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What should one do in the event of azoospermia or asthenozoospermia?

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Although there are two possible causes for extreme infertility in the male, assisted reproduction gives men who suffer from these dysfunctions the opportunity to be fathers

What should one do in the event of azoospermia or asthenozoospermia?

Male fertility is becoming more and more affected by “a progressive worsening in the quality of the semen”, says Dr. Marta Trullenque, a specialist at Eugin Clinic. Some of the causes include new lifestyles, stress or environmental changes, apart from congenital or hormone-related factors. According to a recent study by the Spanish Chemical Biochemistry and Molecular Pathology Society (SEQC), 60% of sperm studies show altered parameters, and approximately 7% have a very low or non-existent sperm concentration. To establish that diagnosis, two pathological seminograms are necessary (performed within two or three months of each other).

The most severe case is azoospermia or the absence of sperm in the semen. In its most frequent symptom, known as secretory or non-obstructive, the testicles produce no sperm or only produce a very small quantity. The other type of azoospermia is obstructive: an obstruction prevents the sperm produced in the testicles from joining the rest of the fluids that form the semen, which is what happens with a vasectomy. Although it is not as severe as azoospermia, the presence of sperm is sometimes very scarce (less than 15 million per millilitre), and is known as oligozoospermia.

Another common alteration is one that affects the mobility of the sperm. When the percentage of mobile sperm in the semen is less than 32%, this condition is known as asthenozoospermia, which also reduces the possibilities of fertilising an egg.

Normozoospermia                Astenozoospermia                Oligozoospermia

Can I be a father if I have azoospermia or asthenozoospermia?

Infertility is caused by dysfunctions in the sperm quality. But does this mean that men with azoospermia or asthenozoospermia cannot have children? Not necessarily. What is more, men with these dysfunctions are often able to fulfil their dream of becoming fathers with the help of assisted reproduction.

The first step in the event of a possible dysfunction is an individual diagnosis. To do this, first of all a palpation of the testicles is made and then a spermiogram is performed, which is a semen analysis that will provide a great deal of information. A subsequent blood test will determine whether potential hormone-related factors exist. Lastly, a testicular biopsy is performed — a minor procedure to remove a small simple of sperm from the testicle— which serves to complete the diagnosis.

“Even in the event of diagnosis secretory azoospermia”, says Dr. Trullenque, “in 60% of cases sperm may be produced in a small area of the testicle”. If the semen obtained from the testicle biopsy is suitable for fertilisation, the patient’s sperm can be used in an in vitro fertilisation with intracytoplasmic injection  (ICSI). In other words, a sperm is injected into each egg. Otherwise there is always the option of using a donor’s semen.

In the event of obstructive azoospermia due to vasectomy, there are two options: repermeabilising the blocked ducts or removing the sperm directly from the testicles. “The shorter the time since the vasectomy, the higher the chances of success in the re-channelling operation”, says Dr. Trullenque. If the vasectomy cannot be reversed, then a testicular biopsy is performed to obtain the sperm that will be used in vitro fertilisation with ICSI.

In the case of asthenozoospermia, the objective is to obtain a sample of sperm with sufficient mobility to fertilise the egg. After obtaining this sample, in vitro fertilisation with ICSI is used, as in the cases described above.

Nowadays, in couples who have problems in conceiving, the cause of the infertility is shared equally between men and women. However, as Dr. Trullenque says, “men find it more difficult to accept that they suffer from infertility”. Although there is always the option of using semen from a donor, current assisted reproductive technologies bring higher chances of success in permitting men with azoospermia or astenozoospermia to transmit their own genes to their children.

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