Background
Azoospermia is a condition characterized by lack or inadequacy of sperm in semen.
Although it is congenital (gotten from birth), it could also be caused by the excessive use of corticosteroids and androgens. It is important to note that sperm is NOT the fluid that gushes out in an ejaculation, but the microscopic living reproductive cells that swim invisibly to the unaided eye in the visible fluid. The fluid itself is called semen and contains a form of sugar known as fructose which serves to energize the actual sperm cells.
Corticosteroids are hormones produced in the adrenal cortex from the adrenal glands which sit on top of the kidneys or produced synthetically as drugs and used to treat a range of conditions such as inflammation, colitis, Crohn’s disease, arthritis etc.
Androgens are naturally produced or synthesized hormones that regulate the development and maintenance of male sexual characteristics.
Epidemiology/Prevalence
There are well over hundred thousand diagnosed cases of Azoospermia in Nigeria annually and it could be diagnosed among the 14-60> age bracket in the following proportions:
-Teenagers (14-18 years): rare
-Young adults (19-40 years): very common
-Adults (41-60 years): common
-Seniors (60+ years): rare
Types of Azoospermia
There are four types of Azoospermia namely:
1) Pre-testicular Azoospermia:
This is characterized by inadequate stimulation of normal testicles and genital tract. Typically, Follicule stimulating Hormone levels are low and the testes are inadequately stimulated to produce sperm.
This type is seen in 2 percent Azoospermia cases.
2) Testicular Azoospermia:
In this type of Azoospermia, the testes are abnormal, atrophic or absent and sperm production is hampered entirely.
This type is seen in 49-93 percent of Azoospermia cases and is usually permanent.
3) Post-testicular/Obstructive Azoospermia:
In this type, sperm is produced but not ejaculated along with semen. The main cause is physical obstruction.
This is the type of Azoospermia induced by vasectomy as a form of consented sterility.
It is seen in about 7-51 percent Azoospermia cases.
4) Idiopathic Azoospermia:
Azoospermia could be of unknown cause.
However, a couple of risk factors could engender condition.
These factors include weight and age.
A study in 2013 came up with the following risk factor relationship ratios:
-Overweight 1:1
-Obese 1:3
-Morbidly obese 2:0
Basically from the age of sperm production to andropause.
Symptoms?
The common symptom of Azoospermia is infertility and of course detrimental variations in the clinical parameters that confirm fertility.
Diagnosis
Azoospermia can be diagnosed through a laboratory procedure known as semen analysis.
The parameters of semen analysis include:
1) Volume of semen (Should be up to 2ml)
2) Reaction and PH 7.2-7.8
3) Sperm count (not less than 15 million per mililitre or 39million per ejaculation).
4) Morphology/shape and structure of sperm: must be a smooth, oval-shaped head that is 5-6 micrometers long and 2.5-3.5 micrometers wide (less than the size of a needle point), a wide cap (acrosome) that covers 40-70 percent of the sperm head.
5) Motility/mobility of sperm cells
6) Liquefaction: Must not be too watery or too thick.
7) Pus cells and RBCs (Red blood cells)
8) Fructose level in semen.
Treatment
Azoospermia is treatable by specialist medical interventions and could be chronic if ignored.
Minimum Required Qualities of Semen For Fertility
1) Volume of semen per ejaculation must be at least 2ml (small teaspoon)
2) Sperm count must be at least 20million per 1ml of semen. Yeah!
3) Number of sperms in each ejaculation must be at least 40 million.
4) 75 percent of sperms per ejaculation must be alive.
5) 50 percent of sperms per ejaculation must be motile/mobile.
6) 30 percent of sperms per ejaculation must have normal shape and structure (Morphological adequacy).
7) Sperms with head defects must be less than 35 percent.
8) Sperms with mid-piece defect must be less than 20 percent.
9) Sperms with tail defect must be less than 20 percent.
Conclusions
1) It is important to go for fertility test electively from the age of adulthood.
2) Avoid excessive use of steroids, hence they’re prescription drugs and should not be used outside a doctor’s prescription. It’s also important that the prescriptions come from a physician who has an idea of your Medical history.
Written By:
Ukabuilu Chukwuka O.