Patient's question:
Is it innate or acquired, and under what circumstances is it usually obtained? Can you explain it? Thank you. First question supplement: (2007-11-21 16:55:56) If it is obtained, is there still a possibility of treatment? In the case of normal testicular development,Doctor's answer:
Hello!When infertile men undergo semen analysis, they often find no sperm in their semen, which can be extremely frustrating. In fact, azoospermia (the absence of sperm) is a major cause or factor of male infertility, affecting approximately 19 to 30% of infertile men. Why is there no sperm in the semen?
There are many factors or causes that can lead to azoospermia, such as endocrine dysfunction, testicular spermatogenesis disorders, and blocked spermatic ducts. The male reproductive system is regulated by the hypothalamus and pituitary gland. When there is endocrine dysfunction in the hypothalamus or pituitary gland, it can lead to undescended testicles or abnormal testicular function. In such cases, the testicles not only fail to produce sperm but also produce reduced levels of androgens, resulting in infertility, loss of male characteristics, and decreased sexual function.
Many factors, such as undescended testicles, mumps, Klinefelter syndrome, and long-term consumption of raw cottonseed oil, can damage the testicles. If only the spermatogenic cells are damaged, there may be no other abnormal symptoms besides infertility. However, if the cells that produce androgens are also damaged or the testicles atrophy, both fertility and sexual function will decline.
Certain conditions, such as congenital abnormalities, inflammation, trauma, and tumors, can cause blockages in the sperm transport ducts. International reports indicate that blockages in the spermatic ducts account for 3 to 10% of male infertility cases, while in China, it accounts for about 2%. Among these blockages, the most common is a blocked vas deferens. This condition, in addition to the primary symptoms of the blockage, can cause infertility but does not affect male development or sexual function.
Since there are many and complex factors or causes of azoospermia, it can be difficult to identify them. Generally, endocrine tests, testicular biopsy, and spermatic duct examinations are required. If the level of gonadotropins in the blood is lower than normal, it may indicate a hypothalamus or pituitary disorder. Conversely, if the level of gonadotropins is elevated, it may suggest a testicular issue. If both the endocrine system and the testicles show no abnormalities, the cause is likely a blockage in the spermatic ducts. In hospitals with the necessary facilities, retrograde vasography can be performed to determine the cause.
For azoospermia caused by hypothalamus or pituitary dysfunction, treatment with hormones such as human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG), or gonadotropin-releasing hormone (GnRH) often yields good results.
If the testicles are only slightly damaged, hormonal treatment may restore fertility. However, if the damage is severe and the spermatogenic cells are damaged, the chances of recovery are very low. In cases of blocked spermatic ducts, if the blockage can be located and is not extensive or multiple, surgical repair may be possible. After surgery, pregnancy may be achieved. However, if there is widespread or multiple bilateral blockages of the spermatic ducts, or if both sides of the ducts are absent along with seminal vesicles, treatment is very difficult.