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, and how should it be treated?Additional Question: My ultrasound showed that my testicles and vas deferens are developing normally. Is sperm production related to staying up late, mood, or diet?
Doctor's answer:
I. OverviewSemen is obtained through methods such as external ejaculation or masturbation. If sperm are not found in three consecutive centrifuged sediment smears, it is referred to as "azoospermia."
Azoospermia is divided into two types: true and false. True azoospermia refers to the atrophy and degeneration of sperm-producing cells in the testes, rendering them unable to produce sperm, also known as "congenital azoospermia." False azoospermia refers to a condition where the testes can produce sperm, but they cannot be expelled due to obstructed seminal ducts, also known as "obstructive azoospermia." Both fall under the category of absolute infertility.
II. Etiology and Pathology
① Sperm production disorders
Congenital malformations such as anorchidism, cryptorchidism, and incomplete testicular development.
Testicular trauma, trauma to the artery of the vas deferens, testicular torsion, mumps complicated with orchitis, and others leading to testicular atrophy.
X-ray exposure.
Endocrine disorders such as hypofunction of the gonads and pituitary.
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 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
In addition to infertility, most patients show no clinical symptoms or signs. Some patients have a history of prostatitis, seminal vesiculitis, epididymitis, or epididymal tuberculosis. Some patients exhibit local signs such as testicular underdevelopment, testicular atrophy, or epididymal nodules, along with other systemic symptoms.
Diagnosis
① Sperm count in semen analysis is negative three or more times;
② Testicular biopsy