Azoospermia

Azoospermia (azoo) is a condition in which the male semen contains no sperm. Around 1% of all men and about 15% of male infertility cases are due to azoo.[1] Although the man is producing semen, sperm may not be produced. This can be diagnosed by sperm analysis (SA) – a simple test that tests sperm after ejaculation. In addition to a SA, doctors will look at family and medical history, do a physical examination, and conduct a hormonal analysis. All of these factors will provide a good predictor of azoo and what kind it is.[2]

Types of Azoospermia

There are two kinds of azoo:

Obstructive azoospermia – in this case, sperm is produced but a blockage in the testicles keeps the sperm from reaching the semen.

Nonobstructive azoospermia - in this case, no sperm is being produced or a detectable amount will not show up in the semen sample.[3]

There can be several reasons for azoo, such as cancer treatment, genetic conditions, drug use, or presence of a varicocele. However, in many cases, the cause of azoo is still not understood and can be due to genetics or environmental toxins.[4]

Treatment for Azoospermia

The first step to treatment is to do a repeat SA. This will confirm the results of the first SA, or in some cases, change the diagnosis.

If the presence of azoo is confirmed, there are several ways conceiving a child is still possible.

For obstructive azoo, surgery may be possible. With surgery, blocked tubes or ducts can be fixed easily. There are two types of surgery:

Microsurgery – in this procedure, the doctor makes a small incision in the scrotum and fixes the blockage. You are under anesthesia during this procedure.

Endoscopic surgery – in this procedure, a thin scope with a light and camera is threaded through the urethra. This eliminates the need for an incision and can repair the blocked. You are under anesthesia for this procedure.[5]

For nonobstructive azoo, there are still some ways to conceive a child.

Hormone treatment – a doctor may prescribe hormones such as follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), Clomiphene (Clomid) or Letrazole. These hormones encourage the body to produce sperm again or create enough for a sperm extraction for in vitro fertilization (IVF). This process is called a microTESE and is explained in depth further below.

Varicocelectomy – in this procedure, doctors can use a small microscope to identify varicoceles and tie the veins. Caricoceles are enlarged veins in the scrotum that can cause swelling, pain and infertility. By tying the offending vein(s), sperm production may be restored.[6][7]

For both cases of azoo, in vitro fertilization (IVF) is available as treatment to conceive a child. In IVF, a woman’s eggs are extracted and fertilized. After 3 or 5 days of incubation, the surviving embryos are placed back inside the woman in hopes of conception. With azoo, intracytoplasmic sperm injection (ICSI) will be a necessity. With ICSI, an embryologist will pick one sperm to inject into the woman’s egg for fertilization. For those with azoo, a procedure called a microTESE may be required.

During microTESE (microscope-assisted testicular sperm extraction), a doctor will use a small microscope to retrieve tissue from the testicles that may contain sperm. This is the best chance to find usable sperm without damaging the testicles or testicular tissue. Embryologists can then select one sperm from this tissue (if found) to place into an egg for fertilization during IVF.

For the cases where microTESE finds nothing, donor sperm may be a consideration. This decision may be difficult for some. It is important to weigh all options and make sure to be emotionally okay with it. For more information on donor sperm, please visit the Donor page in the menu above.

[1] “Azoospermia Diagnosis and Tests.” n.d. Cleveland Clinic. Accessed April 30, 2018. https://my.clevelandclinic.org/health/diseases/15441-azoospermia/diagnosis-and-tests.

[2] Schlegel, P N. 2004. “Causes of Azoospermia and Their Management.” Reproduction, Fertility, and Development 16 (5): 561–72. https://doi.org/10.10371/RD03087.

[3] “Treatments for Obstructive Azoospermia.” n.d. Stanford Health Care. Accessed April 30, 2018. https://stanfordhealthcare.org/medical-conditions/mens-health/azoospermia/treatments/obstructive-azoospermia.html.

[4] “Azoospermia.” n.d. Johns Hopkins Medical Health Library. Accessed April 30, 2018. https://www.hopkinsmedicine.org/healthlibrary/conditions/mens_health/azoospermia_22,Azoospermia.

[5] “Sperm Extraction for Azoospermia.” n.d. Stanford Health Care. Accessed April 30, 2018. https://stanfordhealthcare.org/medical-conditions/mens-health/azoospermia/treatments/sperm-extraction.html.

[6] Inci, Kubilay, and Levent Mert Gunay. 2013. “The Role of Varicocele Treatment in the Management of Non-Obstructive Azoospermia.” Clinics (Sao Paulo, Brazil) 68 Suppl 1 (Suppl 1). Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo: 89–98. https://doi.org/10.6061/CLINICS/2013(SUP01)10.

[7] Elzanaty, Saad. 2013. “Non-Obstructive Azoospermia and Clinical Varicocele: Therapeutic Options.” International Urology and Nephrology 45 (3). Springer Netherlands: 669–74. https://doi.org/10.1007/s11255-013-0443-x.