To understand the base of the problem we have to go through the physiology along with pathology of Spermatogenesis Hormonal Control of Spermatogenesis and Sperm Maturation.
Like other peptide hormones, FSH (Follicle-Stimulating Hormone) & LH (Luteinizing Hormone) are known to act on their target cells by combining with specific cell surface receptors. A variety of lesions at various levels may result in defects in spermatogenesis and sperm maturation. It has already been seen, spermatogenesis is a process activated and controlled by different hormones, through a feedback mechanism. Ultimately everything is dependent on the hypothalamic-pituitary-testicular axis. All these endocrine glands work in harmony with each other. If this harmony is lost, it is manifested at the end level, of spermatogenesis, or sperm maturation.
There are many patients in whom all the investigations are within normal range but still sperm count is low. Why this happens is not exactly known. Is this basically because we consider the range of hormonal levels as an absolute figure or range and not as what is normal for that individual and we do not consider the exact sensitivity of that particular individual. So maybe the FSH and LH levels are within normal limits according to the laboratory standards but they do not suit that particular individual.
The low sperm count could be due to stress factors the person is facing or has faced. The following could be one of the explanations,
Psychosomatic Diseases are frequently the ill effects of chronic stimulation of Endocrine glands & their End organs. Another explanation could be of a stress disease vicious cycle. Stress causes disease and in turn, again gives rise to stress.
So, to cause aspermia the lesion may not be in the genital system but maybe from any other system of the body. So is it that the patient who needs the treatment & not the genital system? In short, have we been all along treating lab reports and not the patients? If we are to label this as a psychosomatic disease - then you will agree that
Psychosomatic Diseases are frequently the ill effects of chronic stimulation of Endocrine glands and are clinically represented as end-organ anomalies.
In short, when the patient is diagnosed with azoospermia or aspermia it is only the tip of the iceberg that is being seen and the origin is much deeper.
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