Sperms are male cells responsible for a pregnancy and contain the genetic material from the male partner. Sperm development (spermatogenesis) takes place in the seminiferous tubules (ducts) of the testes. Although sperms are produced at a rate of up to 1,000 per second, its takes almost 65-80 days for the sperms to mature and be capable of resulting in a pregnancy. Sperm development is mainly controlled by the endocrine (hormonal) system that comprises the hypothalamic-pituitary-gonadal axis. Any disturbance in this hormonal coordination can result in abnormal sperm production. The sperms are stored in sacs(epididymis) and ejaculated out through a tube called Vas deferens and ejaculatory duct.

1. Defective sperm production:

Improper hypothalamus and pituitary signals(Hypogonadotropic Hypogonadism), hypothyroid, medications, steroids taken for body building, damaged testis (trauma, infection, genetic conditions, Cryptorchidism, Cancer)

2. Defective sperm transport

Cystic fibrosis, blocked tubes (due to vasectomy, infection or congenital defect)

3. Defective sperm deposition

Retrograde Ejaculation, Erectile dysfunction / impotence, premature ejaculation

4. Damage to sperms

Varicocele, Obesity, Occupational hazards, Lifestyle

• Low Sperm Count: Oligospermia
• Complete absence of sperms: Azospermia
• Low Sperm Motility:Asthenospermia
• Abnormal Sperm Morphology: Teratozoospermia

Although there are no sure shot methods to improve sperm count, the following medications may be tried based on individual profile.

Clomiphene citrate, Anastrazole, Gonadotrophins(Injections)

Using today's minimally invasive techniques, sperm can be obtained from men in almost any instance. The following are some of the methods for obtaining sperms in men who are diagnosed with absent sperms in 2 separate semen analysis. The sperms thus obtained are either injected directly into the oocytes obtained from female partner (Intracytoplasmic injection of sperm-ICSI) or frozen for future use.

• PESA: Percutaneous Epididymal Sperm Aspiration: A needle is used to penetrate the scrotal skin and draw a small amount of sperm from the epididymis.
• TESE: Testicular Sperm Extraction: involves removing small samples of testis tissue for processing and eventual extraction of sperm.
• MicroTESE-Microscopic TESE: is a very thorough search for sperm under high magnification in cases of extremely low sperm production.
• Testicular Mapping: Even in men with absence of sperms on testicular biopsy, focal regions of sperms have been detected. Testicular mapping is a minimally invasive and less painful procedure than biopsy where a fine needle is used to aspirate from different areas of both the testes. Many men who have been diagnosed with non-obstructive azospermia either due to hypospermatogenesis, maturation arrest or sertoli-cell only syndrome (germinal cell aplasia) have been found to have small 'pockets' of sperm production within the testicles
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  Fig: Template for Different areas of the testes from which aspiration is done
  
  Courtesy : The Turek Clinic
• Testicular biopsy: A small sample from the testicles is removed under anaesthesia to test for presence of sperms.

Genetic factors can play a role in fertility not only by affecting current sperm quality and quantity but also increase the possibility of transmitting infertility to the future generations. Testing is done for conditions like Klinefelters syndrome, cystic fibrosis, Y chromosome micro deletions.

Varicocele is dilatation of the blood vessels present in the scrotum. If a varicocele is found, sometimes surgery to ligate (tie off) the abnormally dilated veins is recommended. If the varicocele is of significant size (Grade II or Grade III), about two thirds of men undergoing varicocele ligation will see improvement in the sperm quality. Pregnancy rates following varicocele treatment are in the range of 40%, but most pregnancies occur 6-9 months following surgery depending on the female’s age. If the initial sperm count and motility are in the severe male factor category, it is unlikely that this surgery will improve sperm counts enough to enable the couple to conceive without assistance.