Do you know that 80% of infertility is blamed on women. Including the sex of a baby. Just put your ear to the ground, you will hear very educated and enlightened men blaming their wives for delivering three, four and five baby girls at a stretch, without a boy.
For crying out loud let me repeat for the umpteenth time “the sex of a child is solely determined by men not women”.
Yesterday Wednesday January 8th, 2025 a patient with hepatitis came to consult me in Gregory University Specialist Hospital. He said he has three girls 10, 8 and 5 years and needed at least one boy, but it seems his wife has problem (I hushed him. “You just stop there, I bellowed. Your wife is not the one that determines the sex of your child). He said he knows that it seems the thing is in their blood. The elder sister also has 4 children all girls. “What arrant nonsense” I recriminated. “ It seems you did not understand me. You are responsible for the sex of your child and not your wife, what has your wife’s elder sister and allusion to family tree got to do with the sex of your children.
I felt like chasing him and his ignorance out of my office.
Then he veered off cause and said the Laboratory Scientist said he has low sperm count. The result he showed me, indicated 0% sperm cells or Azoospermia. Hence this article.
Azoospermia is a medical condition characterised by the absence of sperm in a man’s ejaculate. Sperm, the male reproductive cells are essential for fertilising an egg and initiating the process of conception.
Azoospermia can be classified into two main types. Obstructive and non-obstructive azoospermia.
In obstructive azoospermia there is a physical blockage that prevents the sperm from reaching the semen. This obstruction can occur in the vas deferens or other parts of the male reproductive tract. Non-obstructive azoospermia, on the other hand is typically associated with lack of sperm production in the testes, often due to issues with sperm development or maturation. Azoospermia is a significant factor in male infertility and its underlying causes can range from genetic factors and hormonal imbalances to infection and environmental influences.
The diagnosis of azoospermia is typically made through sperm a semen analysis, where a sample of semen is examined under a microscope to determine the presence or absence of sperm.
1. While obstructive azoospermia may be treated surgically to address the blockage, non-obstructive azoospermia poses more significant challenges. Assisted reproductive technologies such as in-vitro-fertilization(IVF), combined with sperm retrieval techniques may be options for couples facing infertility due to azoospermia. It is crucial for individuals experiencing fertility issues to consult with their doctors including Urologists and reproductive specialists, to explore potential causes and treatment options tailored to their specific circumstances.
The overall incidence of infertility accounts for nearly 150% of all couples. Male azoospermia affects nearly 1% of all male population and about 10 to 15% of all infertile men. At any given time there are about 600,000 azoospermia men of reproductive age in Nigeria, most of whom will have non-obstructive azoospermia.
Azoospermia men are also at increased risk of developing cancer compared to the general population. For example between 5% and 8% of men with testicular cancer will be azoospermic. The exact incidence is unknown as infertility is not a reportable disease, and is usually managed in the Physician offices and is probably under-reported in developing nations, where advanced treatment is either too costly or unavailable.
The psycho-physiology of azoospermia refers to intricate inter-play between psychological factors and physiological processes involved in male reproductive health. The psychological aspects can significantly impact the endocrine system and, subsequently, spermatogenesis, the production and maturation of sperm cells within the testes.
Stress, anxiety and depression for instance, have been linked to disruptions in hormonal balance, particularly elevated levels of cortisol and decreased levels of reproductive hormones like testosterone. This altered hormonal milieu can negatively influence the intricate feedback loops that regulate sperm production potentially contributing to conditions such as azoospermia.
Conversely the diagnosis of azoospermia itself can evoke a range of emotional responses, including grief, frustration and feeling of inadequacy. I have had male patients who on learning that their semen contain no sperm had threatened suicide, until I took time to explain, in each case that is remediable. That if it is obstructive azoospermia minor surgical procedure can correct the anomaly.
These psychological factors may further exacerbate hormonal imbalances, creating a cyclic relationship between the mind and the body. Stress reduction techniques, counseling and psychological support can play a crucial role in mitigating the psychophysiological impact of azoospermia,
Integrating mental health considerations into the overall approach of managing azoospermia is essential, recognising that addressing both the physiological and psychological dimensions is key to comprehensive care for individual and couples facing fertility challenges.
Azoospermia does not have specific symptoms associated with it, the only sure-fire indication is infertility that the male partner has, which you would notice after trying to get pregnant.
However some particular reasons cause azoospermia and you could see symptoms of these causes occasionally they include:
Little or no sperm.
Painful urination.
Pain in the pelvic area.
Cloudy urine after you have sex.
Smaller or swollen testicles.
Delayed puberty.
The penis is smaller than normal.
Cannot get erection easily.
Low hair growth near male genitalia.
Bigger breast (gynocomastia).
Reduced sex drive.
Loss of muscular strength.
The causes of azoospermia may include congenital anomalies, infections, surgical complications, prostate enlargement, ejaculatory duct obstruction, genetic factors, testicular dysfunction, auto-immune disorders, radiation, chemotherapy and idiopathic (unknown) causes.
Diagnosis of azoospermia could be achieved through physical examination, biopsy, blood tests, genetic testing, MRI, spermatic venography, a scrotal transrectal ultrasound, semen analysis and post ejaculatory urinalysis.
Treatment of azoospermia depends on the cause and may include hormone therapy, ejaculator- duct-obstruction surgery, microsurgical sperm extraction microsurgical varicocelectomy, vasectomy reversal.
Azoospermia with a genetic origin cannot be prevented. But following steps can help reduced the risk of Azoospermia caused due to other reasons.
Avoid radiation
Avoid activities and sports that can cause trauma to the reproductive organs
Judicious use of medication
Avoid exposure to lot temperature for a long time.
Please be medically guided
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