Azoospermia (No Sperm)

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Dr. K, I have no sperm in my ejaculate. What does that mean and where do we go from here?

“Azoospermia” is the term used by many docs to describe when no sperm are seen in a man’s ejaculate. It is discovered in 5 – 10% of men who are seen in an infertility clinic.

Most couples ask whether this automatically means that there is no chance of having kids. The answer is that just because sperm are not seen in the ejaculate does NOT mean that sperm may not be found somewhere farther upstream. While azoospermia is a real reproductive challenge, a careful fertility evaluation that includes a history, a physical exam, a hormonal profile, genetic studies and possibly a biopsy will help your male fertility specialist define what your chances are of having your own biological children and the best way of helping you get there. “Azoospermia” is the term used by many docs to describe when no sperm are seen in a man’s ejaculate. It is discovered in 5 – 10% of men who are seen in an infertility clinic. Most couples ask whether this automatically means that there is no chance of having kids. The answer is that just because sperm are not seen in the ejaculate does NOT mean that sperm may not be found somewhere farther upstream. While azoospermia is a real reproductive challenge, a careful fertility evaluation that includes a history, a physical exam, a hormonal profile, genetic studies and possibly a biopsy will help your male fertility specialist define what your chances are of having your own biological children and the best way of helping you get there. So don’t let a semen analysis stop you from having hope and finding a male fertility specialist near you to complete this type of comprehensive fertility work-up. If you are ready to do all you can to overcome this reproductive hurdle, read on and empower yourself with education so that you can make the best decision for you and your partner.

Dr. K, they said I was azoospermic only on one semen analysis? Should I get this checked again?

Absolutely!!! If you live way out there where laboratories rarely do semen analysis or give results on parchment paper that report no numbers and just say whether there are sperm seen, you need to get yourself to another laboratory. Ideally, you want to find a laboratory that is certified to perform semen analysis. Unless you had your semen analysis done at a reputable center that does a good number of them, you definitely need to get it rechecked!

Dr. K, why do I have azoospermia? What is the cause?

Male fertility specialists will often try to categorize the azoospermia into two types: non-obstructive (a problem with the production of sperm) or obstructive (a problem with delivering the sperm out to the penis). 59% of the time, the reason for azoospermia can be traced back to a problem in producing sperm within the testicular factory. 37% of the time, it is due to an obstruction or blockage in the pipes that deliver the sperm out to your penis. Less than 5% of the time, it may be due to a specific hormonal or genetic abnormality (Jarow JP, Current Problems in Urology Vol 2, No 1, 1992.) In general, men with non-obstructive azoospermia (a problem with sperm production) may have smaller testicles and a higher FSH (the hormone from the brain that tells the testicle to make more sperm).

Dr. K, I’m azoospermic and also have a varicocele. Does fixing the varicocele help sperm come back?

Recent data from the American Urological Association 2009 meeting provide hope for men with azoospermia (no sperm in the ejaculate) and a varicocele (dilated veins in the scrotum). Weedin et al. from Houston, Texas (Abstract 2023) did a comprehensive review of the published literature to find 239 azoospermic men who have had a varicocele surgically treated. 39% had sperm return to their ejaculate. 25% were able to establish a pregnancy either naturally or with IVF. Those men whose testicular biopsies showed Maturation Arrest or Hypospermatogenesis had a higher probability of success as compared to those with Sertoli-Cell Only.

Bottomline: Surgically correcting a varicocele can bring sperm back to an azoospermic man’s and natural pregnancies are possible.

 

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