Diagnosing cause of azoospermia: What to do next if you find out you don’t have any sperm

Finding out that you don’t have any sperm is devastating for most men (and their partners). Lack of sperm in the ejaculate is called azoospermia. This article is a quick overview of how urologists diagnose causes of azoospermia and what treatment options are available.

The first step to treating azoospermia is to identify a cause. There are two major types of azoospermia, obstructive azoospermia (caused by a blockage in the reproductive system) and non-obstructive azoospermia (caused by a lack of sperm production). Determining if the reason for a lack of sperm is from either a blockage versus a production issue is critical, as both are treated differently.

A “blockage” in the reproductive system means that sperm are being made, but they are hitting a “roadblock” and cannot get out of the body. A production issue means that the piping is open, but no sperm are being produced.

A diagnosis can be made based on lab values, physical exam, or a biopsy.

Physical Exam: At physical exam, men with blockages typically have normal sized testicles, with a length of greater than 4 cm. Sometimes there are other subtle findings, including fullness of the epididymis or lack of a vas deferens (the tube that sperm swim through). Men with a production issue oftentimes have smaller testicles, which may be soft in consistency. They do generally have a vas, which is able to be felt.

Hormone Tests: Blood hormone testing is very useful in distinguishing these conditions. If a man has blockage, his testosterone is generally normal and FSH is in the normal range. This is because the testicle is functionally normal. Conversely, if a man has a production issue, his testosterone may be low and FSH elevated, indicating some degree of baseline testicle functional impairment.

Genetic Testing: There are also some genetic conditions that may result in impaired or no sperm production. One of these is when a man has the genetic complement of XXY, or Klinefelter syndrome. Normally males have the genetic complement of XY and females have XX. If a male has XXY, the “extra” genetic material may result in severely impaired sperm production. The other genetic condition that may result in impaired sperm production is called “Y chromosome microdeletion”. This is when there is a genetic abnormality on the Y chromosome that affects the sperm “blueprint”, resulting in very low or no sperm production. Cystic fibrosis may result in non-formation of the vas deferens. Therefore, men who are carriers for genes causing cystic fibrosis may have obstructive azoospermia.

Testicular Biopsy: The final test to determine if a man is blocked or not is a testicular biopsy. This procedure can be done in the clinic under local anesthesia. Once the testicle is completely anesthetized, several pieces of tissue are taken and examined under a microscope looking for sperm.

If a blockage is found, the decision is then made for sperm retrieval concurrent with an IVF cycle versus reconstructive surgery. If a production issue is identified, therapies with medications may be considered to stimulate the testicle to make sperm.


Mary Samplaski

Mary Samplaski

Dr. Mary Samplaski, MD is the Director of Male Infertility, Andrology and Microsurgery at the University of Southern California (http://keck.usc.edu/faculty/mary-samplaski/). She completed her medical school education at the George Washington University. She went on to do her residency training in Urology at the Cleveland Clinic Foundation. She then completed a 2-year fellowship training program in Male Infertility and Andrology at the University of Toronto. She has also done additional specialty training at the Miami Project in Male Infertility in the Spinal Cord Injury population. Dr. Samplaski is an internationally recognized leader in Male Infertility, Andrology and Microsurgery. She has spent time in Ghana with the International Volunteers in Urology medical outreach program. She is committed to the advancement of the field of Male Reproductive Medicine through her research, and she has over 50 peer-reviewed publications and book chapters. Her research interests include ethics and infertility, Klinefelter's and the role of the internet in medicine. Dr. Samplaski has received numerous awards and accolades for her academic accomplishments, including the prestigious Bruce Hubbard Stewart Award for Humanistic Medicine. Dr. Samplaski has been interviewed by CNN Heath, the Huffington Post, New York Post, LA Times and Twitter. She remains active on social media, and is followed by many reproductive groups and many of her patients.
Mary Samplaski

Author: Mary Samplaski

Dr. Mary Samplaski, MD is the Director of Male Infertility, Andrology and Microsurgery at the University of Southern California (http://keck.usc.edu/faculty/mary-samplaski/). She completed her medical school education at the George Washington University. She went on to do her residency training in Urology at the Cleveland Clinic Foundation. She then completed a 2-year fellowship training program in Male Infertility and Andrology at the University of Toronto. She has also done additional specialty training at the Miami Project in Male Infertility in the Spinal Cord Injury population. Dr. Samplaski is an internationally recognized leader in Male Infertility, Andrology and Microsurgery. She has spent time in Ghana with the International Volunteers in Urology medical outreach program. She is committed to the advancement of the field of Male Reproductive Medicine through her research, and she has over 50 peer-reviewed publications and book chapters. Her research interests include ethics and infertility, Klinefelter's and the role of the internet in medicine. Dr. Samplaski has received numerous awards and accolades for her academic accomplishments, including the prestigious Bruce Hubbard Stewart Award for Humanistic Medicine. Dr. Samplaski has been interviewed by CNN Heath, the Huffington Post, New York Post, LA Times and Twitter. She remains active on social media, and is followed by many reproductive groups and many of her patients.

6 thoughts on “Diagnosing cause of azoospermia: What to do next if you find out you don’t have any sperm”

  1. I have 9 percent of normal forms , 50 percent head deffects , 41 percent tail defects . My volume us 61*10. Is this normal.

  2. Hi doc, recently I took a test for getting a baby. Results show that I am having azoosphermia. And also took hormone test which shows that fsh level is 12.7 and lh level is 11.4. My doc asked me to go for ivf quickly. In 2012 I have checked and it was normal, again in 2014 when I checked, the report was oligozoospermia, after that I took some tablets like zinc foliate and oligo care. But now when I checked, I was shocked to see the result as azoosphermia. How would have this happened? Also whenever I was asked to collect semen, I found it difficult to collect right from the beginning till now. What is the problem inside me. Another doubt is that can fsh level be lowered? If so how? Kindly give me some suggestions and currently I am 37 years old and my wife is 31 years old.

    1. This seems like a complicated issue. It would be best if you could work with a specialist. There are doctors who specialize in male fertility. I would recommend visiting one to get a full evaluation and some options. Have you been to a urologist who works in male fertility or andrology?

      Has anything else changed in your health or your life over this time?

  3. Hi doc here’s my report, I should inform you that me and my wife have been trying for 12 months + so far with no success

    Report

    Method of Production : Masturbation
    Time produced: 10:30 AM
    Time analyzed: 11:00 AM
    Colour: Creamy White
    PH: 8.0
    Volume: 9.0 cm3
    Viscosity: Less Viscous
    Liquefication: Complete
    Total Count: 42 Million/cm3

    Motility (70%)
    Fully Active 30%
    Slightly Active 40%
    Dead 30%

    Morphology
    Normal 50%
    Abnormal 50%

    Pus cell: 2-3/hpf
    Epithelic cell: 0-1/hpf
    Others: Nil

    staph infection was detected which was indicated sensitive to levoflaxi which is what I am taking.

    Can we conceive?

    1. The results look pretty normal. I’d recommend getting tested again a few weeks after completing the levoflox.
      Infections can interfere with fertility. But otherwise, this looks healthy.

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