Azoospermia

Azoospermia is a condition where no sperm are found in the semen. While this diagnosis can feel alarming, it is important to know that azoospermia does not always mean permanent infertility. In many cases, sperm can still be retrieved surgically, or production can be supported with appropriate treatment.

This article explains what azoospermia is, why it occurs, how it is diagnosed, and what fertility options may be available, helping you understand the next steps after a diagnosis

What is Azoospermia?

Azoospermia is diagnosed when two semen analyses show zero sperm present in the ejaculate. It affects approximately 1 in 100 men and up to 5% of men with infertility.

There are two main types of azoospermia:

• Obstructive azoospermia (OA) – sperm are produced but blocked from reaching the semen
• Non-obstructive azoospermia (NOA) – sperm production in the testes is significantly reduced or absent

Distinguishing between these types is essential, as treatment options differ significantly.

Types of Azoospermia

Obstructive Azoospermia (OA)

In obstructive azoospermia, sperm production is normal, but a blockage prevents sperm from being ejaculated. Semen is usually acidic and volume is usually low.

Common causes include:

• Congenital absence of the vas deferens (CBAVD) – often linked to cystic fibrosis gene mutations
• Infection or inflammation of the reproductive tract which can cause blockages
• Surgical scarring – including previous vasectomy
• Ejaculatory duct obstruction (EDO)

Men with OA often have normal testicular size and hormone levels, which can be an important diagnostic clue.

Non-Obstructive Azoospermia (NOA)

Non-obstructive azoospermia occurs when the testes produce little or no sperm.

Potential causes include:

• Genetic conditions (such as Klinefelter syndrome or Y-chromosome microdeletions)
• Hormonal imbalances, including Testosterone use and PEDs
• History of undescended testes
• Chemotherapy or radiotherapy
• Severe varicocele
• Idiopathic causes (no clear explanation)

In NOA, testicular size may be reduced and hormone levels may be abnormal.

Symptoms of Azoospermia

Azoospermia usually causes no physical symptoms. Most men only discover the condition during fertility testing.

Occasionally, associated symptoms may include:

• Low libido
• Erectile difficulties
• Reduced facial or body hair
• Testicular pain or swelling (depending on cause)

Because symptoms are often absent, semen analysis is essential when investigating fertility concerns.

How is Azoospermia Diagnosed?

Semen Analysis

Diagnosis requires at least two semen analyses, confirming the absence of sperm after centrifugation.

Hormone Testing

Blood tests may assess:

• Follicle-stimulating hormone (FSH)
• Luteinising hormone (LH)
• Testosterone
• Prolactin

These results help distinguish between obstructive and non-obstructive causes.

Genetic Testing

Genetic screening may be recommended, particularly in cases of NOA or congenital absence of the vas deferens.

Scrotal and Transrectal Ultrasound

Imaging can identify:

• Blockages
• Testicular abnormalities
• Ejaculatory duct obstruction

Many men benefit from a comprehensive male fertility assessment, combining semen analysis, hormonal profiling, and imaging. Acorn Andrology offers structured testing options within its
fertility packages, supporting accurate diagnosis and personalised care.

Treatment Options for Azoospermia

Treatment depends entirely on the underlying cause.

Treatment for Obstructive Azoospermia

Options may include:

• Surgical correction of blockages
• Sperm retrieval techniques such as:
  • PESA (Percutaneous Epididymal Sperm Aspiration)
  • MESA (Microsurgical Epididymal Sperm Aspiration)
  • TESA (Testicular Sperm Aspiration)

Retrieved sperm can often be used with ICSI (Intracytoplasmic Sperm Injection).

Treatment for Non-Obstructive Azoospermia

Management may involve:

• Hormonal therapy (in selected cases)
• Surgical sperm retrieval (micro-TESE) where appropriate
• Assisted reproductive techniques if sperm are retrieved (IVF and ICSI)

Even in NOA, sperm may still be found in small areas of the testes in some men.

Can Men with Azoospermia Have Biological Children?

Yes, in many cases. Advances in sperm retrieval and assisted reproduction mean that biological fatherhood is possible for some men with azoospermia.

Success depends on:

• The type of azoospermia
• Underlying cause
• Testicular function
• Female partner’s fertility

Specialist assessment is essential to understand realistic options and outcomes.

Emotional Impact of Azoospermia

Receiving an azoospermia diagnosis can be emotionally challenging. Men often experience feelings of shock, anxiety, or loss, particularly as fertility testing is often unexpected.

Access to clear information, appropriate support, and a structured care pathway can make a significant difference during this time.

When Should You Seek Specialist Advice?

You should consider specialist assessment if:

• A semen analysis shows no sperm
• You have known risk factors (previous surgery, chemotherapy, genetic conditions)
• You are planning fertility treatment
• You want clarity on reproductive options and next steps

Early evaluation can avoid unnecessary delays and ensure appropriate investigations are carried out.

Frequently Asked Questions (FAQs)

In Conclusion

Azoospermia is a complex but not necessarily irreversible cause of male infertility. Accurate diagnosis, specialist assessment, and modern fertility techniques offer many men a pathway forward.

A structured fertility evaluation — including repeat semen analysis, hormone testing, genetic screening, and imaging — is crucial to identifying the cause and appropriate options. Exploring professional assessment through dedicated
fertility packages can help ensure no aspect of male fertility is overlooked