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What is Azoospermia?

It is the complete lack of sperm in the ejaculate, as in, zero sperm count. It occurs in 5% of infertile men. If this is the case, then one or both of two conditions may be present:

A) There is a problem with sperm production.

B) There is a blockage such that sperm production, although normal, cannot reach the ejaculate.

Ayub.M. USA

I am very thankful to your doctors. My wife conceived last month and everything is going on good. My last reports done 3 months back showed 12 million sperm count. That was awesome, as I had always seen my reports as zero sperm count for the last 15 years.

A Production Problem or a Delivery Problem?

The primary question, which needs to be answered when faced with azoospermia, is whether the problem lies in sperm production or in delivery. That is, are the testes simply not producing sperm or are they producing sperm but unable to deliver it in the ejaculate? The purpose of an initial evaluation is to distinguish between these two alternatives.

If the testes are making sperm but none are in the ejaculate, the sperm must be retrieved by some other mechanism, either by restoring the normal flow of sperm or by circumventing it. If the testes are not producing sperm then we need to explore whether the problem can be reversed.

Even if the problem cannot be reversed, there are a number of cases in which the level of spermatogenesis is advanced enough to allow a natural conception with Welling Homeopathy treatment. The following paragraphs briefly describe causes for both production and delivery problems.

F.S. France

I got my reports yesterday and I was pleasantly surprised to see 1 million sperm count within just 3 months of starting treatment. I would surely continue the treatment now. Cheers.

Production Problems

The three major causes for lack of sperm production are hormonal problems, "testicular failure," and varicocele.

Hormonal Problems: The testicles need pituitary hormones to be stimulated to make sperm. If these are absent or severely decreased, the testes will not maximally produce sperm. Importantly, men who take androgens (steroids) either by mouth or injection for body building shut down the production of hormones for sperm production.

Testicular Failure: This generally refers to the inability of the sperm-producing part of the testicle (the seminiferous epithelium) to make adequate numbers of mature sperm. This failure may occur at any stage in sperm production for a number of reasons.

Either the testicle may completely lack the cells that divide to become sperm (this is called "Sertoli cell-only syndrome.") or there may be an inability of the sperm to complete their development (this is termed a "maturation arrest.") This situation may be caused by genetic abnormalities, which must be screened for.

Varicocele: A varicocele is dilated veins in the scrotum, (just as an individual may have varicose veins in their legs.) These veins are dilated because the blood does not drain properly from them. These dilated veins allow extra blood to pool in the scrotum, which has a negative effect on sperm production. This condition may be corrected by minor outpatient surgery.

M.Shankar. Mumbai

I would like to thank your doctors for helping me get sperm count. My last reports done 2 months back showed 7 million and I am hoping to see more progress when I repeat the test next month.

Sperm Delivery Problems - Ductal Absence or Blockage

Sperm delivery complications are generally caused either by a problem with the ductal system that carries the sperm, or problems with ejaculation. The sperm carrying ducts may be missing or blocked.

Thus the patient may have bilateral (both sides) congenital (from birth) absence of the vas deferens. Or he may have obstructions either at the level of the epididymis (the delicate tubular structure draining the testes) or higher up in the more muscular vas deferens. He may have become mechanically blocked during hernia or hydrocele repairs.

Sperm are stored in sacs called the seminal vesicles, and then are deposited in the urethra, which is the tube through which men urinate and ejaculate. The sperm must pass through the ejaculatory ducts to get from the seminal vesicles to the urethra. If these are blocked on both sides no sperm will come through.

Finally, there may be problems with ejaculation. Before a man ejaculates, the sperm must first be deposited in the urethra. This process is called emission. There may be neurological damage from surgery, diabetes, or spinal cord injury, which prevents this from happening.

Also, for the sperm to be pushed out the tip of the penis, the entry to the bladder must be closed down. If it does not close down the sperm will be pushed into the bladder, and later washed out when the patient urinates.

Azoospermia Diagnosis

One important point concerning this diagnosis is that although no sperm are found in the ejaculate, there are often usable sperm found in the testis, as not all sperm that are made in the testis actually make it into the ejaculate.

There is a "threshold" effect with sperm production, such that if production of sperm is high enough in the testis, then sperm"spillover" into the ejaculate. However, if that critical level of sperm production is not met, there may still be mature sperm in the testis that do not make it into the ejaculate. Hence absent sperm in the ejaculate doesn’t mean there is no production of sperm in the testis.

Azoospermia Evaluation

First, a thorough review of medical problems, exposures, past surgery, medications, and family history is undertaken in the office to help define the causes of azoospermia. Then, a brief, well-performed physical examination is performed. Third, blood tests are taken that include testosterone and follicle-stimulating hormone (FSH). Fourth, two semen samples are needed.

With each sample, a standard semen analysis is performed. If no sperm are found, then the semen sample undergoes an additional evaluation in which the sample is "spun" down in a centrifuge to concentrate small numbers of sperm at the bottom of the tube. If 10 sperm or even 1 sperm is present in the pellet analysis, then conditions such as reproductive tract obstruction can be ruled out.

Again, the value of finding even a small number of sperm in the pellet analysis is very significant because:
1) it means that complete obstruction is unlikely, and
2) it means that men may have the production of sperm intact and the homeopathic medications just need to stimulate and increase the sperm production above the threshold level.

Causes for Azoospermia

If at all possible, treating the specific condition that is causing the azoospermia may reverse the process and lead to sperm production. This is especially true for azoospermia due to hot tubs or hot baths or testosterone supplements.

Conditions That Cause Azoospermia

• Primary testicular failure Klinefelter syndrome
• Y chromosome microdeletions
• Genetic infertility due to abnormal chromosomes (karyotype)
• Unexplained genetic infertility
• Secondary testicular failure Kallman Syndrome
• Unexplained gonadotropin deficiency
• Hypothalamic/pituitary tumor
• Hyperprolactinemia
• Cancer treatment (chemotherapy, radiation, surgery)
• Varicocele effect
• Pituitary suppression Drug-induced (anabolic steroids, alcohol, glucocorticoids)
• Testosterone supplements
• Congenital adrenal hyperplasia
• Severe illness (cancer, kidney or liver failure)
• Diabetes mellitus
• Sickle cell anemia
• Hemachromatosis
• Sperm autoimmunity
• Pesticide/toxin exposure (including hot tubs and baths)
• Undescended testicles at birth
• Obstruction Congenital absence of the vas deferens (CAVD)
• Ejaculatory duct obstruction
• Epididymitis
• Scrotal trauma or surgery
• Young syndrome
• Vasectomy

Treatment of Azoospermia