Azoospermia

Azoospermia is the complete absence of sperm in the semen and has many causes. Obstructive azoospermia implies that there is a blockage in the genital tract yet normal testicular production of sperm. Other causes of azoospermia are nonobstructive, meaning that there is a significant diminution in sperm production within the testicle. Obstructive azoospermia accounts for about 40% of all cases of azoospermia. Obstruction may be either congenital or acquired. Vasectomy is a common form of male contraception in that the vas deferens is cut and sealed on each side forming an acquired obstruction. It is the most common cause of obstruction in the vas. Another common cause of obstruction is a prior infection which results in scarring of the ductal structures. Congenital obstruction can be due to either a malformation or the absence of the vas deferens.

Obstruction of the male reproductive tract can often be corrected by an operation, but is some men, surgical correction is not possible. In this situation, it may still be possible for the man to father children by removing a few sperm from his reproductive system and using the sperm for in vitro fertilization (IVF) with intracytoplasmic sperm injection, ICSI.

Finding the cause of the obstructive azoospermia is helpful for several reasons. It allows your physician to decide whether you are a candidate for surgical treatment. If your obstruction is not surgically treatable, your doctor might be able to suggest other treatment options for you or your partner. If there is a major medical or genetic disorder underlying the azoospermia, it may be important to identify these disorders. It is also important to know whether the genetic problem may be passed on to your children.

The genetic abnormality that may be associated with obstructive azoospermia occurs in some men who are born without the vas deferens. This condition is called congenital bilateral absence of the vas deferens CBAVD. About two-thirds of men who have CBAVD have a genetic mutation that can cause cystic fibrosis if they initiate a pregnancy with a woman who has the same genetic mutation.

Therefore, if you have CBAVD, genetic testing and counseling should be sought to help you and your partner understand the risks of passing this defect to your children.

The options available to couples in whom the male partner has obstructive azoospermia include surgical correction of the obstruction, removal of sperm from the male reproductive system combined with IVF/ICSI, artificial insemination with sperm from a donor, and adoption.

The best treatment option for you depends on the cause of the obstruction as well as a number of personal factors. The reproductive, health status of your partner, social, marital, religious, cultural and financial factors and genetic factors are other important considerations. Before you choose the best treatment for you, an evaluation of both you and your partner is recommended. This evaluation will determine whether your obstruction is surgically correctable and what are the approximate chances for having a baby with each option.