Azoospermia affects 1% of male population


  • Ask Dr G
  • Sunday, 20 Apr 2014

Easter Sunday is a day of festivity celebrating the resurrection of Christ from the dead. Although I don’t celebrate this religious festivity, I am ever so grateful having received the eggs from friends and patients.

To me, the decorated Easter egg is a celebration of springtime, which is a traditional symbol of fertility and rebirth. 

The award winning foreign correspondence and regular contributor to Vanity Fair and the Guardian, Janine di Giovanni once said: “Easter is meant to be a symbol of hope, renewal and a new life” I cannot agree more!

This reminds me of a letter I received from TK recently.

Dear Dr. G,

I am 35 years old and have been married for three years. My wife and I enjoy a healthy relationship and great intimacy. We live a very healthy life.

My wife is slightly older than me and has been going to see her gynecologist, who assured her nothing is wrong with her reproductive organs. She has been asking me to go and see a urologist, but I am rather apprehensive and scared.

I recently built up my courage to get a sperm test and I am completely shocked when I was told I have no sperm.

How can that be? I have a strong sexual desire and no erectile dysfunction. I don’t think I suffer from premature ejaculation either. I am worried and confused?

Can you tell me what is “Azoospermia”? Why do I suffer from this condition? Is it curable? Will I be able to father a child? 

Please help
TK.


It is estimated between three to seven percent of couples have difficulties conceiving despite having regular sexual intercourse. The sad fact is many more would experience involuntary childlessness (ranging from 12% to 28%). This may be the result of delay in treatment seeking behavior, especially in men. Although it is a well-known fact that women gets less fertile with advancing age, the etiology of infertility is not exclusively female in origin.

Many would be surprised to learn that 40 percent of the issues involved with the infertility are due to male factors and another 40% due to women. The remaining 20% are result from the complications with both partners.

It often frustrating to learn many men would assume the causes of the infertility are exclusively female factor. As a result, the delay in the treatment seeking behavior would compromise the success of conception as we are all working on a tight “timeline” due to the female “fertile biological clock”.

Azoopsermia is a medical condition where a man does not have any measurable sperm in his semen. This condition affects about 1% of the male population and around 20% of all men presented with issues of infertility.

The causes of Azoospermia can be broadly divided into obstructive or non-obstructive. Obstruction of the sperm ducts can occur in previous trauma or vasectomy. In some cases, the “naughty past” of a man which he is not so proud of (such as previous infection of chlamydia or gonorrhea) would come back to haunt them as azoospermia. Obstruction of the sperm ducts can occasionally be associated with genetic condition such as Congenital Bilateral Aplasia of Vas deferens (CBAVD) that is closely linked with Cystic Fibrosis.

Non-obstructed causes of Azoospermia can also occur. These are generally conditions that render the cessation of spermatogenesis such as previous chemotherapy, mumps, varicocele or even radiation. Some even believe the phone in the trouser pockets may not be too “sperm-friendly”. So, keep the “Crown Jewels” away from those hand sets, boys!

It is not uncommon for men to assume while the “machinery” of the sexual health is functioning optimally, the reproductive apparatus should also be at its best. In reality, the sexual libido in a man is controlled by his circulating testosterone and his erection is exerted by the integrity of the blood vessels and nerves to the penis. So, many years of “trying” for a baby may just be seer “pleasure” with no outcome for men who suffer from Azoospermia.

In the space age of 21st century, ART (Artificial Reproductive Technology) has brought optimism to many. Procedure such as PESA (Percutaneous Epididymal Sperm Aspiration); MESA (Microscopic Epididymal Sperm Aspiration) or TESE (Testicular Exploration Sperm Extraction) will be carried out with the intention to quest for those healthy sperms in hiding. Though, such pursuit for the sperms will mean a small operation on the scrotum. I am sure many would agree it is a small price to pay in comparison to childbirth! In many instance, this has brought hope to millions, who were deemed impossible in that quest for parenthood.

A man who can build up his courage to admit the possibility of deficiency in fertility is a sign of time that things are changing. This may be symbol of hope for “mankind” and definitely hope for couples living in the “darkness” of childlessness. Martin Luther King once said: “We must accept finite disappointment, but never lose infinite hope!” So boys, get the specimen bottle out and get tested. After all, how difficult can it be?

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