What is azoospermia?

Azoospermia is the condition where sperm is not found in the semen analysis (spermogram). It can be confused with the absence of semen. The absence of semen is called aspermia and is a very different condition from azoospermia. Azoospermia refers to the presence of semen, but without any sperm cells in it.

What is the frequency of azoospermia, and what are its causes?

In 15% of infertile men, there is no sperm output. The most common cause of azoospermia is undescended testis. Following that, other causes include varicocele, blockages in the sperm ducts, genetic and hormonal disorders, cancer treatments, and environmental factors.

Can men with azoospermia have children without the use of in vitro fertilization (IVF)?

As implied by the definition of azoospermia, it refers to the absence of sperm in the spermogram. This does not mean that there is no sperm production in the testicles. Sperm may still be produced in the testicles, but there could be a blockage in any part of the ducts that carry sperm outside of the testicle. Unfortunately, blockages in these ducts cannot be corrected with surgical intervention.

Temporary conditions that can affect sperm production include high-fever illnesses, certain chemotherapy drugs, and some hormonal disorders. In these cases, it is possible to become a father without the need for surgical treatment.

Can every man with azoospermia have children through normal means after treatment?

Unfortunately, it is not possible for every azoospermia patient to have children through normal means. If the cause of azoospermia is testicular-related, such as genetic disorders or irreparable blockages in very fine sperm ducts, it is unfortunately not possible for these patients to be treated and have children through normal methods. What should be noted here is that they cannot have children through natural means; however, these patients still have the possibility of becoming fathers through in vitro fertilization (IVF).

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Which diseases cause azoospermia that can be treated?

Cancer treatments such as chemotherapy, radiation therapy, external hormone administration, or the excessive production or lack of certain hormones in the body, as well as high-fever illnesses, can temporarily stop sperm production in the testicles. These patients may be able to conceive naturally after the treatment.

Varicocele very rarely causes azoospermia. If no other cause is found in a patient with azoospermia, sperm output can be restored after varicocele treatment. (You can read more about varicocele treatment in the relevant section.)

The treatment of sperm duct obstruction is more difficult the closer it is to the testicle because the sperm ducts exiting the testicle are extremely thin and numerous, making them difficult to intervene with.

Which diseases cause azoospermia where, after treatment, children cannot be conceived through normal means?

Disorders in genes involved in sperm production, such as AZF genes
Chromosomal abnormalities like Klinefelter syndrome
Congenital absence of sperm ducts
Damage to fine sperm ducts after severe infections
Testicular inflammation after bilateral mumps in adulthood
Bilateral undescended testes

can lead to azoospermia. Currently, these conditions cannot be treated with available methods. Experimental treatment approaches, whose efficacy has not yet been proven, are under investigation. To clarify and avoid misunderstanding, it should be noted that these patients cannot have children through natural conception. However, they can still become fathers through in vitro fertilization (IVF).

What is done to treat azoospermia caused by cancer treatment?

The goal of cancer treatment is to stop the uncontrolled proliferation of cells. These treatments can also affect normal cells that rapidly multiply, such as cancer cells, causing harm. The sperm production process can be affected by chemotherapy and radiation therapy used in cancer treatment. Typically, this effect is temporary, and sperm production usually resumes about a year after treatment ends. During this period, antioxidant, vitamin, and mineral supplements may be used. Additionally, if radiation therapy is administered to an organ other than the testes and surrounding area, the testes can be protected during the procedure to prevent disruption to sperm production. It is recommended to freeze sperm before starting chemotherapy drugs that may potentially harm sperm production as a precautionary measure.

How is azoospermia caused by hormonal disorders treated?

The intake of male hormone (testosterone) or female hormone (estrogen) can reduce FSH levels, which in turn stops sperm production. In treatment, external hormone intake is stopped.

When FSH levels are low, sperm production will also be absent. Treatment can be done with external FSH hormone administration.

Pituitary tumors that secrete prolactin can also reduce FSH levels, disrupting sperm production. Treatment is achieved by removing the tumor either through medication or surgery.

Which levels of blockage in the sperm ducts can be treated?

If the blockage is located at higher levels of the duct, the obstruction can be removed surgically, allowing sperm to exit. The cause of the obstruction at higher levels could be prostate cysts, which occur when the sperm duct passes through the prostate and opens into the urethra. These cysts can cause blockages in the sperm duct, which can be corrected through a closed method surgery (TUR ED) by accessing the urethra.

If the blockage is in the vas deferens (the sperm duct), the obstructed portion of the duct can be surgically removed, and the healthy ends of the duct can be reconnected (vasovasostomy), allowing sperm flow to be restored.

Do androgen-based drugs used for bodybuilding have an effect on sperm?

Yes, when there is no androgen deficiency in the body, taking external androgens will stop sperm production. Excess androgens inhibit the secretion of the hormone responsible for sperm production in the brain. If continued, testicular shrinkage may begin. When the external androgen intake is stopped, if the shrinkage of the testicles has not become permanent, it generally improves within a year.

What is TESE surgery?

In patients with sperm production disorders that cannot be treated or where sperm output cannot be achieved despite treatment, there may still be some areas in the testicle where sperm production occurs. These areas can be identified by surgically opening the testicular tissue (TESE). It is very difficult to identify these areas with the naked eye, which is why the procedure should be performed under a microscope (micro TESE). With micro TESE, areas in the testicle that are likely to produce sperm can be identified under the microscope, and tissue samples can be taken from these areas to retrieve sperm. If sperm is found, it can be used for in vitro fertilization (ICSI).

What are PESA and TESA?

In cases where only sperm duct obstruction exists or in individuals born without sperm ducts, sperm can be retrieved by inserting a needle directly into the testicle (TESA) or into the epididymis (PESA) without the need for TESE. This is because these patients have no problem with sperm production; the issue is that sperm cannot exit the testicle due to the obstruction in the sperm ducts.