Patient's question:
Medical History: I've been married to my wife for 4 years. This year, we want to have a child, but we haven't been able to conceive. Both of us are developing normally. My first semen analysis showed 30% viability, but this time the test revealed no sperm. What could be the reason for this? How should it be treated?First follow-up question: I had a color Doppler ultrasound, and it showed that my testicles and vas deferens are developing normally. Does sperm production have anything to do with staying up late, mood, or diet?
Doctor's answer:
Okay, here is the English translation of the provided text, following your instructions:I. Overview
Semen is obtained through methods such as masturbation or retrograde ejaculation. When repeated centrifugation and smear examination of the sediment three times consecutively fail to detect sperm, it is referred to as "azoospermia".
Azoospermia is classified into two types: true and false. True azoospermia refers to atrophy and degeneration of the testicular germ cells, rendering them unable to produce sperm, also known as "congenital azoospermia". False azoospermia refers to a situation where the testes can produce sperm, but they cannot be expelled due to obstruction of the male reproductive tract, also known as "obstructive azoospermia". Both fall under the category of absolute infertility.
II. Etiology and Pathology
① Sperm Production Disorders
Congenital anomalies such as anorchidia (absence of testes), cryptorchidism, and testicular hypoplasia.
Testicular trauma, trauma to the artery of the vas deferens, testicular torsion, mumps orchitis, etc., leading to testicular atrophy.
X-ray irradiation.
Endocrine disorders such as hypofunction of the gonads or pituitary gland.
Deficiency of vitamins A, C, E, and complex B.
② Sperm Transport Obstruction
Congenital absence of the vas deferens, trauma or ligation of the vas deferens.
Gonococcal epididymitis, tuberculosis of the epididymis and prostate with caseous necrosis.
Ejaculatory duct obstruction.
Testes that cannot produce sperm are usually smaller in size, softer in texture, and lack elasticity; whereas in obstructive azoospermia, the testicular volume is often normal, full, and elastic.
III. Clinical Manifestations
Apart from infertility, there are often no clinical symptoms or signs. Some patients have a history of prostatitis, seminal vesiculitis, epididymitis, or epididymal tuberculosis. Some patients have local signs such as testicular hypoplasia, testicular atrophy, or epididymal nodules, along with other systemic symptoms.
Diagnosis
① Semen analysis showing no sperm for three or more consecutive tests;
② Testicular biopsy