Azoospermia

Medically reviewed by Drugs.com. Last updated on Apr 2, 2024.

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What is azoospermia?

Azoospermia is a condition that prevents a man from having sperm in his semen. It is a major cause of male subfertility. Subfertility is a condition that prevents a man from getting a woman pregnant after 1 year of unprotected regular sex. This means that no birth control methods, such as birth control pills, diaphragms, condoms, or the rhythm method, have been used.

What causes azoospermia?

Azoospermia may occur if the flow of sperm is blocked and cannot leave the body (obstructive cause). Azoospermia may also be caused by a problem with sperm production (nonobstructive cause).

• Obstructive azoospermia:
  • Genetic conditions , such as congenital bilateral absence of the vas deferens, may affect sperm transport.
  • Infections of the male reproductive system, such as in the testicles or prostate, may affect male fertility.
  • Trauma may cause azoospermia. Previous injury or surgery to the spine, pelvis, lower abdomen, or male sex organs may cause damage to the male reproductive system. This may include surgery on an inguinal (groin) hernia. Trauma may affect sperm production or cause an obstruction in the flow or transport of sperm.
  • A varicocele is a condition that causes the veins (blood vessels) in the scrotum to become enlarged and dilated (widened).
• Nonobstructive azoospermia:
  • Medicines , such as steroids, antibiotics, and medicines used to treat inflammation or cancer may affect male fertility.
  • Smoking, drinking alcohol, and using illegal drugs may also cause problems with sperm production.
  • Genetic conditions may affect sperm production or development of reproductive organs. These include Klinefelter syndrome and Kallmann syndrome.
  • Abnormal hormone levels may be caused by disorders of the testicles. This may affect the production of sperm.
  • Radiation used to treat cancer may affect sperm production.
  • Retrograde ejaculation is a condition that causes semen to travel into the bladder instead of outside the body. It is usually caused by a problem with the neck of the bladder and may be due to spinal cord injuries, medicines, or diabetes.
  • Other causes include pesticides, heavy metals, heat, and undescended testes (testicles that did move from the abdomen into the scrotum). Any of these can affect sperm production.

What are the signs and symptoms of azoospermia?

• Inability to get your partner pregnant
• Increased body fat, body hair, and breast tissue
• Clear, watery, or whitish discharge from the penis
• Presence of a mass or swelling on the scrotum that feels like a bag of worms (varicocele)
• Stress or emotional pressure from not being able to conceive a child
• Testicles that are small, soft, or cannot be felt
• Veins that are enlarged, twisted, and may be seen in the scrotum (varicocele)

How is azoospermia diagnosed?

Your healthcare provider will ask questions about your health and the medicines you take. He or she will also ask how long you have been trying to have a baby. He or she may ask about the timing and frequency of your sexual activities, and any problems with sexual urges and functions. Your provider will also ask about your lifestyle, such as alcohol intake and smoking. You may need any of the following:

• A physical exam may be done. Your provider will look for signs of any imbalance in your hormones, such as increased body fat, body hair, and breast tissue. The size and shape of your testicles will also be examined. Your provider may also do a digital rectal exam (DRE) to check your prostate and other parts of your reproductive system.
• A biopsy is a procedure used to take a sample of your testicle. Your provider may take the sample with a needle or through a small incision in the scrotum. The sample is sent to a lab for tests. This will help determine the ability of the testicles to produce normal sperm.
• Blood tests may be done to get information about your overall health.
• Genetic testing may be done to look for abnormal genes. Abnormal genes may cause problems with sperm production, sperm transport, or formation of the male reproductive organs.
• An MRI takes pictures of your pituitary gland to look for other causes of your infertility. You may be given dye to help the pictures show up better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
• A spermatic venography is a test that will examine and show the position of the veins in the scrotum. It may be used to check for a varicocele.
• A scrotal or transrectal ultrasound uses sound waves to find lumps and other changes in your testicles and scrotum. These tests may be used to check for a varicocele or any missing parts of the reproductive system.
• A semen analysis is a test to check a man's fertility. It is done by taking a semen sample.
• A post-ejaculatory urinalysis is a test that is done on your urine after you have ejaculated. This test looks for sperm in the urine. Sperm in urine can be a sign of an obstruction or problems with ejaculation.

How is azoospermia treated?

The treatment will depend on the cause of your azoospermia. You may need any of the following:

• Medicines may be given to treat an infection of the reproductive system. Hormones may be used to treat a hormonal imbalance.
• Percutaneous embolization is a procedure that may be used to treat a varicocele. An obstruction (blockage) is made in the enlarged veins. This stops the flow of blood within the vein.
• A sperm extraction is a procedure to remove sperm from the testicles or epididymis if there is an obstruction. The sperm that is taken out may be saved or used to fertilize a woman's egg.
• Surgery may need to be done to remove a varicocele or repair a blocked vas deferens.

When should I contact my healthcare provider?

• You have a fever.
• You have chills or feel weak and achy.
• You see changes in your body, such as increased body fat, body hair, or breast tissue.
• You have pain in the groin area that does not go away.
• You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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