Azoospermia is a condition where there is no sperm present in the ejaculate. This is experienced by 15% of those with male-factor infertility and 1% of the general male population. Although azoospermia is rare, there's a lot that we know about the condition, including potential treatment methods.
If you're trying to start a family and suspect that azoospermia is why you're struggling to conceive—or if you've recently been diagnosed—read on to learn more about azoospermia symptoms, diagnosis, treatment methods, and more.
Azoospermia is a condition where there is zero sperm found in ejaculated semen. (This is more severe than oligospermia, a condition in which sperm count is abnormally low.) It’s also sometimes known as “aspermia.”
Understanding the cause of your azoospermia is critical to finding the best treatment method. There are two types of azoospermia: obstructive and non-obstructive.
With obstructive azoospermia, the primary issue is a blockage or missing piece in the male reproductive system. This means that sperm production may be adequate or even high, but the sperm can't enter the semen or be ejaculated. In cases like this, treatment methods will focus on repairing the blockage or extracting sperm directly from the testes.
If a person has azoospermia but there’s no blockage, that means that there’s an issue with sperm production. This could be a hormone imbalance, an issue within the testes, or even a genetic mutation. Treatment methods may include medication and lifestyle changes to improve sperm health and production.
Below, you'll find common causes for both obstructive and non-obstructive azoospermia.
Severe UTIs, tuberculosis, direct trauma, and orchitis — inflammation of the testicles — can also cause epididymitis.
People who work in environments where they are exposed to chemicals or toxins that are known to impact sperm production (like pesticides and heavy metals) may be at greater risk of developing azoospermia. Some of these environments may include work in the agriculture, herbicides, construction, plastic production, and welding industries.
Because people with azoospermia often have normal sexual function and ejaculation, most don't experience any symptoms of azoospermia, and may not be aware of the issue until they are actively trying to conceive.
Most symptoms will be attributed to the root cause rather than azoospermia itself. For example, if the cause of a person's azoospermia is epididymitis, then they may feel swelling or discomfort around the testicles. People who have azoospermia caused by a hormone imbalance such as hyperprolactinemia may experience symptoms like low sex drive, fatigue, or erectile dysfunction. People with cystic fibrosis will be diagnosed at birth, but those who are CF carriers may not know until adulthood (if ever).
For many, infertility is the first and only sign that something is amiss. If you have been trying to conceive, start with sperm testing to get a clearer view of your fertility.
The first step to diagnosing azoospermia is a semen analysis. The process is this: You will produce a semen sample via masturbation that will be sent to a lab to be examined. There, lab scientists will measure semen volume, sperm count/concentration (how many sperm), sperm motility (how sperm are moving), and sperm morphology (how sperm are shaped).
If there is no sperm in your semen sample, then you may have azoospermia. Typically a doctor will order a repeat analysis to confirm.
Then, your physician may want to perform other diagnostic tests to understand the root cause of your azoospermia. For example, they may want to perform an ultrasound to view the scrotum and other parts of the reproductive tract, to see if an obstruction is present. They may also want to order blood tests to evaluate hormone levels or check for genetic conditions.
Since azoospermia can be caused through obstructive or non-obstructive means, it's important to get down to your root cause so you can find the best treatment method.
Taking that initial step of sperm testing can be emotionally taxing. For many, the thought of calling a doctor's office to make an appointment, driving out to a clinic, and then producing a sample in a stark facility feels off-putting. If physically visiting a doctor's office isn't within your comfort zone, you can still get answers.
At-home sperm analysis kits allow you to produce a sample at home and overnight your confidential kit to a facility for testing. With Legacy, you also receive easy-to-understand reports and a complimentary virtual fertility appointment with a male fertility clinician, so you can discuss your results with an expert and figure out the best next steps.
Because no sperm is present in the semen, azoospermia makes conception without medical intervention unlikely.
However, it can absolutely be possible for those with azoospermia to have biological children. Being diagnosed with azoospermia can feel demoralizing if you're trying to start a family. It's important to slow down, take a breath, and remember that this condition does not mean it's impossible to have biological children. You still have options.
Azoospermia treatment will depend on the cause. Some common approaches include:
In our sperm improvement guide, you'll find tips for healthy lifestyle changes, such as diet and exercise, to improve fertility. Although these changes alone may not be able to treat azoospermia, making lifestyle improvements alongside your doctor's recommendations can improve your sperm health and your overall well-being.