What to do about azoospermia or asthenospermia?

Azoospermia is the complete absence of gametes in the semen. It can be secretory: the testicles do not produce spermatozoa or produce a very small number. It can also be obstructive: the testicles excrete gametes, but the seminal pathways are blocked and prevent their progression out of the male reproductive system.

Asthenospermia or asthenozoospermia is characterized by little or no sperm mobility. Depending on its severity, it can result in reduced fertility or complete infertility. Sperm abnormalities can be genetic or acquired, or occur after medication or surgery. How are these disorders diagnosed?

Diagnosis of azoospermia and asthenospermia

Sperm dysfunction does not cause any symptoms. They are usually detected during an infertility test. You will be offered a sperm count if you and your partner have not achieved pregnancy after 12 months of regular unprotected sex. You will be given a spermogram. This test consists of observing a sample of sperm under a microscope. If no gametes are visible in the ejaculate, azoospermia is likely to be diagnosed. Sperm may be present (at least 15 million/ml, according to 2010 WHO standards).

But their motility may be impaired with less than 32% of sperm with progressive motility (type A+B motility). This is called asthenospermia. To confirm the diagnosis, a new spermogram should be performed after three months. Additional examinations may be prescribed to look for the causes of the spermatic alteration. These include palpation of the external genitalia, blood hormone analysis, scrotal ultrasound, etc.

Existing treatments for asthenospermia

When asthenozoospermia is moderate, first-line treatments can be considered. For example, if the lack of sperm movement is caused by an infection, antibiotics or an anti-inflammatory protocol may help restore normal sperm motility. A varicocele may be detected, i.e. a dilation of the veins of the spermatic cord that may alter the conditions of development of the spermatozoa.

In these cases, an embolization may be performed. This is an intervention that aims to block the dilated veins of the scrotum to divert the blood flow to other vessels. Sometimes, the removal of factors that are detrimental to male fertility may be sufficient to resolve asthenospermia. These factors include exposure to toxic substances (alcohol, tobacco, pesticides, endocrine disruptors, etc.), weight gain or exposure to heat. A course of treatment with vitamins, minerals, trace elements and antioxidants may also be indicated.

Treatments available for azoospermia

If you have non-obstructive azoospermia (testicles that do not produce sperm) and a hormonal cause has been identified, hormonal treatment can help restore the secretions naturally necessary for spermatogenesis. In the case of obstructive azoospermia, a surgical operation can free the blocked ducts (vasovasostomy). If surgery is not an option, the doctor may suggest a sperm search and collection by biopsy. Gamete collection may be possible even in the case of secretory azoospermia. This is possible because sperm can still be produced in a small area of the testicle. The gametes collected in this way can be used in a medically assisted reproduction protocol.

Azoospermia, asthenospermia and in vitro fertilization (IVF)

If the treatment of azoospermia or asthenospermia has not resulted in satisfactory sperm production (in quantity and quality), or if the only solution is gamete collection, an in vitro fertilization (IVF) procedure can be implemented. If your spermatozoa have a minimum of mobility and are present in sufficient concentration, a classic IVF can be attempted.

In the laboratory, a sample of your gametes will be put in contact with an egg cell from your partner, so that fertilization can take place. If your spermatozoa are not very mobile or have been collected in very low numbers, IVF with ICSI (intracytoplasmatic microinjection) is recommended. In this case, a spermatozoon will be directly injected into the oocyte, which will maximize the chances of obtaining an embryo. This embryo, after an incubation phase, will be transferred to your partner's uterus.

As a last resort, sperm donation

If it is impossible to obtain an embryo with your sperm, or if you have azoospermia and it is impossible to collect copies of your gametes, you can use sperm donation. In vitro fertilization, with or without intracytoplasmic microinjection, will be performed with your partner's eggs and a donor's sperm. The men who donate sperm are over 18 years of age and are selected in accordance with the legislation in force.

They are in good physical and mental health and undergo a series of genetic tests to rule out the risk of transmitting a hereditary pathology. Once collected, the sperm samples are frozen and kept in quarantine for six months. They are tested again to ensure that there is no infectious process before they are used.

Source: IVI-Fertilite.fr

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