undergo karyotype and Y-micro-deletion testing.JOURNAL, 15367371, 10.1071/RD03087, 2004, Schlegel, PN, Causes of azoospermia and their management, 16, 5, 561–72, Reproduction, Fertility, and Development, JOURNAL, 19421675, 2009, Poongothai, J, Gopenath, TS, Manonayaki, S, Genetics of human male infertility, 50, 4, 336–47, Singapore Medical Journal,

Treatment

Pre- and post-testicular azoospermia are frequently correctible, while testicular azoospermia is usually permanent. In the former the cause of the azoospermia needs to be considered and it opens up possibilities to manage this situation directly. Thus men with azoospermia due to hyperprolactinemia may resume sperm production after treatment of hyperprolactinemia or men whose sperm production is suppressed by exogenous androgens are expected to produce sperm after cessation of androgen intake. In situations where the testes are normal but unstimulated, gonadotropin therapy can be expected to induce sperm production.A major advancement in recent years has been the introduction of IVF with ICSI which allows successful fertilization even with immature sperm or sperm obtained directly from testicular tissue. IVF-ICSI allows for pregnancy in couples where the man has irreversible testicular azoospermia as long as it is possible to recover sperm material from the testes. Thus men with non-mosaic Klinefelter's syndrome have fathered children using IVF-ICSI.JOURNAL, 10.1093/humrep/dep431, Should non-mosaic Klinefelter syndrome men be labelled as infertile in 2009?, 2010, Fullerton, G., Hamilton, M., Maheshwari, A., Human Reproduction, 25, 3, 588–597, 20085911, free, Pregnancies have been achieved in situations where azoospermia was associated with cryptorchism and sperm where obtained by testicular sperm extraction (TESE).JOURNAL, 10.1111/j.1365-2605.2009.00977.x, Reproductive outcome of men with azoospermia due to cryptorchidism using assisted techniques, 2010, Haimov-Kochman, R., Prus, D., Farchat, M., Bdolah, Y., Hurwitz, A., International Journal of Andrology, 33, e139–e143, 19622071, 1, free, In men with post-testicular azoospermia, different approaches are available. For obstructive azoospermia, IVF-ICSI or surgery can be used and individual factors are considered for the choice of treatment. Medication may be helpful for retrograde ejaculation.

See also

• DAZ protein family

References

{{Reflist}}

External links

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