Etiology, diagnosis and treatment of azoospermia

**Azoospermia**

Azoospermia refers to the condition where semen obtained through withdrawal after 5-7 days of abstinence, and after three consecutive ejaculations, does not pass the required sperm count.

If no sperm is found in the above tests, and no sperm is found after centrifugation and microscopic examination of semen smears, it is called azoospermia.

Azoospermia. Statistics show that azoospermia accounts for 19% to 30% of male infertility, and is currently a major cause of male infertility.

One of the common reasons for fertility issues.

Traditional Chinese medicine generally classifies this condition under the categories of "sterility" and "infertility," classifying it as a difficult-to-treat condition in andrology.

**Western Medical Etiology and Pathology**

(1) Testicular spermatogenesis disorder. The testes are the only organ that produces sperm. Testicular spermatogenesis disorder can result in...

In the following three situations: First, there are no spermatogenic cells in the testicular tissue; second, although germ cells are present, they are mostly...

The first type is immature, lacking the ability to produce sperm, which is called spermatogenesis arrest; the second type may produce a small amount of sperm, but without sperm production.

The inability to ejaculate sperm is called Sertoli cell disorder. All three of these conditions can lead to azoospermia.

(2) Obstruction of the vas deferens. This means that although the testes have the ability to produce sperm, the channels for transporting sperm are blocked.

Unobstructed flow, such as bilateral epididymal tuberculosis, congenital absence or inflammatory obstruction of the vas deferens, as well as the ejaculatory ducts, prostate and

The inability to ejaculate due to urethral diseases or other conditions results in the absence of sperm in the semen during clinical examination.

(3) Ejaculatory dysfunction, including subejaculatory disorders and retrograde ejaculation. A semen analysis should be performed.

No sperm found.

**Traditional Chinese Medicine Etiology and Pathogenesis**

Congenital factors, mostly due to weak constitution and insufficient kidney essence, lead to underdeveloped or poorly developed reproductive organs.

Defects, etc. Acquired factors, primarily related to the kidneys, which govern the storage of external substances and the foundation of reproduction. Excessive sexual activity and unrestrained indulgence deplete these resources.

It can damage kidney essence; or it can be caused by emotional distress, qi stagnation, seminal duct obstruction, and failure of semen to be expelled, leading to azoospermia.

**Key Points of Western Medicine Diagnosis**

**(I) Medical History and Symptoms**

Clinically, many cases of azoospermia are idiopathic azoospermia, with no specific medical history or symptoms. If the above is not...

If azoospermia is caused by the same underlying disease, then the corresponding clinical manifestations will appear.

**(II) Physical Signs**

Apart from idiopathic azoospermia, there are signs of related diseases depending on the cause.

**(III) Laboratory Tests**

(1) Semen analysis: Semen was collected after 5-7 days of abstinence, centrifuged, and the sediment was smeared. Three or more consecutive analyses were performed.

No sperm was detected.

(2) Seminal fructose determination: If the seminal fructose determination is zero, it indicates that the seminal vesicle is absent.

(3) Testicular biopsy: to assess testicular spermatogenesis function and help to differentiate the cause of testicular spermatogenesis disorders.

Azoospermia and obstructive azoospermia.

(4) Vas deferens angiography: to observe whether the vas deferens is blocked and to identify the location of the obstruction.

(5) Endocrine assays: Blood levels of FSH, LH, T, E₂, PRL, etc., are measured. If the FSH level is higher than normal...

A test result exceeding twice the normal value often indicates testicular spermatogenesis dysfunction.

**Western Medicine Diagnostic Criteria and Differential Diagnosis**

**(I) Diagnostic Criteria**

A diagnosis can be made if three consecutive semen analyses show no sperm.

**(II) Differential Diagnosis**

(1) Azoospermia caused by testicular spermatogenesis dysfunction: if the testicular volume is less than 12 mL, hormone tests will show...

There are two manifestations: one is a significant increase in both FSH and LH while T decreases; the other is a significant increase in both FSH and LH.

The value of T decreased significantly.

(2) Obstructive azoospermia: normal testicular size and normal sex hormone levels.

(3) If, based on semen analysis, testicular volume measurement, and sex hormone testing, it is still impossible to determine whether the condition is obstructive, then...

Men with spermatorrhea may consider undergoing a testicular biopsy.

**Western Medical Treatment**

**(I) Azoospermia caused by testicular spermatogenesis dysfunction**

Treatment should be tailored to the specific cause. For testicular spermatogenesis dysfunction due to hypogonadotropin deficiency, appropriate treatment can be administered.

Hormone replacement therapy is used to adjust and stimulate the spermatogenesis process in the testes.

**(II) Obstructive Azoospermia**

Depending on the location, extent, and nature of the obstruction, the following surgical treatments may be used:

(1) Vas deferens anastomosis: Applicable to recanalization of short vas deferens obstruction.

(2) Vas deferens-epididymis anastomosis: suitable for patients with epididymal tubule obstruction, currently commonly performed via microsurgery.

The success rate of epididymovasostomy has significantly improved.

(3) Postcystic urethral orifice colostomy: Applicable to seminal vesicle cysts and ejaculatory duct obstruction.

(4) Epididymal vas deferens cannulation: Applicable to distal vas deferens obstruction that cannot be surgically repaired, and where there is no obstruction within the epididymis.

Patients with obstructive lesions.

**(III) Artificial Insemination**

For couples who urgently need a child, and where the woman's gynecological examination is normal, donor semen can be used for artificial insemination.

AID (Alternative Insemination) therapy.

**(iv) Other Therapies**

In recent years, with the development of reproductive medicine, intracytoplasmic sperm injection (ICSI) has emerged.

This involves directly injecting spermatogonia or a single, motile, normal sperm from the testis or epididymis into the cytoplasm of an egg cell.

The technology used in this field has already been successfully reported domestically.

**Traditional Chinese Medicine Treatments**

**(I) Kidney Essence Deficiency Syndrome**

[Main Evidence] Infertility after marriage, azoospermia, weak physique, short penis, small or abnormally soft testicles.

Soft, low libido, pale complexion, forgetfulness and absent-mindedness, weakness in the lower back and knees, sparse beard and pubic hair, inconspicuous Adam's apple, impotence.

Impotence, premature ejaculation, pale red tongue, thin white tongue coating, deep and thready pulse.

[Treatment] Tonify the kidneys and replenish essence.

[Prescription] Sheng Sui Yu Lin Dan (from "Bian Zheng Lu").

**(II) Syndrome of Obstruction of the Seminal Ducts**

[Main Evidence] Infertility after marriage, azoospermia, robust physique, ruddy complexion, normal testicular size and texture.

Normal symptoms include obstruction of the seminal ducts, normal secondary sexual characteristics, lower abdominal distension and pain, dark yellow urine (like dribbling), normal or increased libido, and a dark tongue.

Yellow tongue coating, wiry and rapid pulse.

[Treatment] Promote blood circulation, remove blood stasis, and unblock the meridians.

[Prescription] Guizhi Fuling Wan (from *Synopsis of Prescriptions of the Golden Chamber*). Ingredients: Cinnamon twig, Poria cocos, Moutan bark, stir-fried peach kernel, etc., in equal amounts.

Divide into portions. Grind into powder, mix with honey to form pills, or decoct in water for oral administration.

**VII. Prevention and Care**

(1) During adolescence, mumps infection should be avoided as much as possible; once infected, it should be treated promptly to prevent complications.

Orchitis.

(2) Avoid contact with radiation or toxic substances.

(3) Avoid working in high temperatures.

(4) During medication, it is advisable to avoid smoking, alcohol, strong tea and spicy and stimulating foods.