Azoospermia is a medical condition which many men go through and it involves absence of measurable amount of sperm within the ejaculated semen. About 5% of men with issues of infertility suffer from this condition. This condition might occur either due to problem with sperm production or some blockage within the male reproductive tract, or both.
The treatment of a patient suffering from problems of infertility begins with a detailed review of previous medical problems, lifestyle, information regarding any drug intake, surgery in the past as well as family history in order to investigate the probable cause of azoospermia. This is followed by a thorough physical examination of the patient. Examinations of blood samples are then done for testosterone and follicle stimulating hormone (FSH).
The next step involves analysis of two semen samples. In the beginning, each of these samples has to undergo a standard semen analysis. If sperms are found to be absent in the earlier test then an additional evaluation is done where the samples are spun in a centrifuge in order to concentrate the small numbers of available sperm that accumulates at the bottom of the test tube. On further laboratory examinations, if 10 or even 1 sperm is found to be present in the pellet then the cause of azoospermia is inferred to be due to reproductive tract obstruction.
However, if from the above medical examinations it is not clear regarding the cause of azoospermia, as to, whether it is due to problem with sperm production or a blockage in the male reproductive tract, then in that case the next step involves assessing sperm production within the testis itself. This is achieved by testis biopsy of the male patient under local anaesthesia. Once the cause of azoospermia is confirmed, the treatment is done thereafter by an experienced physician.
How is the treatment done?
In the context of azoospermia, if sperm are diagnosed to be absent in the ejaculate of the male patient, then it can be inferred that this had occurred either due to blockage the male reproductive tract or due to problem in sperm production. Azoospermia due to blockage in male reproductive tract and problem in sperm production are referred to as obstructive azoospermia and non-obstructive aaoospermia respectively.
Blockage or obstructive azoospermia may arise due to various reasons such as previous infection, prostatic cysts, surgery, injury or congenital absence of vas deferens (CAVD). Except the problem of congenital absence, all other causes of obstructive azoospermia can be cured with the help of microsurgery or endoscopic reconstruction. Patients with problems of blockage can opt for sperm retrieval along with assisted reproductive technology in order to conceive.
However, in cases of non-obstructive azoospermia, the condition can be cured with the help of medical treatment which can assist some men to produce ejaculated sperm (for example, the patients with reversible conditions like Kallman syndrome, varicocele, hyperprolactinemia, etc.). However, in most cases sperm retrieval from the testis of the male patient accompanied with assisted reproduction becomes the only way to have a biological family. The difficulty with non-obstructive azoospermia is that only 50%-60% of the male patients have usable testicular sperm. In addition to this, clinical examinations such as size of the testicles, serum FSH level, biopsy reading and history of the ejaculated sperm are not capable to accurately predict the recovery of sperm from the testis.
Who is eligible for the treatment? (When is the treatment done?)
Any male individual who fails to conceive a biological family and is found to have low or no sperm count from a detailed semen analysis is said to suffer from azoospermia and is eligible for such treatment. The other symptoms related to having abnormal sperm involves unusual colour of the semen such as greenish, yellowish, reddish or brownish tinted (probably due to presence of blood), low volume of semen, unusual strong odour of the ejaculate and/or thicker or thinner sperm consistency. A male individual having all such symptoms must immediately for consulting an expert physician.
Who is not eligible for the treatment?
Any male individual who has a healthy sperm count and is capable of conceiving a biological family is not eligible for this treatment.
Are there any side effects?
There are a few unpleasant side effects of the treatment of azoospermia. A few medicines may result in symptoms such as nausea, vomiting, headache, irritability, allergies among people who are hypersensitive to such drugs, liver problems. Some of the hormone based medicines can have side effects like edema, oily skin and even depression. Surgical treatment for azoospermia can lead to side effects such as profuse bleeding or injury to the bladder, kidney, intestines, blood vessels and other body tissues. Subfertility may still remain in some cases, even after the treatment. Without complete treatment, it might not be possible to get a female pregnant. If any of these side effects are seen to occur then the male patient needs to discuss about it with an experienced physician.
What are the post-treatment guidelines?
The post treatment guidelines for patients of azoospermia include taking of prescribed medicines regularly on time, having a nutritious diet plan that can enhance sperm production, having a period of rest for those patients who have undergone surgical treatment.
Only if the cause of azoospermia is congenital, then it cannot be treated effectively. Apart from this, all other obstructive and non-obstructive azoospermia can be cured with medical or surgical treatment. In cases of medical and surgical treatment the full course of treatment should be taken in order to successfully cure the condition. In case a patient has any side effect from the treatment, then he should immediately contact the physician.
How long does it take to recover?
The time taken for the recovery of patients suffering from azoospermia may vary depending upon the cause of this condition. Once the problem is diagnosed to be either obstructive or non-obstructive azoospermia, the treatment is done accordingly. However, cases of congenital azoospermia are irreversible and cannot be treated effectively. All other cases of obstructive as well as non-obstructive azoospermia can be dealt with surgical and medical treatment respectively. It takes about 2 to 3 weeks’ time for this condition to be diagnosed and treated successfully. Once the treatment is done the patient should take rest for a few days as advised by the doctor. Any cases of side effects should be immediately brought to the notice of the physician.
What is the price of the treatment in India?
The price of treatment of azoospermia in India varies in different places. In metropolitan cities the price of treatment is relatively higher than in other small towns and cities of India. The price range varies from Rs. 45,000 to Rs. 60,000 for the full treatment of this symptom. The cost of treatment also depends upon the cause of azoospermia. For cases of testicular sperm extraction an additional amount of Rs. 50,000 is charged by the infertility clinics.
Are the results of the treatment permanent?
To be honest, the treatment of azoospermia has about 50% chances of success. Problems related to congenital azoospermia are irreversible and cannot be treated effectively. A few cases of non-obstructive azoospermia are reversible can be treated effectively with the administration of medicines. Other cases related to obstructive azoospermia can be treated effectively by surgical methods. However, in most cases, artificial sperm retrieval from the testis of the male patient accompanied with assisted reproduction becomes the only way to have a biological family.
What are the alternatives to the treatment?
The alternative treatment for azoospermia involves ayurvedic treatment. However, there are only very limited natural options of treatment available for patients suffering from azoospermia. The first and foremost thing to be kept in mind is to have a healthy and nutritious diet that enhances more sperm production within the males. Men who are having obesity along with azoospermia must go for weight loss which is highly recommendable for restoring sperm production.
In addition to this, a variety of herbal medicines can be used which helps to boost men’s hormonal balance and production of healthy sperm. These botanical medicines have proved to be highly effective in treating problems related to non-genetic and non-obstructive azoospermia.