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Low sperm count and azoospermia

Sperm production is a complex process, and there is remarkable variation in the sperm parameters of healthy, fertile males. A poor sperm analysis should therefore be repeated before making any conclusions about fertility. 

In an event of low sperm count (oligozoospermia) or complete lack of sperm (azoospermia), a andrological consultation should be carried out to assess possible underlying causes of reduced fertility.

The consultation should include:

  • family history
  • all medications taken, incl. supplements
  • medical history
  • assessment of lifestyle
  • physical examination
  • testicular ultrasound
  • hormonal evaluation
  • general health assessment, blood tests
  • in some cases, genetic testing

Oligozoospermia can sometimes be treated medically. In most cases, no known cause is identified. ICSI treatment is however available for the treatment of male infertility, with very favorable results. 

Azoospermia may be caused by blockage or congenital lack of vas deferens, with normal sperm production in the testes (obstructive azoospermia), or by lack of sperm production in the testes (non-obstructive azoospermia). In obstructive azoospermia, sperm can be collected from the testis (TESA) and used for fertility treatment of the spouse. A very common cause of obstructive azoospermia is a previous vasectomy. In a fairly rare type of non-obstructive azoospermia called hypogonadotropic hypogonadism, hormonal treatment can be administered to induce the sperm production. In most men, no benefit is seen from medication, but even in these men, nearly half will have small areas of focal sperm production in the testes, and sperm can be collected in a microsurgical operation called micro-TESE. Surgically retrieved sperms are frozen and later thawed for the fertility treatment of the spouse (ICSI).