Azoospermia

What is azoospermia?

• Azoospermia (a-zoo-SPER-mee-ah) is a condition where a man has no sperm present in his semen. It is a major cause of male subfertility. Subfertility is a condition where a man has been unable to get a woman pregnant after one year of unprotected regular sex. This means not using birth control methods, such as birth control pills, diaphragms, condoms, or the rhythm method.
  
  
• The male reproductive system includes the testicles or testes, prostate, penis, scrotum, vas deferens, epididymis, and seminal ducts. Normally, testicles in the scrotum produce sperm, which then flows through the epididymis, vas deferens, and seminal ducts. Sperm mixes with fluid in the seminal ducts to form semen, which leaves the body through the penis. Semen is the thick, white, sperm-containing fluid released during ejaculation (process of ejecting semen from the penis). Problems with the production or flow of sperm may affect male fertility. With treatment, such as medicine and sperm extraction, your infertility may be resolved and your partner may conceive.

What causes azoospermia?

Azoospermia may be from an obstructive or nonobstructive cause. An obstructive cause is where the flow of sperm is blocked and is prevented from leaving the body. It may also be from a nonobstructive cause, such as a problem with sperm production.

• Obstructive azoospermia:
  
  
  • Genetic: You may have been born with genes that may cause infertility. A gene is a piece of DNA that tells your body what to do or what to make. Genes may affect sperm transport, such as in congenital bilateral absence of the vas deferens.
    
    
  • Infections: Infections of the male reproductive system, such as in the testicles or prostate, may affect male fertility.
    
    
  • Trauma: Previous injury or surgery to the spine, pelvis, lower abdomen (stomach), 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.
    
    
  • Varicocele: A varicocele is a condition where the veins (blood vessels) in the scrotum are enlarged and dilated (widened). Ask your caregiver for information about varicocele.
    
    
  • Vasectomy: A vasectomy is a surgical procedure that is done on males as a method of birth control. The vas deferens (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, or burned. The semen that is ejaculated no longer contains sperm.
  
  
• Nonobstructive azoospermia:
  
  
  • Drugs: Certain drugs, such as steroids, antibiotics, and drugs to treat inflammation or cancer may affect male fertility. Smoking, drinking alcohol, and using illegal drugs may also cause problems with sperm production.
    
    
  • Genetic: You may have been born with genes that may affect sperm production, such as Klinefelter's syndrome. These genes may also affect the formation of your reproductive (sex) organs, such as Kallmann's syndrome.
    
    
  • Hormones: Disorders of the testicles may produce abnormal levels of hormones that may affect the production of sperm.
    
    
  • Radiation: Radiation, such as that used to treat cancer, may affect sperm production.
    
    
  • Retrograde ejaculation: Retrograde ejaculation is when semen travels 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 factors: Pesticides, heavy metals, heat, and undescended testes (testicles that did move from the abdomen into the scrotum) may affect sperm production.

What are the signs and symptoms of azoospermia?

You may have any of the following:

• 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 non-palpable (cannot be felt).
  
  
• Veins that are enlarged, twisted, and may be seen in the scrotum (varicocele).

How is azoospermia diagnosed?

Your caregiver will take a complete medical, reproductive, and sexual health history from you. He may need to know how long you have been trying to have a baby. The timing and frequency of your sexual activities, and problems with sexual urges and functions are also important. You will also be asked about your lifestyle, including alcohol intake and smoking, medications taken, and past diseases. You may need any of the following:

• Physical examination: Your caregiver 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 caregiver may also do a digital rectal exam (DRE) to check your prostate and other parts of your reproductive system.
  
  
• Biopsy: A sample of your testicle is taken by a needle or through a small incision (cut) 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: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Genetic screening: 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.
  
  
• Imaging tests: Dye may be used in certain tests to make pictures show up better. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. Imaging tests may include the following:
  
  
  • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your pituitary gland to check for other causes of your infertility. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
    
    
  • Spermatic venography: This test will examine and show the position of the veins in the scrotum. It may be used to check for a varicocele.
    
    
  • Ultrasonography: 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.
  
  
• Semen analysis: A semen analysis is a test to check a man's fertility. It is done by taking a semen sample. You may need to talk with your caregiver about the method of sample collection.
  
  
• Urinalysis: Post-ejaculatory urinalysis is a test that is done on your urine after you have ejaculated. This test looks for the presence of sperm in the urine, which may suggest an obstruction or problems with ejaculation.

How is azoospermia treated?

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

• Medicines: Antibiotics may be given to treat an infection of the reproductive system. Hormones may be used to treat a hormonal imbalance.
  
  
• Percutaneous embolization: This procedure may be used to treat a varicocele. An obstruction (blockage) is made in the enlarged veins. This stops the flow of blood and treats a varicocele.
  
  
• Sperm extraction: Sperm may be extracted (removed) 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: Surgery may need to be done, such as removing a varicocele or repairing a blocked vas deferens. Ask your caregiver for more information if you need surgery.

Where can I find support and more information?

Having azoospermia may be hard for you. You and those close to you may feel angry, depressed, or frightened. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group. This is a group of people who have the same condition as you have. Contact the following for more information:

• American Society for Reproductive Medicine
  1209 Montgomery Highway
  Birmingham , AL 35216-2809
  Phone: 1- 205 - 978-5000
  Web Address: http://www.asrm.org
  

• International Council on Infertility Information Dissemination
  P.O. Box 6836
  Arlington , VA 22206
  Phone: 1- 703 - 379-9178
  Web Address: http://www.inciid.org
  

• RESOLVE The National Infertility Association
  1760 Old Meadow Rd, Ste 500
  McLean , VA 22102
  Phone: 1- 703 - 556-7172
  Web Address: www.resolve.org
  

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 caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Azoospermia