Dr Uma Gordon, consultant gynaecologist, and specialist in reproductive medicine and surgery. She is also the Clinical Director of Bristol Fertility Clinic.
I see a lot of men coming to me for the management of azoospermia, which is the complete absence of sperm in the ejaculate.
They're usually quite distressed with this diagnosis, understandably, because they're healthy.They don't have anything in their history to suggest there'll be no sperm.
The very first investigation, which is a semen analysis, has shown that there is no Sperm and that is why they're not conceiving.
So, it is important to reassure them, to counsel them and to say that they can have their own genetic children and that treatment options are available.
We may repeat the semen analysis, and normally it takes three months, or we usually say, repeat it in three months,but with this diagnosis, we will be repeating it quite soon, say, in about two weeks or so, just to confirm the diagnosis.
We will be taking a detailed history, we will be doing the examination, and we'll also be doing tests to see why there is no sperm in the ejaculate. Let me describe it this way, you've got a bulb, but it is not working.
There's no electricity coming out. It could be because the switch itself is faulty, and that means the hormones are not there and we call it that it is called hypogonadotropic hypogonadism, where the pituitary gland, which is in the brain, is not producing the hormones that are needed for sperm production.
So the switch itself can be faulty. The bulb can be faulty. That means the testes itself has failed. And why?
There could be conditions linked to that, which has led to the testes losing the germ cells and therefore not being able to produce sperm. Thirdly, the wiring could be at fault, and we usually put it down as obstructive.
There is an obstruction in the pathway, and that's why sperm is not coming out. So when I explain it this way, I think men are able to make some sense and understand that it could be hormonal, the switch itself could be at fault, there could be obstruction, there may be something to do with the pathway, or unfortunately, the testes itself is defective and is not producing sperm.
Depending on what the diagnosis is, we can then provide appropriate treatment. For example, if it is linked to the hormones, you replace the hormones, you don't go and do surgery.
But if it's obstruction, then surgery might be the appropriate path to take. So just to say to you, it is quite common to see men with a complete absence of sperm. Please be reassured that treatment options are available.
It's important you see somebody who has an interest in male infertility and can do the appropriate workup, diagnosis and management option for you.
