Azoospermia or Nil Sperm Count or Zero Sperm Count is a condition where there is no sperm present in semen. This type of semen disorder affects about 3% of infertile men, meaning there is a lack of sperm. It’s important to understand that the testicles have different functions. The production of normal sperm in semen is necessary for pregnancy and normal fertility, while the testicles also produce male hormones like testosterone and others. In many cases, even if there is no sperm in the semen, the production of male hormones remains normal.

Explanation of sperm production:

1. At the age of 14, the secretion of L.H. and F.S.H. hormones from the pituitary gland increases.

2. The increase in these hormones leads to the proliferation of sperm-forming cells (germ cells) in the testicles.

3. The germ cells multiply under the control of the pituitary hormones and other hormones, including testosterone, growth hormones, androstenedione, insulin-like growth factor-I, thyroid hormones, paracrine hormones, and growth factors.

4. Under the control of these hormones, germ cells divide and mature into primary spermatocytes.

5. The primary spermatocytes then mature into spermatids and eventually into mature spermatozoa (normal sperm) under the control of the hormones.

6. After several weeks of maturation in the testicles, the sperm become motile and capable of fertilizing an egg.

7. This entire sperm cycle, from the initial stage to the final stage of normal mature sperm, takes about three months.

8. In order to produce normal sperm, the testicles must have normal sperm-generating germ cells and regular regulating hormones. Any major problem in the development of spermatozoa will result in the absence of sperm production and result in a zero sperm count.

Causes of Azoospermia or Nil Sperms

The causes of azoospermia, a hormone disorder, can be attributed to a diverse range of endocrine issues, including:

1. Hormone Deficiency: The pituitary gland can be deficient in hormones like L.H., F.S.H., Prolactin, thyroid hormone, and GnRH, leading to conditions such as hypopituitarism, idiopathic hypopituitarism, Kallman syndrome, and isolated hypogonadotropic hypogonadism. This can also be caused by drugs and toxins, or idiopathic hypogonadotropic hypogonadism, among other reasons.

2. Semen Obstruction: Although the testes may be producing sperm, the outflow from the testes to the outside via the urethral opening may be obstructed, leading to absent sperm in the semen.

3. Absence of Germ Cells: This is also known as Sertoli cell-only syndrome and results in the absence of germ cells, or sperm-forming cells, in the testes.

4. Maturation Arrest: This refers to the arrest of the maturation process of primary spermatocytes to secondary spermatocytes, spermatids, or mature spermatozoa.

5. Testicular Issues: This can be caused by primary Leydig cell dysfunction, chromosomal issues such as Klinefelter syndrome and variants, defects in androgen biosynthesis, or orchitis.

6. Severe Varicocele: This is a varicose vein within the cord that connects to the testicle and can decrease sperm production by raising the temperature of the testes and producing higher levels of nitric oxide, which can block sperm production, damage sperm directly, and reduce oxygen supply to the testes.

7. Antisperm Antibodies: The presence of antisperm antibodies can bind to sperm, making them less motile or even immotile or dead, also known as necrospermia.

8. Trauma: Trauma can also cause azoospermia.

9. Environmental Toxins: Exposure to environmental toxins can also cause azoospermia.

10. Viral Orchitis: This refers to inflammation of the testicles caused by a viral infection, which can cause azoospermia.

(11) Viral Orchitis