5 September 2022

Azoospermia: What is it and how do we treat it?

Normozoospermia analyzed by microscope. Semen analysis normal sp
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London


What is azoospermia?

A low sperm count is characterised by having fewer sperm in the ejaculate than the average – normally, this is anything fewer than 15 million per millilitre. Azoospermia is a lesser-known phenomenon, meaning a complete absence of sperm. Bear in mind, though that it does not often mean the absence of ejaculate. Men produce sperm and seminal fluid in different parts of the reproductive system, meaning you still produce ejaculate seminal fluid and may not notice a difference.

Azoospermia is a condition that affects about 15% of infertile men – more than 1 in 10 – and around 1% of the adult male population overall. This does not sound like a high risk for an individual, but over a whole population, it is a large number. Many men only become aware that they are not producing sperm when they start trying for a family, and must seek out fertility advice.

What are the different types of azoospermia?

There are three main types of azoospermia. If you receive a diagnosis of azoospermia, it is important to understand which type of azoospermia is the problem. The treatments we recommend would vary according to the cause. Ultimately, the testicles may not produce any sperm, or the pathway by which sperm travel out of the body is blocked.

  • Pretesticular azoospermia: The testicles are normal, but do not produce any sperm because of a hormone imbalance or previous cancer treatment such as chemotherapy. This is quite rare.
  • Testicular azoospermia: Damage to the testicles prevents them from producing sperm in a normal way. This could be the result of an injury or infection, a childhood illness such as viral orchitis, or a genetic condition such as Klinefelter’s syndrome. A varicocele, which is an enlarged vein in the scrotum or testicle, can cause blood to pool in the area, increasing the heat of the testicles and causing discomfort. A varicocele can also lead to a low sperm count or in some cases, the absence of sperm.
  • Post-testicular azoospermia: The testicles are producing sperm normally, but an obstruction prevents the sperm from exiting the body. Causes could be a vasectomy, in which the blockage is intentional; a blockage in the epididymis, which carries sperm from the testicles to the urethra; or retrograde ejaculation, in which sperm goes into the bladder rather than the penis during ejaculation.

What are the symptoms of azoospermia?

It is common to not experience any symptoms, or even know there is anything wrong until you want to become a father and your attempts to conceive are not successful. If you do experience symptoms, they are more likely related to the underlying cause of your condition, rather than a direct result of the azoospermia itself. Where symptoms other than infertility do occur, they could include:

  • Lumps, swelling or a feeling of discomfort around the testicles
  • Low libido or low sex drive
  • Erectile dysfunction
  • Decreased facial and bodily hair

Does azoospermia cause infertility?

If there is no sperm present in the semen, it will not be able to fertilise an egg, and so without medical intervention or spontaneous remission, you would be functionally infertile. However, there is still plenty of hope for your own genetic offspring. Depending on the cause of your condition, several treatments can help you to conceive and become a parent. If you have a female partner, her fertility status would also need to be taken into consideration when deciding on the most appropriate fertility treatment. Unfortunately, it is not possible to guarantee the success of every treatment, but it can be very effective.

What treatments for azoospermia are available?

1. Treatment of infection

If you have any active infections, you must treat these before taking any other steps. It’s possible for an infection to have a negative impact on fertility even if there are no obvious symptoms, such as painful urination.

2. Surgical repair

In some cases, we can remove or repair blockages or severed connections. Microsurgery can be used to remove a varicocele, correct retrograde ejaculation and sometimes reverse a vasectomy by re-joining the severed ends of the vas deferens. Although it’s possible to remove an obstruction, it cannot guarantee successful conception will take place.

3. Hormone treatment

Hormonal medication can stimulate sperm development, with the result being that the sperm can reach the seminal fluid. In some cases, hormonal medication may allow for enough sperm production so that we can extract the healthy sperm cells through means of a testicular biopsy. This would allow for their subsequent use in an In Vitro Fertilisation (IVF) treatment.

4. Sperm extraction from post-ejaculate urine

It is possible to extract healthy sperm from post-ejaculate urine. This can be very effective in cases of un-correctable retrograde ejaculation. Depending on the extracted quantity, the sperm can be used in a fertility treatment such as Intrauterine Insemination (IUI) or IVF.

5. Testicular sperm extraction

In cases of untreatable obstructive azoospermia, you can have a testicular sperm extraction (TESE) procedure. In this method, we extract sperm directly from the testicular tissue under general anaesthetic. The resulting sperm can either be used right away with Intracytoplasmic Sperm Injection (ICSI) or cryopreserved for future use.

Finding out more about IVI

We know that receiving a diagnosis of azoospermia can be very distressing for men who want to start their families. Remember that it isn’t necessarily a sentence of lifelong infertility, as you have seen from the options above. Even though there is no way to guarantee success, it’s always worth finding out more about the causes and possible fertility solutions to your condition.

Why not browse our website to find out more about the treatment options available, or contact us and arrange for a visit to one of our clinics in London or Birmingham, and together we can take it from there.

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