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What is Azoospermia, What are its Causes?

Azoospermia is the absence of measurable sperm in a man's semen. It is one of the most common causes of male infertility. The rate of azoospermia in men with infertility problems is up to 20%.

In men, sperm production takes place in the testicles. It is in the semen by mixing with the fluid coming from the seminal vesicle from the reproductive canals. Men with this problem may have very little or no sperm in the semen.

It is not possible to have children naturally in men with azoospermia. In this case, there is no sperm in the man's semen, living or dead. In men, sperm may not be found in the semen due to congenital or subsequent conditions. In azoospermia, sperm ducts are usually open in men. However, since there is no mature sperm production in the testicles, sperm cannot be found in the semen.

In case of not having a child despite having regular unprotected sexual intercourse, the suspicion of azoospermia is also emphasized. If the expectant mother does not have an obstacle for pregnancy, the causes of male infertility are investigated. Azoospermia is a disorder that can occur due to different reasons.

What are the causes of azoospermia?
Azoospermia is seen in approximately 2% of the male population in our country. This situation is also described as a case of severe infertility on men. Azoospermia is not seen in all men with infertility problems. In these cases, successful pregnancy can be achieved in in vitro fertilization with the help of microsurgery.

The causes of azoospermia can be as follows;
Having Linefelter's syndrome
Some genetic disorders
Use of suppressive drugs
Absence of vas deferens
cystic fibrosis disease
The condition of not descending from the testicles to the scrotum
Hormonal disturbances since puberty
catching some sexually transmitted infections
Occlusion of the vas deferens in surgical operations on the inguinal region
Conditions such as testicular damage are among the causes of azoospermia.

The causes of azoospermia can also be grouped under the following headings;
Prestestcular azoospermia: In this case, there may be a problem with the hormones responsible for sperm production. In addition, when brain diseases damage the pituitary or hypothalamus regions, hormone production is interrupted. Radiation, cancer treatment and drugs applied to the head area can also affect hormone production and lead to azoospermia.

Testicular azoospermia: In some men, testicular function and structure may be impaired. Conditions such as absence of testicle, non-descending, inability to produce sperm, and inability to produce mature sperm are characterized as testicular azoospermia. Carrying an XXY chromosome instead of an XY chromosome is also among the obvious reasons. Mumps disease, testicular tumor, radiation, diabetes and enlargement of testicular vessels may also be among the causes in males towards the end of adolescence.

Posttesticular azoospermia: Due to certain obstructions in the reproductive tract in men, problems may occur in semen excretion. It is among the most common causes of azoospermia cases. This problem may arise from birth or may develop later. It may occur later due to reasons such as infection, cyst, injury, vasectomy surgery.

What are the symptoms of azoospermia?

Azoospermia is a disease that usually causes no symptoms. It has no particularly proven symptoms. However, some symptoms in men may be a harbinger of azoospermia;

Decreased sexual desire compared to the past
Experiencing erection problems
Significant reduction in hair or body hair
Swelling, lumps or different discomforts around the testicles are among the symptoms.

What are the types of azoospermia?
Azoospermia can develop in two different types;

obstructive azoospermia
It can be seen as a result of congenital deficiencies in sperm ducts, genital infections and some surgical procedures. The patient can be treated by opening the sperm channels. In vitro fertilization treatment can be carried out with methods such as testicular examination, hormone examinations, and ultrasonography.

Causes not related to obstruction
Hereditary problems develop due to the fact that the testicles have been found in the upper canals since the time of birth, the rotation of the testicles around themselves. In this process, the only method of having a child will be surgical sperm retrieval and microinjection.

How is azoospermia diagnosed?

The most preferred method for the diagnosis of azoospermia is the spermiography test. This test is also known as sperm test or semen analysis. In this procedure, the patient must empty sperm into the laboratory container. The sperm sent to the laboratory are examined in detail. The normal sperm count in 1 ml of semen is more than 15 million. If there are less than 15 million sperm per milliliter, the sperm count is considered insufficient. This condition is known as oligospermia.

During semen analysis, sperm shape and motility are also examined along with the sperm count. The absence of a measurable number of sperm in the semen sample in the laboratory is considered as azoospermia. The correct diagnosis is made by evaluating this test with two different sperm samples taken 2 weeks apart.

For the diagnosis of azoospermia, a detailed history of the patient is taken from childhood. Real information should be given on all subjects such as diseases, surgeries, drugs used, radiation therapy and substance abuse. In some cases, specialists may request additional applications such as genetic testing, FSH level, serum testosterone, reproductive organ ultrasound, brain imaging.

How is azoospermia treated?

In order to start treatment after the diagnosis of azoospermia, the causes of this problem are examined. If there is an azoospermia due to obstruction, an operation is performed to remove the obstruction. In patients with low hormone production, external hormone therapy is carried out.

If insufficient sperm production is due to varicocele, the veins can be surgically ligated. It is possible for people with azoospermia to have children with procedures such as the Rosi technique. Sperm cells that do not have the ability to fertilize are provided with the ability to fertilize with electrical support. In cases of azoospermia, it is possible to have a child with advanced applications.

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