We cured azoospermia (Semen without sperm)

Azoospermia (absence of sperm) causes up to 10% of cases of male sterility… But #SaberEsPoder and Dr. Otto Paredes, Creafam fertility expert, explains to us how most cases are temporary and can be treated with medication, surgery or perform in vitro fertilization with sperm extraction.

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Hello, here we are at Creafam Veracruz evaluating the quality of semen. The male factor is obviously very important when talking about reproductive prognosis, so today we are going to show you how to make a good diagnosis of the male factor because #KnowledgeIsSuccess

Here we can see the image that I usually see in the microscope, the semen sample is placed in a device called the Makler camera that has this grid that comes here and thanks to it we can calculate the amount of sperm that we have. evaluating. With a line that has 10 squares we count how many sperm there are and in this way we extrapolate the millions of cells that that sample has on average. What do we usually do? If the sample, for example, has a small amount of sperm, then we count several lines and take the average.

First case: Infection an low movility

This particular case has an estimated concentration of 25 million sperm per ml. of ejaculated semen we subsequently evaluated mobility. You can see: There are sperm that move, advance forward, there are others that remain spinning in the same place, but the important thing is that they are mobile sperm, therefore they are alive and can potentially generate fertilization. We see how many sperm are immotile and that way we establish the total percentage.

According to the World Health Organization program, a sample is considered normal if it has more than 20 million sperm per milliliter of ejaculated semen and has a mobility of more than 35%. Of the 35% of progressive mobiles, that is, that they move, it no longer matters as much if the movement is type A or type B as it was previously, that is, whether they are fast or slow, the important thing is that they have movement. We also evaluate how the bottom of the sample is, we can find inflammatory cells, round cells such as cellular debris and that can inform us if there is an inflammatory process in the seminal tract of this patient.

Here we can see, for example, this rounded image that you see here corresponds to a white blood cell, a leukocyte, here we have another one. Generally there should be between none or 1 leukocyte per field, in this case this sample has between 2 and 3 leukocytes per field. What do you mean by field? By visual field, when I move the slide in the microscope, different spaces are presented, each of them in terms of microbiology we call it a visual field. So, we count how many inflammatory cells there are per field and that also allows us to estimate if there is an inflammatory process. This particular case corresponds to a patient who comes for a check-up. I took a similar sample a month and a half ago. I evaluated it and it was very more inflammatory cells, his mobility was much less than what he has at the moment and so with that diagnosis we indicated medical treatment.

He received cycles of antibiotics, cycles of antioxidants and today we are evaluating what the change has been. Generally, in semen samples, in order to observe a significant change, we must wait at least four weeks. Because? Because spermatogenesis is a process that is progressive, so we are improving the environmental conditions at the level of the testicular tissue, we are giving nutrients or a better microenvironment to the sperm for their maturation process and in this way we are monitoring it.

In this case, a sample of 25 million sperm has remained more or less similar to the previous sample, but its mobility improved significantly. The first sample had only 30% progressive mobiles and today we are already counting 50% progressive mobiles, that way we see if there is a response or not to the treatment, so I follow up with this type of devaluations. If I have a patient who has low mobility and it is very evident that it is the only factor, that is, good concentration, normal morphology but only low mobility, I always ask them for prolactin and TSH values, which is the thyroid-stimulating hormone. And yes, men should also be studied from a hormonal point of view. This patient has hypothyroidism, so he not only received antibiotics for the inflammatory treatment… For the inflammatory process he had, but also thyroid hormone, so to the extent that his endocrinological axis is regulated, it will also be reflected in the seminal quality. .

Second case: Excretory azoospermia

On one occasion, for example, I had a patient who was in a situation of azoospermia, that is, he did not have any sperm in the ejaculate sample that I analyzed. So, re-examining the history we saw that she had been prescribed treatment with testosterone, she had a different situation, a different endocrine condition and this was the treatment that was prescribed.

Testosterone inhibits the endocrinological axis of men, which decreases the release of FSH and LH, which are the gonadotropins that stimulate the testicle, and finally he was in azoospermia. So what happened? First, inform him of the situation, second, suspend that treatment, we waited for a period of 2-3 months, we evaluated him again and the azoospermia persisted, but since we know that the origin was an endocrinological block, so we decided on a different strategy, we stimulated the testicle. So we gave him the gonadotropins and after six months this patient already had a normal count, so look at the difference, knowing a good endocrinological diagnosis we indicated a different treatment. This couple, once we had sperm in the ejaculate, finally went to fertility treatment and today they are parents of 2 babies.

Sometimes they ask us on YouTube: “Hey, look, my husband is azoospermic, how much does an in vitro procedure cost or how much does an insemination with bank semen cost?” Look, you really need to have a good clinical background evaluation, laboratory tests because cases like this exist, so there are patients who are susceptible to medical treatment to improve their condition before advancing to fertility treatment. I have had patients who, with this type of strategies, whether gonadotropins, antibiotics or antioxidants, have improved their seminal quality and instead of going to in vitro, they go to insemination. Therefore, the diagnostic strategy is essential to establish an appropriate therapeutic strategy.

There are times when they tell me “I have a semen analysis that I had done in a general laboratory. Can I bring it?” Yes, of course you can bring it, we review it and we see that the information does not match the entire clinical part that we are questioning. So it is important to have a good diagnosis, when we evaluate these semimograms here many times we have been surprised that the information is completely different from what the patients suspected. So if you have several years of infertility, it is assumed that the sample is normal because something must not be happening. So a good diagnosis is the basis for establishing the appropriate treatment.

“Azoospermia is present in up to 10% of cases of male infertility, but fortunately it is treatable with the proper diagnosis”

Dr. Otto Paredes
Dr. Otto Paredes
Fertility Expert

Reproductive medicine and gynecological endocrinology
Instituto Valenciano de Infertilidad, Spain.

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