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About 10% of infertile men will have no sperm at all in the semen. This is called azoospermia. The conditions, which cause azoospermia, can be classified into 3 groups - pre-testicular, testicular and post-testicular. An example of azoospermia because of pretesticular disease is hypogonadotropic hypogonadism, where the testis does not produce sperm because of the absence of production of gonadotropins by the pituitary. Consequently, even though the testes are normal, no sperm are produced because of the absence of the needed hormonal stimulation. In testicular conditions, the testis does not produce sperm because of testicular failure (end-organ damage). In these men, the testicular damage is so severe that no sperm are found in the semen. This is also called non-obstructive azoospermia, and an example of this is Klinefelter's syndrome. In post-testicular conditions, even though sperm are being produced normally in the testes, the outflow passage is blocked (ductal obstruction or obstructive azoospermia).
If a semen report shows azoospermia, then it needs to be rechecked. The lab should be instructed to centrifuge the sample in order to look carefully for sperm. A close analysis of the report will often help the doctor to differentiate between non-obstructive and obstructive azoospermia. Thus, if the semen volume is low, the pH is acidic and the fructose is negative, then this is likely to be due to an obstruction at the level of the ejaculatory duct. If sperm precursor cells (immature sperm cells) are seen in the sample on careful microscopic examination, then this clearly means that the problem is not because of an obstruction.
We request men with azoospermia to provide a sequential ejaculate for semen analysis - two samples, produced 1-2 hours apart. Occasionally, in men with non-obstructive azoospermia, the second sample may show a few sperm, because it is "fresher".
A FSH level test in the blood (as described in the next chapter) is also helpful in differentiating between obstruction and testicular failure. If the FSH level is high, it means the problem is testicular failure. If, on the other hand, the FSH level is normal, then a testis biopsy is needed to come to the correct diagnosis.
Rarely, some men will not be able to ejaculate at all. This is called aspermia, and their semen volume is zero. While this is sometimes because of a psychological problem (because the man cannot achieve an orgasm in spite of being able to get an erection), the commonest reason for this is condition is retrograde ejaculation.
Poor sperm tests can results from:
If the sperm test is abnormal, this will need to be repeated 3-4 times over a period of 3-6 months to confirm whether the abnormality is persistent or not. Don't jump to a conclusion based on just one report - remember that sperm counts do tend to vary on their own! It takes six weeks for the testes to produce new sperm - which is why you need to wait before repeating the test. It also makes sense to repeat it from another laboratory to ensure that the report is valid.
What if the sperm count is persistently poor? Then other tests may be advised to try to pinpoint what the problem is; and these are described in the next chapter.
Next Chapter© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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