Azoospermia [nil sperm count ] is called when there is no sperm in semen. This type of semen disorder is found in approximately 3% of infertile men i.e. absent sperm. You should know that testis has two separate functions
(i) Production of normal sperms in semen which needed for pregnancy & normal fertility.
(ii) The other function of testis is production of male hormones i.e. testosterone & others. So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.
How sperms develop: When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases.
Causes of Nil Sperms:
The various causes of nil sperm are as follows :
Hormone disorder : The various endocrine (Hormone) disorder leading to azoospermia are as follows
(1) Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.
(2) Obstruction in the outflow of semen (Sperms) from testis to outside through urethral opening. Many times the production of sperms in testis is absolutely normal but these sperm are unable to come out due to obstruction in the out flow tract leading to absent sperms in the semen. The various causes of obstruction are absent vas deferens, absent seminal vesicle, posttraumatic, post surgical ligation of vas deferens.
(3) Absence of germ cells in testis also called sertoli cell only syndrome. In this there are no germs cells i.e. sperm forming cells in the testis. For you knowledge,
(4) Maturation Arrest (. Spermatid arrest): of primary spermatocytes to secondary spermatocyte, spermatids or to mature spermatozoa. Due to may local, systemic, hormonal growth factor deficiency or due to idiopathic factor. The various paracrine hormones and growth factors are essential for normal development i.e. maturation of one germ cells to multiplication of ultimately production of multiple mature, normal & motile sperms. Many other factor as infection, varicocele, drugs, chemotherapy may also lead to maturation arrest. The other causes may by developmentally defective germs cells & spermatocyte. So that they did not have inherent capacity of developing into a mature & motile sperms.
4) Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis),
5) Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the cord that connects to the testicle. 6) Drugs (e.g. spironolactone, alcohol, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
7) Presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia
9) Environmental toxins
10) Viral orchits
11) Granulomatous disease as tuberculosis, sarcoidosis of the testis
12) Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease
13) Neurological disease as myotonic dystrophy
14) Development and structural defects, Germinal cell aplasia, sertoli cell only syndrome, Cypt-orchidism
15) Androgen resistance
16) Mycoplasma infection
17) Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm count.
18) Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the sperm forming germ cell in the testis.
Diagnosis of Cause of Nil Sperm Count :
we first try to find out cause. We take detailed history, thorough drug history, and general physical examination, examination of testis, epididymis & testicular veins & sperm carrying duct examinations. . The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.
Investigation & Diagnosis: For completes diagnosis of causes of azoospermia (nil sperms) one or more of the following tests may be required as:
1) Complete male hormone profile: This profile includes all the male hormone tests which affect testicular development, growth & other genital organ development as well as genital functions. L.H., F.S.H., Testosterone, prolactins, thyroids test,
2) Antisperm antibody
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Fine Needle Testicular Biopsy of the testis to look for evidence of spermatogenesis & testicular structure.
Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype (chromosome analysis)
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when needed
17) Immunobead test
18) MRI head, Hemogram, test for systemic diseases.
19) Olfactory test is done to find out kallman's syndrome
At our center facility for all the above tests are available.
Other Cause for Azoospermia[nil sperm count ] :
Pus in Semen
Pus cells in semen may be due to infection into genito-urinary tract due to any of the following causes:
1.) Chlamydia infection
Chlamydia is a common infection of genitourinary tract all over world. It's a bacterial infection. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.
2) Gonorrhea (Gonococcal Urethritis)
It is caused by the bacterium Nesseria gonorrhoea.
Symptoms include pus in semen. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.
3) Non-Specific urethritis or NSU (Non-gonococcal Urethritis): It is caused by any of the following causative agent Chlamydia trachomatis, Ureaplasma urelyticum, Mycoplasma genitalium ,Candioda species, Anaerobes, Trichomonas vaginalis,, Unidentified / idiopathic. Some times it may be Persistent/recurrent non-gonococcal urethritis or Prolonged urethritis.
4) Candidal Balanitis (Thrush) is a fungal infection.
5) Prostatitis( Acute or Chronic)
Urine may show threads or ‘beads of pus' positive leycocyte esterase test.
Methelyne blue stain
Antigen detection techniques
Poly merase chain reaction
Fungi detection test
Herpes simplex virus antibodies
In some male's, antibody production starts against its own sperms. These antisperm antibodies may then enter the testis & seminal fluid and ‘attack' the sperms & sperm forming cells. These antisperm antibodies stick the sperms with each other and thus tend to seriously reduce sperm motility, thereby causing infertility. By the use of various treatments, the amount of antibodies may be reduced and fertility restored.
Antisperm antibodies have been found to be present in up to 40% of couples with unexplained infertility, and in 10% of unexplained male infertility. Infertility in a couple can occur if the woman's cervical mucus provides a hostile environment by producing antibodies to her partner's sperm. More often, the problem is due to the male partner producing antibodies against his own sperm. Unilateral or bilateral obstruction of the genital tract (either congenital or acquired), epididymitis and varicocele are also sometimes associated with an autoimmune response against spermatozoa.
Absent Ejaculation Orgasm
Absent ejaculation in which patient does not gets orgasm & semen discharge even after prolong sexual activity
3. Delayed ejaculation: In this disorder orgasm & semen discharge occurs after abnormally prolonged sexual activity.
4. Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder.
(4) Absent Ejaculation or Orgasm: There are certain conditions in which patient does not get orgasm even after prolonged sexual activity. the cause of this can be primary, Psychogenic or due to certain medication, neurological diseases, surgeries etc. Treatment needs diagnosis of cause & then treatment.
· Blood Tests: In women, blood tests are commonly used to detect the antibody.
· Post-Coital Test: The post-coital test can detect the presence of antisperm antibodies in a woman's cervical mucus.
· Sperm Testing: In men, sperm testing is the best way to analyze for antisperm antibodies. The immunobead assay and the mixed agglutination reaction test are both used.
Homeopathy Treatment :
Correction of the Cause: First of all we try to find out the primary cause of nil sperms by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.
1) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually sperm count normalizes in three month time with proper hormone treatment.
More informations : www.homeopathyonline.in
By Dr Harshad Raval M.D [Homeopathy]
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