Patient's question:
Is it innate or acquired, and under what circumstances is it usually obtained? Can you explain? 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, it is common for them to feel 10 points frustrated upon finding no sperm in their semen. In fact, azoospermia (the absence of sperm) is a major factor or cause of male infertility, affecting approximately 19~30% 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 sperm production disorders, and blocked spermatic ducts. The male reproductive system is regulated by the hypothalamus and pituitary gland. When endocrine dysfunction occurs in the hypothalamus or pituitary gland, it can lead to testicular underdevelopment or functional abnormalities. 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 cryptorchidism, mumps, Klinefelter syndrome, and long-term consumption of raw cottonseed oil, can damage the testicles. If only the sperm-producing cells are damaged, the only abnormal symptom may be 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 3~10% of male infertility cases, while in China, it accounts for approximately 2%. Among these blockages, obstruction of the vas deferens is the most common. This condition, in addition to the primary symptoms of the blockage, can lead to infertility but does not affect male development or sexual function.
Since there are many and complex factors or causes that can lead to azoospermia, it can be difficult to identify them. Generally, endocrine tests, testicular biopsy, and examination of the spermatic ducts 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 testicles show no abnormalities, the cause is likely a blockage in the spermatic ducts. In hospitals with the necessary facilities, retrograde seminal vesiculography 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 sperm-producing cells are destroyed, 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 (reconnection) may be possible, and pregnancy may result after surgery. However, if there is widespread or multiple bilateral blockages of the spermatic ducts, or if both sides lack seminal vesicles, treatment is very difficult.