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What Are The Findings From The Semen Analysis And Ultrasound Of Scrotum When Suffering From Azoospermia?

Posted on Mon, 10 Feb 2014

Question: I have been Diagnosed with Azoospermia (No Sperm). I came to know it a couple of months back when both got ourselves tested as she was not able to get pregnant for a Long Time. I am very sad about it would like some assistance what exactly I should do,to make sure we get it treated. Here are the some of the results,We got after the Tests.Please check them and let me know what should be our Next steps. 1st Semen Analysis - 1.0ml (Quantity), Dirty White, Total Sperm Count - Nil Millions/ml ,Active/Sluggish/Non Motile - Nil, Morphology - ( Normal Forms -NIL ) (Abnormal Forms - 100%) Took 2nd Semen Test as well after some days,Got Same results.The Report is missing at the Moment,so not able to provide exact details Ultra Sound of Scrotum: Right Testis 19*40*16 mm Left Testis 20*37*15 mm Both Testes Normal Shape & echo texture. No Focal Lesions Noted. Very Minimal fluid in Tunical Cavities. Prominent pampiniform plexus of veins in left hemi-scrotum with valsalva manouvre,the average diameter of viens measuring 2.2mm. Both epididiymi are Normal in Size,Shape,echopattern.Scrotal wall thinkness Normal Impression : Minimal Degree Left Varicocele. No Significant Hydroceles, Suggest Clinical Correlation. Harmones : Testosterone - 3.91 ng/mL FSH - 11.49 mIU/mL (Method CLIA) LH - 5.95 mIU/mL Prolactin - 16.69 ng/mL Now that I have provided all the Information,Please suggest me the best options from here and If possible suggest some good hospitals in Hyderabad and Approximate Costs. Awaiting your Response.

Answered by Dr. Mahesh Koregol (2 hours later)

Brief Answer: testicular failure Detailed Answer: Hi Azoospermia in your case is probably due testicular failure. That's why your testosterone levels are low and FSH high. Anyway I suggest you get examined by urologist who will be able to check testis size and advice accordingly. The treatment is difficult if primary testicular failure. You can get testicular biopsy done see if sperms exist. Let me know if you have any more questions

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (55 minutes later)

How can you say its Testicular Failure,when the reports say that they are in within Normal Range? How is it possible that I have Testicular failure. What causes it? I do not have any bad habits like smoking,drinking etc.then why and when did it happen,please answer my previous question and this one is detail.

Answered by Dr. Mahesh Koregol (12 hours later)

Brief Answer: possibly Detailed Answer: Hi I request you to read the information again . I said IF. If it is primary testicular failure it is difficult which has to be examined by a urologist by touching and examining. The FSH Value is 11 which is little higher border ( as we take normal less than 10). So it does not provide enough information and is borderline high. Testosterone levels normal are between 2.4 to 22 ng. Your value is 3.91 which is ok but for your age according to experience it should be more than 5. Ultrasound report is normal. But these need to be correlated by examination by urologist who can palpate and see if there is a problem. Please send me second semen analysis report soon which will confirm it. Next option after urologist examination is to go for testicular biopsy. If it is not primary testicular failure you will find if there are mature sperms in the testis which will confirm it is obstructive azoospermi and not primary testicular failure. Let me repeat again that I have not told it is primary testicular failure. You only need to get biopsy to confirm it after examination by urologist. There is no other way to find out. This is not related to smoking or drinking. It is possibly genetic in origin other wise infection earlier in life. Let me know if you have any more questions. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (2 hours later)

These tests like Testosterone,FSH,LH,Ultrasound etc where taken after a Urologist examined me physically,said the testicles were a bit small compared to Normal. He suggested for Testis Biopsy and Varicocele Correction. You say its due to Harmonal Imbalance,can it be corrected with medication and if yes,suggest some options. Also let me know of the apporximate cost of a Biopsy and suggest a couple of good doctors or Hospitals in Hyderabad to start treatment. I did not have any infections,In my family no one has similar problem,so can you explain how it would be genetic. The 2nd Semen sample gave same results a above,I lost the report so not able to provide exact values. If Lets say Testicular Failure is the Problem. What should be the Next course of action. Please go through each question and answer it for me. I will let you know any other question if any once its answered.

Answered by Dr. Mahesh Koregol (35 minutes later)

Brief Answer: biopsy Detailed Answer: Hi The hormone imbalance is because testis is small. These hormones indicate the status of testicular functioning. They cannot be corrected by medicines because they are just indicators of functions. Genetic does not necessarily mean in this generation. It could be long back 3 to 4 generation previous also which has been carried by other generations and transferred to you. Infections like genital tuberculosis would have affected silently. It is difficult to know the cause now. This angle is thought if it is confirmed by testicular biopsy about presence of sperms. If primary testicular failure is confirmed using donor semen for pregnancy is the only practical option as no sperms in you. I have no idea about hyderabad as I consult in bangalore. Testicular biopy is a simple procedure and any urologist can do it. Costs approx 15000 Let me know if you have any more questions Regards Dr. Mahesh Koregol

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (2 days later)

I still cant digest that you think that I have Testicular failure. Its impossible. Earlier after Ultrasound,the Urologist suggested variocele issue,which you say is Normal. So not able to understand what exactly is the issue and why it has happened. As I do not have any Bad Habits and living a Normal Life. Testis is not that small as much as its being stressed upon.Its Normal in size and I have confirmed it from various sources regarding Normal Parameters. And As far as my knowledge of my family goes there has been no such genetical or Infertility issues in my family or in past generations. Also the Hormone levels are within Normal Range,However it may be in Lower Normal or Higher Normal Range,But that is still in Normal Range,so that should not be a major imbalance. Is Biopsy the only option ahead now? Nothing with medicines,Homeopathy etc. Also what are approximate cost of IUF,IVF and other mostly used ART's in India. I know I am asking too many questions,but do understand my concern,about my family and future,Go through each of the questions and answer them.

Answered by Dr. Mahesh Koregol (29 minutes later)

Brief Answer: No Detailed Answer: Hi I have already clarified in my previous post that I am not labelling or diagnosing it as primary testicular failure. Please don't presume unless it is confirmed. Medical science does not run on assumptions. The diagnosis needs to be confirmed before panicking. Biopsy is the only way forward to differentiate between obstructive azoospermia and testicular failure. I understand that you are in distress due to this but practical thinking is important. I appreciate your desire to learn more. IVF Procedure cost in india is between 65 thousand to one lakh rupees. Injections cost extra approximately around 50 thousand. Let me know if you have any more questions. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar