Azoospermia

What is azoospermia?

Azoospermia is a condition where you have no measurable sperm in your ejaculate (semen).

Typically, testicles produce sperm. Sperm travels through parts of your reproductive system and mixes with fluids to form semen. Semen is the fluid that your penis releases during ejaculation. If you have azoospermia, you may have semen — but there’s no sperm in it. Sometimes, azoospermia is referred to as having “no sperm count.”

Some people are born with no sperm count while some develop it as a teenager or adult. Medication and surgery can help treat azoospermia in certain situations. Just because you have the condition doesn’t mean you can’t have biological children.

Are there different types of azoospermia?

There are three types of azoospermia:

• Post-testicular azoospermia: This means that there’s a blockage or missing connection along your reproductive tract. You’re producing sperm but it’s getting blocked from exiting for whatever reason. This type is also called obstructive azoospermia. It’s the most common type, affecting up to 40% of people with azoospermia.
• Testicular azoospermia: This type of azoospermia means you have poor or no sperm production due to a disorder in (or damage to) the structure or function of your testicles. This is sometimes called nonobstructive azoospermia.
• Pretesticular azoospermia: Your testicles and reproductive tract appear normal but aren’t stimulated enough by hormones to make sperm. This can happen after chemotherapy or due to hormone imbalance. This is also considered a type of nonobstructive azoospermia.

Azoospermia affects about 1% of all men.

What are the symptoms of azoospermia?

You usually don’t realize you have the condition until you begin trying to conceive a child with your partner without success. Some people have symptoms related to the underlying cause. For example, you could have low libido due to hormonal imbalance or a lump on your testicles from an infection.

What are the causes of azoospermia?

Causes of azoospermia can be an obstruction or blockage (most common), or something else like genetics or hormone imbalances.

Post-testicular azoospermia (obstructive azoospermia)

Blockages occur most commonly in the epididymis (corkscrew-shaped duct where sperm matures), vas deferens and ejaculatory duct (tube that sperm goes through to mix with fluid and form semen). These obstructions essentially form a roadblock and don’t allow sperm to leave your testicles.

Problems that can cause blockages include:

• Trauma or injury to your testicles.
• Infections (such as epididymitis).
• Inflammation.
• Retrograde ejaculation.
• Previous surgeries in your pelvic area.
• Cysts or growths.
• Vasectomy.
• Cystic fibrosis gene mutation, which causes either your vas deferens not to form or causes a buildup of thick secretions in your vas deferens (which then blocks sperm).

Pretesticular and testicular azoospermia (nonobstructive azoospermia)

Nonobstructive causes of azoospermia can include genetics or hormonal disorders. As the name implies, there’s no blockage or obstruction causing there to be no sperm.

Causes of pretesticular and testicular azoospermia include:

• Certain genetic conditions like Kallmann syndrome, Klinefelter’s syndrome or Y chromosome deletion.
• Hormone imbalances and endocrine disorders like low testosterone, hyperprolactinemia and androgen.
• Varicocele.
• Reactions to certain medications that may harm sperm production.
• Radiation treatments, chemotherapy or exposure to heavy metals or toxins.
• Not having testicles or having undescended testicles.
• Orchitis.
• Lifestyle choices like misusing drugs or alcohol, and spending lots of time in saunas or hot tubs.

How is azoospermia diagnosed?

Healthcare providers diagnose azoospermia if, on two separate occasions, your semen analysis shows no sperm. A sperm analysis usually comes after a couple is trying to get pregnant without success.

To find the cause of azoospermia, your healthcare provider will take your full medical history, including asking questions about:

• Your previous fertility.
• Injuries or surgeries to your pelvic area.
• Infections like UTIs (urinary tract infections) or sexually transmitted infections (STIs).
• Your current and past medications.
• Any alcohol, marijuana or drug use.
• Heat exposure or use of saunas.
• Family history of birth disorders, cystic fibrosis or infertility.

Your healthcare provider will also conduct a thorough physical examination, paying close attention to the areas of your scrotum. It may also include a rectal exam.

What other tests diagnose azoospermia?

• Your healthcare provider may also order the following tests:
• Blood tests to measure testosterone and follicle-stimulating hormone (FSH) levels.
• Genetic testing.
• X-rays or ultrasound of your scrotum.
• Brain MRI (magnetic resonance imaging) if they believe your hypothalamus or pituitary gland is playing a role.

How is azoospermia treated?

Treatment of azoospermia depends on the cause. Genetic testing and counseling are often an important part of understanding and treating azoospermia. Treatment approaches include:

• Surgery to unblock tubes and ducts or reconstruct and connect ones that aren’t allowing sperm to flow through, if a blockage is the cause of your azoospermia.
• Prescription hormone treatments, if low hormone production is the main cause.
• Retrieving sperm directly from your testicle with a needle. Getting sperm this way can help you achieve a pregnancy using assisted reproductive technology like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

If the cause of azoospermia is thought to be something that could be passed on to children, your healthcare provider may recommend genetic counseling.

Will sperm come back after azoospermia?

Yes, it can, but it depends on the type of azoospermia. For example, if a blockage is causing you not to have any sperm, surgery to fix the blockage may result in having sperm in your semen.

Is there a cure for azoospermia?

There may be a way to cure or reverse azoospermia depending on what causes it. Some causes don’t have a cure.

How can azoospermia be prevented?

There’s no known way to prevent the genetic conditions that cause azoospermia. If your azoospermia isn’t a genetic problem, doing the following can help lessen the chance of azoospermia:

• Avoid activities that could injure your reproductive organs or wear protection (like a cup when playing baseball).
• Avoid exposure to radiation when possible.
• Know the risks and benefits of medications that could harm sperm production.
• Avoid lengthy exposure of your testes to hot temperatures.

What is the outlook for those with azoospermia?

Every cause of azoospermia has a different prognosis. Many causes of azoospermia can be reversed. You and your healthcare team will work together to determine the cause of your azoospermia and treatment options. Hormonal problems and obstructive causes of azoospermia are usually treatable, and fertility can potentially be restored. If testicular disorders are the cause, it’s still possible to retrieve live sperm to be used in assisted reproductive techniques like IVF.

Can I get pregnant naturally if my husband has azoospermia?

Yes, you still may be able to get pregnant naturally. This depends on the type of azoospermia your partner has and if it’s treatable. Your healthcare provider is the best person to discuss treatment and family planning with.

Is IVF the only option if my partner has azoospermia?

It depends on the cause of azoospermia. If the cause is testicular and requires surgical sperm retrieval, then IVF is the only option. If the azoospermia is treatable, couples may be able to avoid IVF.

How do I take care of myself?

Receiving an azoospermia diagnosis can have physical and emotional side effects. It’s important to rely on your healthcare provider’s expertise and lean on your partner while you navigate the best treatment. Your provider may recommend tests to get to the root cause of why you have no sperm. In the meantime, talk to your partner, family or friends about how you’re feeling. It’s normal to feel upset about a setback like this, but don’t let hopelessness set in. Many people go on to have biological children.

When should I see my healthcare provider?

Let your healthcare provider know if you and your partner are unsuccessful at getting pregnant after 12 months of regular, unprotected intercourse, or if you have concerns regarding your fertility. This is often the first sign that a condition is affecting sperm production. Getting a sperm test to see how much sperm you have may be one of the first things your healthcare provider recommends.

What questions should I ask my doctor?

It’s normal to have questions if you’re told you have no sperm. Questions to ask your healthcare provider could include:

• What are the causes of having no sperm?
• What tests do I need to determine the cause?
• Will I be able to have biological children?
• What treatment do you recommend?
• Will my children have this condition, too?