Azoospermia: What It Is, Types, Symptoms & Treatments

Azoospermia is the absence of sperm in semen and may be linked to several factors such as hormonal changes, infections, injuries, genetic issues and more. In this article you will find information on diagnosis and therapeutic options.

In azoospermia the semen contains no sperm cells. The condition can result from obstruction of the vas deferens, hormonal disorders, infections, tumours, testicular injuries or even side effects of medical therapies such as radiotherapy. Learn more below.

What is azoospermia?

Azoospermia is the absence of sperm in semen. It is one of the main causes of male infertility.

It is a sign associated with different health issues, from infections of the male reproductive tract and hormonal imbalances to testicular alterations, impacts and pelvic surgeries.

Azoospermia can also stem from genetics, radiation exposure, chemotherapy, liver diseases and the abusive use of tobacco, alcohol and illicit drugs.

What are the types of azoospermia?

There are two types of azoospermia: obstructive and non-obstructive. See the differences below:

Non-obstructive azoospermia

In non-obstructive azoospermia the man is unable to produce sperm. Main causes include hormonal changes, radiotherapy, chemotherapy and genetic conditions. See how each one affects fertility:

Hormonal changes

LH (luteinising hormone) and FSH (follicle-stimulating hormone) are produced in the pituitary gland and work together to create healthy sperm.

Both act on the testes: LH stimulates testosterone production while FSH nourishes the developing germ cells.

Radiotherapy and chemotherapy

Radio- and chemotherapy sessions can stop sperm production, either temporarily or permanently. Therefore, doctors usually recommend sperm freezing before treatment to preserve fertility.

Genetic conditions

Klinefelter syndrome is a genetic alteration in which the man has an extra X chromosome; consequently he may have little or no sperm production, small testes, low testosterone and sparse facial/body hair.

According to this paper, Klinefelter syndrome is the leading genetic cause of non-obstructive azoospermia.

Obstructive azoospermia

Obstructive azoospermia occurs when there is a blockage in the vas deferens—the ducts that carry sperm out during ejaculation.

The blockage can also be in the epididymis, two structures behind each testicle where sperm is stored and matures.

Other causes of obstructive azoospermia include:

Varicocele: abnormal dilation of the pampiniform plexus veins;
Injuries and trauma: testicular torsion and blows;
Cryptorchidism: undescended testicles;
Bacterial infections: urethritis, prostatitis and epididymitis;
Scrotal and testicular inflammations: mumps.

Symptoms of azoospermia

If azoospermia results from trauma, tumours, infections or inflammation, symptoms will match the underlying issue. For example, when a man has prostatitis he may feel pain during ejaculation and sometimes notice blood.

If the absence of sperm is due to a vas deferens obstruction alone, no symptoms may be present.

Main causes for the absence of sperm in semen

The most frequent causes include:

Obstruction of the vas deferens;
Infections or inflammation of the male reproductive tract;
Injuries to the testes or epididymis;
Varicocele;
Cryptorchidism;
Testicular tumours;
Side effects of chemotherapy or radiotherapy;
Pelvic surgeries;
Genetic alterations.

How is azoospermia diagnosed?

Diagnosis is made through a semen analysis. The sample is obtained by masturbation after a period of abstinence; no lubricants should be used during collection.

Hormonal tests, abdominal ultrasound, scrotal ultrasound and genetic studies might also be requested.

Does azoospermia have a cure? Main treatments

Treatment for obstructive azoospermia depends on the blockage site.

According to scientific publications, some vas deferens obstructions can be treated with microsurgical reconstruction, potentially restoring sperm in semen. Studies report improvements in 70–95 % of cases.

Research also shows that vasoepididymostomy may help selected patients with epididymal obstruction, with 20–70 % of couples achieving natural pregnancy.

Azoospermia and male fertility: what you need to know

Azoospermia directly impacts male fertility, as semen lacks sperm.

About 15 % of men face fertility issues and roughly 1 % are diagnosed with azoospermia, according to this article.

Multidisciplinary care involving urologists, radiologists, gynaecologists, reproductive endocrinologists and psychologists is often essential.

Can a man with azoospermia have children?

Everything depends on specialist evaluation to identify the underlying cause.

If obstructive azoospermia is irreversible, the couple may opt for ICSI in vitro fertilisation, where a single sperm is injected into an egg.

In non-obstructive cases, if minimal sperm production persists—even when absent from semen—retrieval may be possible via micro-TESE, a microscopic dissection to find active spermatogenesis areas.

Retrieved sperm can then be used with ICSI.

When should you see a fertility-focused urologist?

A man should consult a fertility urologist if pregnancy has not occurred after 12 months of unprotected intercourse.

Past chemo- or radiotherapy, infections or inflammation of the testes, genital surgeries and changes in ejaculation are also reasons to book an appointment.

Because it is one of the main causes of male infertility, azoospermia must be investigated by a specialist. An accurate diagnosis is crucial to define the best approach for each case.

For more information on men’s health, keep exploring the tips available on our blog.

Azoospermia: understand the complete absence of sperm in semen and how to treat it

What is azoospermia?