Azoospermia: Definition, Causes & Symptoms

What is Azoospermia?

Azoospermia is a medical term used to describe the condition when men have no sperm count at all in their ejaculate. It is one of the causes of infertility for men and can be diagnosed through a semen analysis test. 

In understanding the types of azoospermia, it is best to quickly review how the sperm travels through a man’s reproductive system. 

Sperm are produced in the testicles. From the testicles, sperm will travel through the reproductive tract and combine with the seminal duct fluid to form semen. Semen is the thick, white ejaculate that comes out through the penis during ejaculation. When one or none of the above processes fail to take place, there is a great chance that you may have azoospermia.

Types of Azoospermia

Also known as post-testicular azoospermia, this condition is mainly caused by problems with ejaculation due to blockages in any part of the reproductive organs or ejaculation dysfunction such as retrograde ejaculation. Patients with this type of azoospermia can produce sperm as normal, but the sperm are unable to be transferred into the ejaculate.

This condition can be categorised into two types, pre-testicular azoospermia and testicular azoospermia.

Pre-testicular azoospermia is mainly caused by hormonal disorders. In this case, the endocrine glands are not producing enough chemicals to trigger healthy sperm production and development. 

Testicular azoospermia, on the other hand, is mainly caused by the testes themselves. This condition could be due to abnormalities in the function or the structure of the testicles or the testes' inability to respond to the hormone released by the endocrine glands. 

Both types of non-obstructive azoospermia are the indicator that the patient is producing very low sperm or no sperm at all. 

Causes of Azoospermia

• Congenital anomaly — some conditions such as blockages or missing vas deferens can be present from birth. Vas deferens is the tube that transports mature sperm into the urethra for ejaculation. 
• Infection or inflammation of the reproductive tracts. The common cause of this condition is due to untreated sexually transmitted infections (STIs) such as chlamydia. 
• Previous trauma or injuries to the reproductive organs, including past surgical procedures such as vasectomy.
• Retrograde ejaculation — even if the cause of this condition is not clear, this condition still hinders the sperm from leaving the testicles during ejaculation.

• Genetic or chromosomal anomaly can happen due to conditions such as Y-chromosome microdeletions, Klinefelter syndrome or Kallmann syndrome. All are cases of genetic mutations with mostly no visible symptoms until the patient encounters infertility problems. 
• Hormonal imbalances. This condition can be brought on by many circumstances including pituitary glands anomaly (hypogonadotropic hypogonadism) or testicular failure to produce testosterone even with hormone support from the pituitary glands. 
• Varicocele refers to the enlargement of veins in the scrotum or testicles. Although it is not exactly clear how varicocele causes infertility, men with varicocele end up producing low-quality sperm or none at all. 
• Radiation, chemotherapy or toxin exposure can lead to a state of temporary or permanent azoospermia. For example, azoospermia is expected during chemotherapy treatment, however, sperm production may take a while before it can go back to the normal level. In less common cases, some patients may never recover the ability to produce sperm anymore. 
• Medication side effects — most medications for cancer treatment especially chemotherapy are likely to contribute to azoospermia. Likewise, drugs such as anabolic steroid which is mostly consumed by athletes are also likely to cause azoospermia.

Symptoms of Azoospermia

Azoospermia is very tricky to detect without undergoing semen analysis testing. Nonetheless, the nearest possible sign of this condition is when a couple has been unsuccessful to conceive after more than a year of trying. 

Other possible symptoms of azoospermia to look out for are mostly related to hormonal imbalances or genetic chromosomal conditions. The symptoms may include: 

• Low sex drive
• Low ejaculate volume or “dry” orgasm 
• Swelling, lumps or a general discomfort around the testicles
• Painful urination
• Cloudy urination after sex (possibility of retrograde ejaculation)
• Reduced male hair growth
• Loss of muscles
• Enlarged breasts
• Difficulty with erections or ejaculation (possibility of erectile dysfunction)

All the same, you may still have azoospermia without experiencing any of the above symptoms.