Azoospermia: what it is, causes, tests and treatment options

Azoospermia means there is no sperm in the ejaculate. Gateshead Health explains that occasionally sperm samples are produced that contain no sperm, and that this is called azoospermia. It is one of the possible reasons for poor-quality semen, which the NHS says is a common cause of infertility in men.

The NHS describes the ways semen can be abnormal as a lack of sperm, which may mean a very low sperm count or no sperm at all, sperm that are not moving properly, and sperm that are an abnormal shape.

The sources used here do not describe symptoms of azoospermia itself. Gateshead Health explains that, in the obstructive forms, the man can still ejaculate seminal fluid, but this fluid will not contain any sperm.

This is why azoospermia is usually found during fertility investigation after a couple has been trying to conceive, or after a semen test, rather than from noticeable symptoms. Some underlying causes, such as testicular infection, injury or lumps, may cause their own symptoms, so any change in the testicles should be checked by a GP.

Gateshead Health and Saint Mary’s Hospital divide the causes into obstructive and non-obstructive. In obstructive azoospermia the testicles produce sperm but they cannot be ejaculated because of a blockage or absence of the vas deferens, the tube that carries sperm from the testicle. In non-obstructive azoospermia, the testicles produce such low numbers of sperm that they are not found in the ejaculate, which Saint Mary’s says could be due to genetic conditions.

The NHS lists damage to the testicles as a cause of poor semen quality, from infection, testicular cancer, testicular surgery, a congenital defect, undescended testicles or injury. It also lists hypogonadism, an abnormally low level of testosterone, which could be caused by a tumour, taking illegal drugs, or Klinefelter syndrome.

Medicines and substances can affect sperm production. The NHS names sulfasalazine, which can decrease sperm number but whose effects are temporary, long-term misuse of anabolic steroids, chemotherapy, some herbal remedies and illegal drugs such as marijuana and cocaine. Vasectomy, which cuts and seals the tubes that carry sperm, means semen will no longer contain any sperm.

The NHS says that for men the tests to find the cause of infertility include a semen analysis, to check for problems with sperm such as a low sperm count or sperm that are not moving properly, and a urine test for chlamydia. The GP will ask about medical and sexual history and may examine the testicles for lumps or deformities.

UHCW and Gateshead Health explain that in non-obstructive azoospermia a biopsy of testicular tissue may be sent to the laboratory to try to find out the cause of the problem. NICE CKS lists semen analysis as the initial investigation in men.

The NHS says that, depending on the cause, surgery can correct an epididymal blockage, and surgical extraction of sperm may be an option if you have an obstruction that prevents sperm release, were born without the vas deferens, or have had a vasectomy or a failed vasectomy reversal. NICE CKS gives surgical correction of epididymal blockage in obstructive azoospermia as an example of surgical treatment to restore fertility.

Gateshead Health explains that sperm can be collected from the epididymis with PESA (percutaneous epididymal sperm extraction), a fine needle passed through the skin, often under local anaesthetic, and that in non-obstructive azoospermia very small amounts of sperm may be collected directly from the testes through multiple testicular biopsies. The sample is examined the same day, and any sperm are frozen for later use.

The HFEA says ICSI, in which sperm are injected directly into the egg as part of IVF, is the most common and successful treatment for male infertility and may be recommended where sperm need to be collected surgically from the testicles or epididymis. Gateshead Health says that if retrieval is successful there is usually enough sperm for several IVF treatments.

Gateshead Health says that as with any surgical procedure, bleeding, infection, injury or anaesthetic risks are possible but rare in sperm retrieval. You may experience local pain and swelling that usually settles within a week, and scarring and shrinkage of the testicle are very rare complications.

If no sperm is retrieved, you are told straight away and the specialist discusses options. The unit does not schedule IVF or ICSI treatment until it is known that there are sperm.

The NHS says to see a GP if you have not conceived after a year of trying through regular unprotected sex, and to go sooner if you have any other reason to be concerned about your fertility, for example if you have had treatment for cancer or think you might have had a sexually transmitted infection. It says it is best for both partners to visit the GP because fertility problems can affect either or both partners.

NICE CKS says that in the UK the leading cause of infertility is factors in the man, accounting for 30% of couples, and that factors in both partners are reported in about 40% of infertile couples.

The NHS says that after an initial assessment, a GP may refer you to a specialist infertility team at an NHS hospital or fertility clinic. It says NHS funding for fertility treatment varies across the UK, with eligibility criteria and waiting lists that can differ by area, and that a GP or your local integrated care board can advise on eligibility.

The NHS notes that private treatment is available, can be expensive and is not guaranteed to be successful, and that you should choose a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA).