How is azoospermia diagnosed?

Azoospermia is diagnosed when, on two separate occasions, no sperm cells can be found in samples of centrifuged seminal fluid using a high-powered microscope.

A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged seminal fluid, if sperm cells are present, they separate from the fluid around them and can be viewed under a microscope.

As part of the diagnosis, the doctor will take the patient’s medical history, including the following:

  • Fertility success or failure in the past (ability to have children)
  • Childhood illnesses
  • Injuries or surgeries in the pelvic area (these could cause duct blockage or poor blood supply to the testicles)
  • Urinary or reproductive tract infections
  • sexually transmitted diseases
  • Exposure to radiation or chemotherapy
  • Any use of medications, past or present
  • Abuse of alcohol, marijuana, or other drugs
  • Recent fevers or exposure to heat, including frequent saunas or steam baths (heat kills sperm cells)
  • Family history of birth defects, mental retardation, reproductive failure, or cystic fibrosis

The doctor will also conduct a physical examination, and will check:

  • The overall maturation, size, and shape of the body and the reproductive organs
  • Contents of the penis and scrotum
  • If the vas deferens is present
  • Tenderness or swelling of the epididymis
  • The presence or absence of a varicocele
  • The rectum for obstruction of the ejaculatory duct

The doctor may also order the following tests:

  • Measurement of levels of hormones such as testosterone and follicle-stimulating hormone (FSH);
  • Genetic testing
  • X-rays or ultrasound of the reproductive organs to see if there are any problems with the shape and size, and to see if there are tumors, blockages, or an inadequate blood supply
  • Imaging of the brain to identify disorders of the hypothalamus or pituitary gland
  • In cases of normal-sized testes and normal hormone levels, a biopsy (tissue sampling) of the testes to learn if it is obstructive or non-obstructive azoospermia. A normal biopsy would mean that there is probably an obstruction at some point in the sperm transport system. Sometimes, any sperm found in the testes is frozen for future analysis or use in assisted pregnancy.

How is azoospermia treated?

Genetic testing and counseling are often an important part of understanding and treating azoospermia.

In cases of obstructive azoospermia, reconstruction or reconnection of obstructed or disconnected ducts can be performed. Hormone treatments may be possible in cases where the main issue is low hormone production.

If living sperm are present, they can be retrieved from the testes for the purpose of assisted pregnancy such as in vitro fertilization or intracytoplasmic sperm injection.

Men with non-obstructive azoospermia should receive genetic analysis before their sperm are used to perform any type of assisted fertilization, in order to learn if there are any genetic risks that may be passed to children.

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