Non-obstructive Azoospermia: Causes & Treatment

Azoospermia is the medical term for an ejaculate that contains no sperm at all. According to the presence or absence of obstruction, it is divided into obstructive azoospermia and non-obstructive azoospermia.

What are the causes of Non-Obstructive Azoospermia?

Non-obstructive azoospermia can be caused by many things, such as:

  • Genetic Causes: Male infertility can have a number of hereditary origins, some of which can lead to non-obstructive azoospermia. They include karyotypic anomalies and Y-chromosome microdeletions. When a male has an extra X chromosome, they have Klinefelter Syndrome, the most prevalent karyotypic anomaly. 
  • Varicoceles: Varicoceles, which are enlarged varicose veins in the scrotum, can potentially have an impact on sperm production. Blood pooling in the scrotum brought on by varicoceles has a detrimental effect on sperm production.
  • Medications: The generation of sperm may potentially suffer from exposure to some drugs. For instance, taking testosterone supplements can interfere with the reproductive system’s operation.
  • Causes of Non-Obstructive Azoospermia by Hormone: The pituitary’s hormones must stimulate the testicles to make sperm. Sperm formation cannot take place if these hormones are lacking or absent. The hormones required for sperm production may have been impacted in men who currently use or have used steroids.
  • Radiations and Toxins: The production of sperm can be hampered by harmful chemical exposure, such as that caused by chemotherapy and radiation therapy. For this reason, sperm banking is advised before chemotherapy or radiation therapy.

What is the treatment for Non-Obstructive Azoospermia?

Hormone replacement therapy (HRT) effectively addresses hormone shortages in males with non-obstructive azoospermia. Aromatase inhibitors, which increase sperm concentration and motility, can treat men with an abnormal testosterone-to-estradiol ratio (T/E2). However, HRT works in patients with low hormones. Patients with high hormone values are difficult to treat and often require donor sperm for IVF. 

Data on whether to surgically repair varicoceles are inconclusive. By tying off the afflicted veins and redirecting blood flow through healthy veins, varicocelectomy can help diminish the enlarged varicose veins, but it is often only used in severe cases.

Pregnancy with Non-Obstructive Azoospermia

In the past, fertility specialists believed that men with sperm production issues could only start a family via donor sperm or adoption. Testicular biopsies, however, frequently reveal sperm in males with non-obstructive azoospermia. In vitro fertilisation (IVF) can use testicular sperm, which frequently have reduced motility, for intracytoplasmic sperm injection (ICSI).

For men with non-obstructive azoospermia, a method called testicular sperm extraction (TESE) and microscopic testicular sperm extraction ( micro TESE) with ICSI has been used. A local or general anaesthetic may be used during testicular sperm extraction. This method can be used to obtain sperm for IVF treatments.

Genetic testing and counselling are advised before IVF if a man has been diagnosed with a hereditary explanation for his non-obstructive azoospermia.