What Is Azoospermia?
Men typically have about 100–300 million sperm in their semen. Azoospermia is when you have no sperm in your semen. Without sperm, it’s not possible to get someone pregnant. Usually, men release sperm when they ejaculate. Ejaculation usually happens when you orgasm:
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Sperm moves from your testicles to your prostate. It mixes with fluid that makes semen.
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A tube (vas deferens) moves semen toward your penis.
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Your penis muscles contract and force semen out of your body.
Azoospermia affects about 1% of men. It accounts for about 10% of men with an infertility diagnosis.
Types of Azoospermia
There are two main types of azoospermia:
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Obstructive azoospermia occurs when your testes produce sperm, but something prevents the sperm from leaving your testes.
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Non-obstructive azoospermia occurs when your testes produce little to no sperm.
Azoospermia Symptoms
Most people don’t have any symptoms of azoospermia. You may not know you have the condition until you try to get someone pregnant.
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Causes of Azoospermia
There are multiple causes of azoospermia. Our specialists use semen analysis to find the reason for azoospermia.
Obstructive azoospermia causes
Obstructive azoospermia can develop for many reasons:
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Vasectomy— Many men choose vasectomies for long-term birth control. Your vas deferens (tube carrying sperm toward the penis) is cut, and the tissue is safely sealed off (cauterized) during the procedure. A vasectomy is the most common cause of obstructive azoospermia.
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Cystic fibrosis (CF)—CF is a genetic disorder. It causes lung damage and digestive problems. In most men with CF, the tube and ducts that transport sperm don’t develop properly. This is called congenital bilateral absence of the vas deferens.
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Ejaculatory duct obstruction—Your ejaculatory ducts take sperm from your vas deferens to your urethra. Your urethra is the tube where urine and semen leave your body. Growths (cysts) that are present at birth or scarring from sexually transmitted infections (STIs) may block these ducts.
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Phimosis—Your foreskin is tight and can’t move back (retract) over your penis. This can block semen from exiting your penis.
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Surgical complications—Surgeries on your groin could injure your vas deferens. For example, repairing an inguinal hernia (bulge in your groin area) could lead to azoospermia.
Causes of Non-Obstructive Azoospermia
Non-obstructive azoospermia can be divided into two sub-types:
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Pretesticular non-obstructive azoospermia: These conditions affect the hormones you need to make sperm.
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Testicular non-obstructive azoospermia: These conditions prevent your testes from making normal sperm.
Pretesticular Non-obstructive Azoospermia Causes
- Elevated estradiol—Estradiol is a form of estrogen that affects male sexual function.
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Hypogonadotropic hypogonadism—This condition prevents your pituitary gland from making the hormones needed to create sperm.
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Hypothyroidism—An underactive or slow thyroid gland can affect sexual health and sperm count.
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Kallman syndrome—Kallman syndrome is a genetic condition that delays or prevents puberty.
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Pituitary tumors—Your pituitary gland is a pea-sized gland that produces and stores hormones. Growths on your pituitary gland can affect your hormones.
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Use of certain medications or treatments—Antidepressants or some heart disease medications can cause non-obstructive azoospermia. Chemotherapy can also damage the hormones that make sperm.
Testicular Non-obstructive Azoospermia Causes
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Exposure to gonadotoxins— Industrial chemicals, radiation, or chemotherapy can damage your testes. Chemotherapy can also damage the hormones that make sperm.
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Klinefelter syndrome (KS)—KS is a genetic condition that causes your testes to produce little to no sperm.
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Noonan syndrome—Noonan syndrome is a genetic condition that causes your sperm to not develop properly.
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Orchiectomy—This surgery removes one or both testicles. You may have an orchiectomy to treat testicular cancer, a traumatic injury, twisted testicles, or as a gender affirmation surgery.
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Post-pubertal mumps orchitis—A mumps infection in your testicles after puberty can alter your ability to make sperm.
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Sertoli-cell-only (SCO) syndrome—SCO syndrome is a condition that causes your testes to have no sperm cells.
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Testicular cancer—Testicular cancer causes irregular cells to grow and divide uncontrollably in your testicles.
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Undescended testicles—In some cases, your testicles don’t move down into their proper position before you are born. Without surgical correction, mature sperm may not develop properly.
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Varicocele—A varicocele is an enlarged vein in your scrotum.
Azoospermia Treatment
Treatment for azoospermia depends on the underlying cause. You may not need treatment unless you and your partner are trying to get pregnant. Your treatment plan depends on what type of azoospermia you have.
Obstructive Azoospermia Treatments
There are several treatments for obstructive azoospermia:
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Vasectomy reversal—You may still be able to get someone pregnant after a vasectomy if you have a reversal procedure.
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Testicular sperm aspiration—We will use a needle to pull out (aspirate) sperm from your testicular tissue. We can use this sperm in fertility treatments such as in vitro fertilization (IVF).
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Transurethral resection of the ejaculatory ducts—This small procedure treats ejaculatory duct blockages. We will insert a camera and surgical tools through your urethra. We will remove any blockages we find. This allows sperm to flow normally.
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Circumcision—You may have a procedure to remove your foreskin. This treats people with phimosis.
Non-Obstructive Azoospermia Treatments
Your treatment plan may differ if you have non-obstructive azoospermia:
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Medications—You may take clomiphene citrate (Clomid®) to help increase your testosterone. You take this medication for four months. After four months, we will repeat your semen analysis. We may recommend this treatment before microsurgical testicular sperm extraction (microTESE). It can double the chances of finding sperm during microTESE.
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MicroTESE—This surgery removes (extracts) sperm from your testes. Your surgeon will make a small cut in your scrotum and open your testicles. They use a high-powered surgical microscope and tools to collect tissue samples. A technologist will analyze the tissue samples for sperm to extract and freeze. You can use your frozen sperm for fertility treatments like IVF.
How to Boost Sperm Count
Why Choose University of Utah Health?
Our team includes fellowship-trained urologists and experienced advanced practice providers who specialize in conditions that affect men’s sexual health and fertility. We create a safe, empathetic, and supportive environment to discuss your needs and concerns. Our experts provide many treatments to help increase your quality of life and sexual health.
Schedule an Appointment
Call 801-587-1454 or request an appointment online to connect with our team. You don’t need a referral to make an appointment. Our financial counselor will confirm your insurance coverage and costs with you.
