No sperm in the semen report? What azoospermia means, its causes and treatment
Azoospermia means no sperm are seen in the semen sample. It happens either because the tubes that carry sperm are blocked, or because the testes are making few or no sperm. Tests find which, and that decides treatment: correcting a cause where possible, or retrieving sperm directly from the testis for IVF with ICSI.
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Hearing that a semen report shows no sperm is a shock. In this video, Dr Mayur Pai explains what azoospermia means, the symptoms that may point towards it, its common causes and the treatments that can be considered; his Hindi and Konkani versions are further down this page. It is often not the end of the road, but the cause has to be found first. For the wider picture, see male infertility explained.
What azoospermia means
Azoospermia means that no sperm are found in the ejaculate. Most men with it feel completely normal, with normal desire and erections, and even the semen looks the same, because sperm make up only a tiny part of it. So it is usually discovered only on a semen test.
One report is not enough to make the diagnosis. The test should be repeated, and the laboratory should spin the sample in a centrifuge and search it carefully, because a few sperm can hide in a sample that first looks empty. A recent fever or illness can also lower sperm production for a while, since sperm take about two to three months to form. To understand the other parts of the report, read what a semen report shows under the microscope.
Are there any symptoms?
Most men have no symptoms at all. The doctor will ask about clues such as:
- a testis that did not come down in childhood, or testes that are small or soft
- mumps affecting the testes after puberty, or an injury to the testes
- surgery in the groin or scrotum, such as a hernia repair
- past infections of the urinary or genital tract
- treatment for cancer with chemotherapy or radiotherapy
- low sexual desire or less body hair, which can point to a hormone problem
- use of testosterone or body-building steroids, which can switch off sperm production
- a very small volume of semen, which can point to a blockage near the end of the tract, or to semen passing backwards into the bladder
The two main types of azoospermia
Obstructive: sperm are made but cannot get out
Here the testes are making sperm, but a blockage stops them from reaching the semen. The blockage may follow an old infection, surgery in the area or a vasectomy. Some men are born without the tubes that carry sperm (the vas deferens); this is linked to a gene also involved in cystic fibrosis, so genetic tests for both partners may be advised. The testes are usually of normal size, with normal hormone tests.
Non-obstructive: the testes make very few or no sperm
Here the problem is in sperm production itself. Causes include genetic conditions, such as an extra X chromosome or small missing pieces of the Y chromosome, undescended testes, mumps, injury and cancer treatment. Sometimes no clear cause is found. The testes are often smaller, and a hormone called FSH is often raised, because the body is pushing the testes harder.
A smaller but important group is hormonal: the gland at the base of the brain does not send the signals the testes need. This type can often be treated with hormone medicines.
The tests that find the cause
- A repeat semen analysis, with the sample spun down and searched carefully.
- A urine test after ejaculation, when the semen volume is low, to look for sperm passing backwards into the bladder.
- An examination of the testes and the tubes that carry sperm, including a check for swollen veins (varicocele).
- Hormone blood tests, including FSH, LH, testosterone and prolactin.
- An ultrasound scan of the scrotum, and sometimes of the glands behind the bladder.
- Genetic blood tests, where the picture suggests a genetic cause.
Together these tell us not just the type of azoospermia, but also the most sensible next step.
Treatment options
Treating the cause directly
Some causes can be treated. Hormone medicines can restart sperm production when the signals from the brain are missing, although this takes months. Stopping testosterone or steroids may allow production to return over time. When semen passes backwards into the bladder, medicines, or collecting sperm from the urine in the laboratory, may help. Some blockages, and a significant varicocele, can be corrected surgically in selected men.
Surgical sperm retrieval
When the cause cannot be corrected, sperm can often be taken directly from where they are made or stored. In obstructive azoospermia, production is usually normal, so sperm can generally be collected from the epididymis or the testis in a short procedure under anaesthesia. In non-obstructive azoospermia, sperm may still be present in small pockets of the testis. Micro-TESE searches the testicular tissue under an operating microscope to find them.
Because retrieved sperm are few, they are used with ICSI, in which a single sperm is injected into each of the wife's eggs as part of IVF. Where possible, extra sperm are frozen for later. You can read how this works in IVF with ICSI for a low sperm count.
Honest expectations
In non-obstructive azoospermia, sperm cannot always be found, even with a careful microscope search. The tests done beforehand help the doctor explain your own situation honestly before any procedure, and if sperm are not found, we sit down together to talk through what the findings mean. Whatever the result, no one is to blame: azoospermia is a medical condition, not a personal failing.
The same explanation in Hindi and Konkani
Dr Mayur Pai has recorded this explanation in Hindi and Konkani as well, so that the whole family can follow it.
Watch on YouTube if the player does not load.
Watch on YouTube if the player does not load.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so micro-TESE, the laboratory work and ICSI are all done by one team, with no referral elsewhere. Free patient transport is available from across Goa.
Getting started
Send your semen reports and any hormone tests to us on WhatsApp at +91 95185 02773, with any questions you have. Consultations are by appointment, so please call our reception on +91 95459 20817 to book. If you can, come together as a couple. Our treatment packages are transparent and fixed, so just ask us about the cost. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
Can a man with azoospermia still become a father?
Often there is a way forward. If sperm are found in the testis or the epididymis, they can be used with ICSI to fertilise his wife's eggs. Whether sperm can be found depends on the cause, which is why the tests come first.
Is azoospermia a sign of sexual weakness?
No. Azoospermia has nothing to do with sexual ability or desire. Most men with it have normal erections and normal-looking semen, and it is usually found only on a semen test.
Can medicines bring the sperm back?
Only in specific situations, such as a hormone problem from the gland at the base of the brain, or after stopping testosterone or steroids. For most other causes, tablets do not restore sperm, and the treatment is sperm retrieval with ICSI. Never start testosterone on your own, as it can switch off sperm production.
Is sperm retrieval a major operation?
No. It is a short procedure done under anaesthesia, usually as a day procedure. Micro-TESE takes longer, because the tissue is searched under an operating microscope. Most men have only mild soreness for a few days afterwards.
Does the wife need tests too?
Yes. Retrieved sperm are used with IVF and ICSI, so the wife's egg reserve, scan and other tests are planned alongside his. When the tubes that carry sperm are found to be absent, genetic tests for both partners may also be advised.
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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.