Learn the seven common causes of azoospermia — no sperm count — and how to deal with it…


You’ve probably heard of the term low sperm count, but some men actually face an even more severe form of male infertility called azoospermia. Also known as no sperm count, the guy’s ejaculate actually has no traces of sperm.

Dr Lewis Liew, a Gleneagles Hospital urologist, notes that about 10 per cent of male infertility issues is related to this condition. The average Singaporean man in his mid to late 30s has a higher risk of suffering from azoospermia. Although this problem can also happen when one’s pre-existing low sperm deteriorates, Dr Liew stresses that the probability is “not high”.

Two tests will determine if a man suffers from azoospermia. First, a semen analysis will confirm if he has the condition. He may then undergo a series of blood tests to check if he has male fertility hormones such as testosterone, luteinising hormone and follicular stimulating hormones.

If the cause is obstructive, the testicles produce sperm that is unable to flow out of the testes because of blockages.

The pituitary gland produces the luteinising hormone (LH) — also known as lutropin — which is responsible for the production of testosterone and plays a critical role in sperm production. The follicle-stimulating hormone (FSH), on the other hand, helps to control the production of sperm.

Azoospermia can be obstructive or non-obstructive in nature. If the cause is obstructive, the testicles produce sperm that is unable to flow out of the testes because of blockages. When the cause is non-obstructive, hormonal or genetic issues give rise to a problem with sperm production. Dr Liew explains what the different causes of azoospermia are and how he can resolve them…

Non-obstructive causes

1. LH and FSH deficiency
WHAT As both luteinising and follicle-stimulating hormones are crucial in influencing the levels of sperm production, a drop in their levels can spell trouble for your spouse’s sperm count.
EXPERT SAYS Excessive alcohol consumption may mess with his LH and FSH levels — a very good reason to stop drinking. Dr Liew says that certain drugs, like anabolic steroids and testosterone supplements, can also suppress a man’s pituitary gland functions. Treatment for pre-existing conditions like Kallman Syndrome — a failure to start or complete puberty ― can also cause his LH and FSH levels to drop. However, Dr Liew assures, “Treatment with synthetic LH and FSH can restart the testicular function and sperm-producing functions of the testes.”



2. Klinefelter syndrome
WHAT Instead of the typical X-Y chromosomes, males with Klinefelter Syndrome are born with two or more X chromosomes — X-X-Y instead of X-Y. And while it is a genetic disorder, Klinefelter Syndrome isn’t hereditary. Men who suffer from the syndrome may not even be aware of it ― signs include sparse body hair, enlarged breasts, small testicles and wider hips.
EXPERT SAYS Dr Liew says that the syndrome is a form of testicular failure and there is no treatment available.

3. Hypospermatogenesis
WHAT In this condition, the testicles produce lower amounts of sperm than usual. A biopsy will be carried out on either one or both testes to draw tissue for examination.
EXPERT SAYS Assisted reproductive therapy is usually the only alternative if he has the condition. Dr Liew notes that a sperm sample will be retrieved from the testes and frozen for later use. Intracytoplasmic sperm injection is an artificial insemination technique where the sperm is injected into a mature egg.

Obstructive causes

4. Vasectomy
WHAT In this procedure, the tube connecting the testicles to the urethra is cut, clamped or sealed, so as to prevent sperm from being released when the man ejaculates. This form of contraception is considered to be permanent, although it may be reversible.
EXPERT SAYS Depending on how much time has passed since the vasectomy, additional blockages may form, which may prevent or complicate its reversal.

As repeated chlamydia infections are common, the best way to prevent infections is to practise safe sex.

5. Sexually transmitted infections
WHAT When the testicles, prostate or reproductive tract get infected as a result of venereal diseases, this can also lead to blockages. Diseases such as chlamydia can block the small tubes in the ejaculatory ducts.
EXPERT SAYS Chlamydia is easily cured with a course of antibiotics. As repeated chlamydia infections are common, the best way to prevent infections is to practise safe sex. While antibiotics can treat the infection, it will not reverse the damage done by the disease.

6. Varicocele
WHAT When the veins around the testicle dilate, this results in varicose veins, a usually harmless condition, although it may trigger blockages.
EXPERT SAYS Dr Liew explains, “Most varicoceles only cause a minor lowering of sperm count but in some cases, the varicocele results in azoospermia.” Although this is the most common cause of male infertility, it is also the most easily resolved. In a surgical procedure, the affected vein will be tied up, so as to redirect the blood flow to normal ones.

7. Testicular cancer
WHAT Sometimes, if a man has low or no sperm count, it may be an early sign of testicular cancer or other tumours in his reproductive system.
EXPERT SAYS As with any form of cancer, he should get checked by a doctor as soon as possible. Besides lumps or swelling of the testicles, other symptoms of cancer include: A feeling of heaviness or aching in the lower abdomen or scrotum, or feeling a soreness of the chest.

Photos: iStock

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