Azoospermia Meaning
Azoospermia is the condition in which there are no sperm cells in the fluid that the man ejaculates. Although there are many types, it is the patient group with the lowest chance of having children. Management of patients with azoospermia requires serious experience and attention. As a result of appropriate treatments, it is possible to achieve pregnancy in azoospermia.
Azoospermia Diagnosis
In addition to a detailed history and physical examination, some tests should be done in azoospermia. In addition to treatment planning, it may be possible to achieve pregnancy by normal means with treatment in some diseases. Tests that must be requested in azoospermia patients:
- Karyotype analysis
- AZF gene deletion
- FSH
- LH
- Testosterone
- Estradiol
In addition to these, additional tests such as ultrasound may be required as a result of the examination.
Azoospermia Causes and Types
Azoospermia is divided into two as Obstructive and Non-Obstructive.
Obstructive azoospermia: In this type, the testicles and hormonal structure are completely normal, but there is a problem in transporting the sperm to the urinary tract. It is considered as the type with the highest chance of pregnancy. In the absence of sperm channels, CTFR gene analysis should be performed. This type may be associated with cystic fibrosis disease.
Non-Obstructive Azoospermia: It is a type of azoospermia caused by problems in the testis itself or hormonal problems that stimulate sperm production. It is seen that the chance of achieving pregnancy is lower than the obstructive type. A detailed assessment is required. It should not be forgotten that the right treatments will increase the chance of obtaining sperm.
Azoospermia can occur with congenital structural defects as well as subsequent effects on the testicles. It is not always possible to predict when the damage to the testis occurs. In addition, it would be an appropriate approach to perform a semen analysis 2 weeks after the first test in patients with azopermia. It should not be forgotten that some drugs and previous febrile diseases may cause temporary deterioration in sperm test.
Azoospermia Treatment in Turkey
The treatment of azoospermia varies considerably according to the etiological cause. For this reason, the treatment must be planned individually by an andrology specialist. In some cases, surgery is an inevitable result, but sometimes sperm egress can be achieved with the drugs used. The presence of 4-5 sperm in the semen can save the patient from an unnecessary surgical burden. For this reason, it is absolutely necessary to get an opinion from an andrology specialist. It should be noted that azoospermia cannot be treated with hearsay and random medications. Again, the knowledge of obstetricians on this subject will not be enough. Just as a woman should be evaluated by a gynecologist, a man should also be evaluated by an andrologist. This approach increases couples' chances of taking a child home. The right treatment and the right time approach are very important in the treatment of azopermia.
Azoospermia natural and medical treatment: This form of treatment with pills and injections must be planned individually. Hormonal and genetic analyzes are extremely important in the planning of this treatment. Antioxidant treatment increases the quality of sperm to be obtained and increases the probability of success in type baby. Similarly, hormonal drugs can increase the sperm production capacity of the testis. The most important point in these treatments is that the treatment should be planned for at least 3 months. Considering that sperm production takes 72-84 days, it is not possible to get a response to any treatment before 3 months.
Azoospermia Surgery:
Micro TESE surgery
TESE can be briefly considered as the process of looking for sperm from the testicles under the microscope. It is one of the most commonly used ways to obtain sperm in azoospermia. It is based on the principle of surgically opening the testis and collecting tubules under the microscope. Although the technique is not very difficult, it requires a great deal of experience. The important thing is to predict in which tubules sperm will be found. It is thought that after 100 TESE procedures, one can be competent in this subject. It is seen that the success of approximately 500 micro TESE procedures performed by us increased after the first 100 cases. The procedure must be performed using microsurgical technique.
Obstructive Azoospermia Surgery
Obstruction of sperm ducts is defined as obstructive azoospermia. With TESE, sperm can be obtained almost always in these patients. However, some patients may have multiple child requests. It can be aimed to completely solve the problem, especially in young patients. Reopening of these channels can be attempted surgically. This surgery, which is performed with the TUR-ED technique, is performed in a limited number of centers. It may be possible to permanently correct azoospermia in the centers where the procedure is performed. However, this technique cannot be applied in patients with no channels.
It is a completely false information that it is not possible to have children in patients diagnosed with azoospermia. With appropriate treatment, sperm can be found in 50-80% of these patients. The main problem is the andrology of these patients. their lack of access to specialists. In our country, the number of physicians who deal specifically with andrology is still quite insufficient. Therefore, these patients should receive appropriate treatment as soon as possible without wasting time.