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Non-obstructive azoospermia refers to no sperm in the semen because of abnormal sperm production.
Sperm production problems can result from hormonal problems, testicular failure, or varicocele, or varicose veins in the testicles.
Hormonal Causes of Non-Obstructive Azoospermia
Hormones are necessary for the testicles to produce sperm. The testicles produce sperm when they are stimulated by pituitary hormones. If there is an absence of these hormones, or a small amount of these hormones, sperm production can be affected. Men who take or have taken steroids may have affected the hormones necessary for sperm production.
Another cause of azoospermia is testicular failure, which is the inability of the testicles to produce enough mature sperm. Causes of testicular failure include chromosome problems, diseases of the testicle, and injury to the testicale. Undescended testicles at birth or frequent and heavy use of marijuana can also increase the risk of testicular failure. This can occur during any stage of sperm production. The testicle may not have the cells necessary that divide to become sperm cells, or the sperm may be unable to fully develop and mature.
Sperm production can also be affected by varicoceles, another cause of azoospermia. Varicoceles are swollen varicose veins in the scrotum, which cause blood pooling. This blood pooling in the scrotum negatively affects the sperm production.
There are also several genetic causes of male infertility that may result in non-obstructive azoospermia. These include chromosomal abnormalities, like Y chromosome microdeletions, and karyotypic abnormalities. The most common karyotypic abnormality is called Klinefelter Syndrome, which affects between 7-13 percent of men with azoospermia.
Treatment for Non-Obstructive Azoospermia
For men with non-obstructive azoospermia, hormone therapy can be a helpful way to treat hormone deficiencies. Men who have an abnormal testosterone to estradiol ratio (T/E2) can be treated with aromatase inhibitors, which can improve sperm concentration and motility.
For men who have varicocles, a surgical technique called varicocelectomy can help reduce the swollen varicose veins. In this surgical procedure, the affected veins are tied off and the blood is re-routed to flow through healthy veins.
Pregnancy and Non-Obstructive Azoospermia
Previously, fertility doctors thought that men who have problems with sperm production could only create their family with donor sperm or through adoption. However, testis biopsies in men with non-obstructive azoospermia have often shown sperm. Testicular sperm often have lower motility, but they can be used for ICSI during IVF.
A procedure called testicular sperm extraction (TESE) with ICSI has been performed for men with non-obstructive azoospermia. According to the Cornell Department of Urology, this has resulted in pregnancy rates of about 20 percent per attempt.
Testicular sperm extraction is performed under local or general anesthesia. The sperm is then retrieved by a testicular biopsy technique. Sperm that is retrieved through this process can be used in IVF procedures.
If men have been diagnosed with a genetic cause for their non-obstructive azoospermia, genetic testing and counseling is recommended before IVF.