Idiopathic Secondary Azoospermia Occurrence in Men with Oligospermia over Time - Beyond the Abstract

A recent study by Karavani et al.¹ highlights a concerning trend in infertile men, revealing that up to 30% of men with severe oligospermia—sperm concentrations under 1 million/ml—developed secondary azoospermia (complete lack of sperm in the ejaculate) over time.

While primary azoospermia, often resulting from congenital conditions or severe spermatogenic dysfunction, is well-documented, secondary azoospermia's causes remain unclear. Possible factors include medical treatments, environmental exposures, or unknown idiopathic causes. The scarcity of robust epidemiological data complicates the development of effective diagnostic and therapeutic strategies, highlighting the need for focused research in this area.

While female fertility preservation through oocyte cryopreservation is well-established with guidelines from reproductive societies like the American Society for Reproductive Medicine (ASRM), the field of male fertility preservation lacks comprehensive research and standardized protocols. This gap presents significant challenges for men with low sperm counts seeking fertility preservation consultation.

Moreover, the diagnosis of severe oligospermia is not just a moment to address fertility concerns, but also a crucial opportunity to discuss broader health issues. Poor sperm quality is often linked to underlying health conditions such as hormonal imbalances, metabolic syndrome, and cardiovascular diseases. Therefore, when severe oligospermia is diagnosed, it presents an important chance for healthcare providers to evaluate and address these potential health issues, ensuring a comprehensive approach to the patient's overall well-being. A broader health plan is important, including regular medical check-ups, nutritional support, and possible medical interventions. Men with such poor sperm quality should be informed at this point about the importance and benefits of lifestyle changes and medical treatments to enhance sperm quality as well, thereby improving their chances of successful conception in the future.

For an andrology specialist, discovering that a patient who previously had sperm in his ejaculate is now azoospermic is deeply concerning. This shift indicates a significant decline in reproductive potential, often signaling progressive spermatogenic failure. Such situations can complicate the path to fatherhood and require surgical sperm retrieval, a procedure with success rates ranging from 40% to 50% only. This phenomenon emphasizes that sperm banking through cryopreservation in men with poor sperm concentration, while sperm is still present in the ejaculate, can prevent male sterility and facilitate future conception using assisted reproductive technology (ART) and intracytoplasmic sperm injection (ICSI) technique.

1. Karavani G, Kattan MS, Lau S et al. Idiopathic secondary azoospermia occurrence in men with oligospermia over time. J Assist Reprod Genet. 2024 Jun 28. doi: 10.1007/s10815-024-03179-6.