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Conditions

IVF and reproductive medicine · Fertility

Azoospermia

Understand absence of sperm in the ejaculate and distinguish obstruction from impaired production.

Editorial publication · Medical review pending.

Understand

Azoospermia is the absence of sperm found in the ejaculate after a properly performed analysis. It may be obstructive or result from very low or absent testicular production.

Possible symptoms

It often causes no symptoms and is found during assessment. Depending on the cause, low semen volume, hormonal features, small testes or a genital history may be present.

Causes and associated factors

Congenital or acquired obstruction, vasectomy, infection, hormonal, genetic or testicular disease, chemotherapy and some medicines can cause it.

Diagnosis

Diagnosis must be confirmed with appropriate analyses, then a specialist distinguishes obstruction from impaired production using history, examination and hormones.

Tests

Repeat semen analyses with pellet examination, FSH and testosterone are common. Depending on findings, ultrasound and genetic testing are important before retrieval or assisted reproduction.

Course of the condition

Prognosis depends on the cause. Sperm can sometimes be retrieved even when absent from the ejaculate, but this is not guaranteed.

Care options

Selected obstruction may sometimes be reconstructed. Surgical retrieval with ICSI, donor sperm or other routes to parenthood may be discussed, with genetic counselling when relevant.

When to consult

Any confirmed azoospermia deserves specialist assessment before conclusions are drawn or assisted reproduction begins.

Urgent help

Azoospermia is not an emergency. Sudden testicular pain, swelling, fever, trauma or a new lump still needs prompt or urgent assessment.

Questions for your doctor

  • Which cause or combination of factors explains our fertility difficulty?
  • Which tests are genuinely useful before deciding?
  • Which options exist before or instead of IVF?
  • Which benefits, limits, risks and costs should we compare?
  • What support and reassessment timeline should we plan?

Continue reading

A procedure linked to a condition does not establish an indication for your individual situation.

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