Azoospermia

What is azoospermia?

Azoospermia means there are no sperm in the ejaculated semen. It affects about 1 percent of all men and around 10 to 15 percent of men with infertility. There are two main types. In obstructive azoospermia, the testes make sperm but a blockage stops them from reaching the semen. In non-obstructive azoospermia, the testes make very few or no sperm. Knowing which type is present guides treatment.

Symptoms and signs

Most men have no symptoms and find out only after a semen analysis. Some possible signs include:

• Inability to conceive after a year of regular unprotected intercourse
• Low semen volume
• Small or soft testes
• Low sex drive, erection problems or reduced body hair, if hormones are low
• A history of undescended testes, mumps affecting the testes, groin surgery or vasectomy

Causes and risk factors

Obstructive causes

• Vasectomy
• Congenital absence of the vas deferens, often linked to CFTR gene changes
• Scarring after infections such as epididymitis or tuberculosis
• Injury during hernia or other groin surgery

Non-obstructive causes

• Genetic conditions such as Klinefelter syndrome (47,XXY) and Y chromosome microdeletions
• Undescended testes, testicular torsion or trauma
• Chemotherapy or radiation
• Low pituitary hormones (hypogonadotropic hypogonadism)
• Use of testosterone or anabolic steroids, which can switch off sperm production

How azoospermia is diagnosed

• At least two semen analyses, with the sample spun down (centrifuged) and checked for any sperm
• Physical examination of the testes and vas deferens
• Blood tests for FSH, LH, testosterone and prolactin
• Genetic tests: karyotype, Y chromosome microdeletion and CFTR testing where relevant
• Scrotal or transrectal ultrasound to look for blockages

Treatment options

Hormone treatment

Men with low pituitary hormones can often start making sperm again with hCG and FSH injections. This can take several months. Men using testosterone or steroids are advised to stop under medical supervision.

Surgical sperm retrieval with ICSI

Sperm can be collected directly from the epididymis or testis using PESA, TESA, TESE or microsurgical TESE (micro-TESE). The retrieved sperm are used with ICSI, where a single sperm is injected into each egg during IVF. Sperm can also be frozen for future cycles.

Reconstructive surgery

Some blockages, including vasectomy, can be surgically repaired, which may allow natural conception.

Donor sperm

If no sperm can be found, donor sperm with IUI or IVF is an option some couples choose after counselling.

Chances of fathering a child

In obstructive azoospermia, sperm can be retrieved in the large majority of men. In non-obstructive azoospermia, micro-TESE finds sperm in roughly half of men, depending on the cause; certain complete Y chromosome deletions make retrieval very unlikely. Pregnancy chances after ICSI also depend strongly on the female partner's age and egg reserve, so outcomes vary and cannot be guaranteed.

When to see a fertility specialist

A man should see a fertility specialist or andrologist after any semen report showing no sperm. Do not start testosterone or "strength" supplements before evaluation. Iswarya Fertility offers male fertility assessment across its 91+ centres.