Azoospermia

Semen analysis revealing no sperm cells and multiple white blood cells
Algorithms for the workup of the infertile male. Algorithm to be considered on initial assessment (top). Algorithm for the management of the patient presenting with azoospermia (bottom).

Medical condition of a man whose semen contains no sperm.

- Azoospermia

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Male infertility

Male infertility refers to a sexually mature male's inability to impregnate a fertile female.

Characters of age, sex, and sexual maturity in Canada geese

Men with this condition may exhibit azoospermia (no sperm production), oligozoospermia (small number of sperm production), or they may produce abnormally shaped sperm (teratozoospermia).

Vasectomy

Elective surgical procedure for male sterilization or permanent contraception.

Open-ended vasectomy

After a vasectomy, contraceptive precautions must be continued until azoospermia is confirmed.

Overweight

Having more body fat than is optimally healthy.

The overweight range according to the body mass index (BMI) is the area on the chart where BMI > 25.

Being overweight also increases the risk of oligospermia and azoospermia in men.

Ejaculation

Discharge of semen from the male reproductory tract as a result of an orgasm.

Ejaculation example
Diagram of the male pelvic and reproductive organs

An unusually low sperm count, not the same as low semen volume, is known as oligospermia, and the absence of any sperm from the semen is termed azoospermia.

Infertility

Inability of a person, animal or plant to reproduce by natural means.

A depiction of the procedure of in-vitro fertilization.

Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.

Cystic fibrosis

Genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine.

Health problems associated with cystic fibrosis
Cystic fibrosis has an autosomal recessive pattern of inheritance
The CFTR protein is a channel protein that controls the flow of H2O and Cl− ions in and out of cells inside the lungs. When the CFTR protein is working correctly, ions freely flow in and out of the cells. However, when the CFTR protein is malfunctioning, these ions cannot flow out of the cell due to a blocked channel. This causes cystic fibrosis, characterized by the buildup of thick mucus in the lungs.
The location of the CFTR gene on chromosome 7
Intracytoplasmic sperm injection can be used to provide fertility for men with cystic fibrosis
Dorothy Hansine Andersen first described cystic fibrosis in 1938.

The main cause of infertility in men with CF is congenital absence of the vas deferens (which normally connects the testes to the ejaculatory ducts of the penis), but potentially also by other mechanisms such as causing no sperm, abnormally shaped sperm, and few sperm with poor motility.

Semen analysis

A semen analysis (plural: semen analyses), also called seminogram or spermiogram, evaluates certain characteristics of a male's semen and the sperm contained therein.

Human sperm stained for semen quality testing in the clinical laboratory
Approximate pregnancy rate varies with amount of sperm used in an artificial insemination cycle. Values are for intrauterine insemination, with sperm number in total sperm count, which may be approximately twice the total motile sperm count.

A vasectomy is considered successful if the sample is azoospermic (zero sperm of any kind found).

Intracytoplasmic sperm injection

In vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg.

Oocyte cytoplasm is injected with the sperm during ICSI
Schematic image of intracytoplasmic sperm injection in the context of IVF.
A medical animation still showing the ICSI procedure.

Additionally, specialists use ICSI in cases of azoospermia (when there are no spermatozoa ejaculated but they can be found in testis), when valious spermatozoa (the name given to sperm samples taken to preservate fertility afer chemotherapy) is available, or after previous irruptions in IVF cycles.

Activin and inhibin

Activin and inhibin are two closely related protein complexes that have almost directly opposite biological effects.

The Activin dimer, from 2ARV.pdb
Schematic diagram of the 1D structures of inhibin and activin. The black line between the monomers represents a disulfide bond.

In men with azoospermia, a positive test for inhibin B slightly raises the chances for successfully achieving pregnancy through testicular sperm extraction (TESE), although the association is not very substantial, having a sensitivity of 0.65 (95% confidence interval [CI]: 0.56–0.74) and a specificity of 0.83 (CI: 0.64–0.93) for prediction the presence of sperm in the testes in non-obstructive azoospermia.

Sertoli cell-only syndrome

Disorder characterized by male sterility without sexual abnormality.

Germinal epithelium of the testicle.
1: basal lamina
2: spermatogonia
3: spermatocyte 1st order
4: spermatocyte 2nd order
5: spermatid
6: mature spermatid
7: Sertoli cell
8: tight junction (blood testis barrier)

Sertoli cell-only syndrome is like other non-obstructive azoospermia (NOA).