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What is Azoospermia?
"If there is no sperm, how can there be a conception?"
Azoospermia is the complete absense of sperm in the ejaculate. It is one of the most severe causes of infertility. Azoospermia due to low sperm production affects approximately 1% of the male population and 10% of men who seek fertility evaluation*.
There are two types of Azoospermia: Non-Obstructive Azoospermia and Obstructive Azoospermia. Testis biopsys have determined that these men have Sertoli cell-only pattern, maturation arrest, or hypospermatogenesis. Men with Obstructive Azoospermia, however, may be producing normal levels of sperm, but the passage may be blocked and the sperm can't make their way into the ejaculate. The absense of a vas-deferens or scar tissue may be the cause of an obstruction.
Most people when receiving this diagnosis automatically assume the impossibility of ever conceiving a child. "If there is no sperm, how can there be a conception?" The truth of the matter is that just because there is no sperm in the ejaculate, it doesn't necessarily mean a man is not producing sperm. Until recently, it was believed that men with non-obstructive azoospermia were untreatable. They were referred to as being "sterile" or having "testicular failure." Couples were told that their only options for having children were to adopt or to do an artificial insemination with donor sperm. Upon further studies, doctors noticed that by evaluating the testis biopsy specimens they would often find sperm present, despite severe defects in spermatogenesis*. This led doctors to believe that a low level of sperm production may be present in the testes of males with azoospermia, but the numbers are so low that they do not survive the transfer into the ejaculate. It was also thought that only ejaculated sperm was healthy enough to fertilize an egg. However this view has changed due to repeated successful pregnancies from sperm extracted from the epididymis or testis of men with non-obstructive azoospermia.
Although the treatment may be extensive and very costly, there is hope for a biological pregnancy.