Azospermia(nil sperm) & Oligospermia-overview
Azoospermia is called when there is no sperm in semen. This
type of semen disorder is found in approximately 3% of infertile men i.e. absent
sperm. You should know that testis has two separate
Production of normal sperms in semen which needed for pregnancy & normal fertility.
The other function of testis is production of male hormones i.e. testosterone & others. So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.
How sperms develop: When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle, from first stage to final stage of normal mature sperms is of three months. Thus to produce normal sperms testis should have normal sperm producing germ cells & normal regulating hormones. Any major hindrance in the development of these spermatozoa will lead to absent sperm production resulting into nil sperm..
Oligospermia, also oligozoospermia, refers to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility (technically "oligoasthenoteratozoospermia"). There has been interest in replacing the descriptive terms used in semen analysis with more quantitative information.
Stress :- reduces sperm
Tobacco:- Nicotine damages sperms
Lead :- Workers in printing press have low sperm count
Avoidance of saunas, hot baths, the wearing of tight underwear, and other situations in which scrotal temperature may be raised
Alcohol:- Alcohol damages sperms
Recent survey has shown trend in decline sperm count in recent times. There may be many causative factors.
A very low volume i.e. less than 0.5 ml may indicate a problem in producing the specimen (including missing the container), a dysfunction with the accessory glands or retrograde ejaculation. High semen volume but low sperm numbers no need of semen concentration our medicine will take care of this problem.
An abnormally low pH i.e. less than 7.0 may indicate retrograde ejaculation when combined with a very low ejaculate volume. A pH of below 7.0, normal volume and azoospermia may indicate an obstruction of the ejaculatory ducts or congenital bilateral absence of the vas in this case result is poor.
An abnormally high pH i.e. greater than 8.5 may indicate an infection or dysfunction of one of the accessory glands result is good.
A sperm count below 20 x 10^6 / ml should be considered clinically relevant, a count nearby 5 x 10^6 / ml count will increase with treatment.
Reduced sperm count is generally idiopathic. However it may be due to defective spermatogenesis or an incomplete obstruction.
If less than 50% of the sperm are moving progressively (asthenozoospermia) a problem with motility or an increased level of sperm degradation may be indicated.
Decreased motility may be secondary to sperm dysfunction, prolonged periods of sexual abstinence, partial blockage or infection.
If greater than 50% of sperm are immotile then the analysis will determine whether the sperm are immotile or dead. This will determine whether the sperm immotility is due to cell death or a motility defect.
Increased cell death may be treatable if the cause is identifiable e.g. partial blockage, increased abstinence periods, infection. Immotile sperm can be used for assisted conception purposes as long as they are alive. All above condition our medicine works and results are excellent.
A human sperm show large variation in morphology, study on sperm obtained from post-coital cervical mucus have helped to define the morphology of an ideal spermatozoon.
Morphological study comprise of many factors like spermatogenesis, sperm transport, sperm maturation and ageing, time in seminal plasma, smearing technique, fixation, staining, mounting and the quality of microscope used.
Sperm Surface Antisperm Antibodies
The presence of both IgG and IgA antisperm antibodies are measured on the sperm surface. The results are given in terms of the number of motile sperm affected by antisperm antibodies surface antibodies may affect both movement of the sperm and the ability of the sperm to bind to the oocyte results are clinically significant and positive if more than 50% of sperm are affected by either class of antibody. IgA antibodies are considered of greater clinical significance than IgG. Antisperm antibodies often are, but not always, associated with testicular surgery or trauma.
B. Azoospermia (Nil
Azoospermia is called when there is no sperm in semen. This type of semen disorder is found in approximately 3% of infertile men i.e. absent sperm. You should know that testis has two separate functions.
Production of normal sperms in
semen which needed for pregnancy & normal fertility.
The other function of testis is production of male hormones i.e. testosterone & others.
So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.
How sperms develop:When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle, from first stage to final stage of normal mature sperms is of three months. Thus to produce normal sperms testis should have normal sperm producing germ cells & normal regulating hormones. Any major hindrance in the development of these spermatozoa will lead to absent sperm production resulting into nil sperm.
Causes of Nil
The various causes of nil sperm are as follows :
Hormone disorder: The various endocrine (Hormone) disorder leading to azoospermia are as follows
Hormone deficiency of pituitary
gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of
GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism,
Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins,
Idiopathic hypogonadotropic hypogonadism & due to many more
Obstruction in the outflow of semen (Sperms) from testis to outside through urethral opening. Many times the production of sperms in testis is absolutely normal but these sperm are unable to come out due to obstruction in the out flow tract leading to absent sperms in the semen. The various causes of obstruction are absent vas deferens, absent seminal vesicle, posttraumatic, post surgical ligation of vas deferens. After some infections, as chlamydial, gonococcal urethritis. It may also be due to post tubercular epididimo-orchitis. The sperm may also not come out of testis if the are imotile due to any of the following causes as imotile cilia syndrome, kartagener syndrome cystic fibrosis & many other rare diseases.
Absence of germ cells in testis also called sertoli cell only syndrome. In this there are no germs cells i.e. sperm forming cells in the testis. For you knowledge, I wish to inform you that in testis germ cell come to testis from neural cord area of the body during neural cord area of the body during development of fetus. So in some fetuses this migration of sperm cells do not occurs leading to testis only having testosterone forming & sertoli cells. Thus this condition is called sertoli sell only syndrome it is a developmental defect.
Maturation Arrest (. Spermatid arrest): of primary spermatocytes to secondary spermatocyte, spermatids or to mature spermatozoa. Due to may local, systemic, hormonal growth factor deficiency or due to idiopathic factor. The various paracrine hormones and growth factors are essential for normal development i.e. maturation of one germ cells to multiplication of ultimately production of multiple mature, normal & motile sperms. Many other factor as infection, varicocele, drugs, chemotherapy may also lead to maturation arrest. The other causes may by developmentally defective germs cells & spermatocyte. So that they did not have inherent capacity of developing into a mature & motile sperms.
Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)
Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.) Varicocele decreases sperm productions by elevating temperature of the testis, may produce higher levels of nitric oxide chemical in the testis which blocks sperm production, varicocele damages sperms directly & lastly varicocele decrease the oxygen supply to testis.
Drugs (e.g. spironolactone, alcohol, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
Presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia.
Granulomatous disease as tuberculosis, sarcoidosis of the testis
Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease
Neurological disease as myotonic dystrophy
Development and structural defects, Germinal cell aplasia, sertoli cell only syndrome, Cypt-orchidism
Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm count.
Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the sperm forming germ cell in the testis.
Environmental Assaults: Over exposure to environmental assaults (toxins, chemicals, infections) can cause nil sperm either by direct suppression of sperm production or on the hormone. Some chemicals that affect sperm production men are: Oxygen-Free Radicals, Estrogen emulation pesticidal chemicals (DDT, aldrin, dieldrin, PCPs, dioxins, and furans), plastic softening chemicals like Phthalates, hydrocarbons (ethylbenzene, benzene, toluene, and xylene)
Exposure to Heavy Metals: Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm production and may cause nil sperms in otherwise healthy men. Trace amounts of these metals in semen seem to inhibit the function of enzymes contained in the sperms, the membrane that covers the head of the sperm.
Radiation Treatment: Over-exposure to radiation & xrays affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production, and, in severe circumstances, may never recover.
Misuse of substances: There are a number of banned substances that can have potentially lethal effects on sperm production. Taking anabolic steroids, for example, to increase performance in sports such as weight lifting, can dramatically alter both the motility and the health of the spermatozoa. Other banned substances, such as cocaine, marijuana and heroin can reduce sperm production & may make a man infertile.
History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of nil sperm count. So we first try to find out cause. We take detailed history, thorough drug history, and general physical examination, examination of testis, epididymis & testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.
Investigation & Diagnosis: For completes diagnosis of causes of
azoospermia (nil sperms) one or more of the following tests may be required
Complete male hormone profile: This profile includes all the male hormone tests which affect testicular development, growth & other genital organ development as well as genital functions. L.H., F.S.H., Testosterone, prolactins, thyroids test
USG or Doppler study of scrotum & testis
Semen culture sensitivity
Fine Needle Testicular Biopsy of the testis to look for evidence of spermatogenesis & testicular structure.
Human Sperm-Zona Pellucida Binding Ratio
Human Sperm-Zona Pellucida Pentration test
Egg penetration test
Molecular genetic studies done in some special cases
Chromosome analysis i.e. Karyotype (chromosome analysis)
Assessment of androgen receptor
Combined Pituitary hormone tests is performed when needed
MRI head, Hemogram, test for systemic diseases.
Olfactory test is done to find out kallman's syndrome
At our center facility for all the above tests are available.
TREATMENT OF NIL SPERMS
finding out cause of azoospermia treatment is started depending on the cause
The various treatments are as follows:
(1) Correction of the Cause: First of all we try to find out the primary cause of nil sperms by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.
(2) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually sperm count normalizes in three month time with proper hormone treatment.
(3) Varicocele ligation: A varicocele is an abnormal tortuosity and dilation of veins of within the scrotum. It can be surgically treated - which might help fertility in some cases.
At our center we have facility for all the testing & treatment facility required for nil sperm count to achieve pregnancy.
Knobbed acrosome (common form)
B. Knobbed acrosome (beaded form)
C. Pyriform head (severe)
D. Pyriform head (moderate)
E. Pyriform head (slight)
F. Nuclear vacuoles
G. Diadem defects
H. Detached head
I. Distal reflex
J. Dag-like defect (broken midpiece)
K. Dag-like defect (severely bent midpiece)
L. Proximal droplet
M. Distal droplet
N. Teratoid (severe)
O. Teratoid (moderate)
P. Normal spermatozoa
Male factor infertility may result from low sperm count or low sperm motility, or decreased ability of the sperm to fertilize the egg or abnormal shape of sperms or lack of semen or inability of man to deposit the sperm into vagina due to erectile dysfunction or hypospadios. The leading cause of male infertility is low sperm count. Others may be low sperm motility, bad quality sperms, lack of semen, presence of pus cells in semen & inability to deposit semen into vagina either due to absent ejaculation or due to any sexual dysfunctions as erectile dysfunctions. In general, most cases of male infertility are due to low sperm count. There are many biologic and environmental factors that can lead to low sperm count. Here is a list of conditions that may cause low sperm count in men. Please click the links for detail information about causes, investigations & treatment options.
- Oligospermia | Low Sperm Count
- Azospermia | Nil Sperms | Low Sperm Motility
- Pus in Semen
- Anti-Sperm Antibody
- Less Semen Formation
- Absent Ejaculation
- Dead Sperms
- Abnormal Sperms
- Immotile Sperms
and Azospermia are two conditions where allopathic system has no effective
treatment. So my team stressed on looking into alternative systems. After
working through various modalities, Sex Specialist Doctor at
Dr Makkar(sexologist) came out with the best solution. Let us see
important points about it.
Before starting this treatment semen test is very essential at your nearest pathology lab and must stop any hormonal treatment at least one month prior to start our treatment. Medicine increases Sperm Count, Sperm Motility, Semen Quantity and corrects Sperm Abnormalities.
of the Cause: First of all we try to find out the primary cause of azospermia or
nil sperms by above mentioned investigations. Then we correct the basic
Advantage of treatment
The treatment is completely free of any side
Medicine is effective in 95% in sperm abnormalities i.e. Low Sperm count, Low Motility, Low Semen Quantity and Abnormal Sperm Cell Morphology.
It is the fastest among all treatment. It raises sperm count fourfold with every month’s treatment till optimum count. So with low sperm count like 3 million per ml. to normal count of 40 million per ml. can be achieved within two months of treatment.
The lowest count which can be helped is 1 lac per ml or 0.1 million per ml. Below, this the result may be variable.
It does not support azoospermia or zero count at all.
It improves not only sperm count but also it’s quality. It raises low sperm motility to high sperm motility. It also improves grades of sperm motility simultaneously.
The success rate of system is very high. In about 3000 patients, it succeeded in 95% of the patients.
The greatest advantage is that even after stopping the treatment the higher count remains longer, where as in male hormones, it falls as soon as the treatment is stopped.
It is quite comfortable to take it, as it has sweet pills and drops only, to take with few doses per day. So, this treatment being simpler avoids complicated procedures in case of male infertility.