Azoospermia: when the semen report shows no sperm
Part of our guide to male infertility treatment in Goa.
Azoospermia is the finding of no sperm at all in the semen, even after the sample has been spun down and the sediment searched under the microscope. Azoospermia treatment in Goa at Heartbeats IVF starts by finding out which kind it is: a blockage that keeps sperm from reaching the semen, or a testis that makes very few sperm. The answer decides whether hormone treatment can help, or whether sperm are collected directly from the body for ICSI.
One report with no sperm is not yet a diagnosis. A high fever or a spell of illness in the last two to three months, or a sample that was not collected completely, can empty a report for a while, so the test is repeated before the word azoospermia is used. When the volume of semen is also very low, a urine test after ejaculation checks whether the sperm are going backwards into the bladder instead. Each line of the report is explained in our guide to the semen analysis report.
Blocked or not made: which kind of azoospermia is it?
Sperm are made in the testis, mature in the coiled tube behind it (the epididymis), and travel up a long tube (the vas deferens) to join the rest of the semen. Azoospermia comes from a problem at one of two points on that path.
- Obstructive azoospermia: a blockage. The testis makes sperm normally, but the way out is closed. Common reasons are an old infection of the epididymis, including tuberculosis, an injury or an earlier operation in the groin or scrotum, a vasectomy, and being born without the vas deferens. On examination the testes are usually a normal size, and the hormone results usually come back normal.
- Non-obstructive azoospermia: very low production. The testis itself makes very few sperm, or none. Reasons include a genetic cause, testes that were undescended in childhood, mumps that affected the testes after puberty, earlier chemotherapy or radiotherapy, and a weak hormone signal from the brain. In many men no cause is found. Smaller, softer testes and a raised FSH level are typical.
One cause deserves a warning of its own. Testosterone injections, gels or tablets, and anabolic steroids taken for body-building, tell the brain that the body already has enough testosterone, and the brain stops sending the signal that keeps sperm production going. Tell your doctor about any such medicine or supplement, even one bought without a prescription. Production often returns some months after it is stopped, but not in every man.
What tests are done after a no-sperm report?
- A repeat semen analysis, spun down. The sample is spun in a centrifuge so that even a few sperm are found. Finding even a handful changes the plan: they can be frozen or used for ICSI without an operation.
- An examination. The doctor checks the size of each testis, whether the vas deferens can be felt on both sides, and whether there is a varicocele (enlarged veins above the testis).
- Hormone blood tests. FSH, LH, testosterone and prolactin. A raised FSH usually points to low production. Low FSH and LH point to a weak signal from the brain, one of the few causes that medicine can treat.
- A scan of the scrotum. It measures the testes and looks at the epididymis and the veins. When a blockage near the prostate is suspected, a scan through the back passage may be added.
- Genetic tests. A chromosome test (karyotype) and a test for tiny deletions on the Y chromosome (the Y microdeletion test), advised when production is very low. When the vas deferens is missing, a test for the cystic fibrosis gene is advised for the husband, and usually for the wife as well.
What each of these tests shows is set out on our page on the male fertility test. The results sort most men into one of the two groups. They can also spare a man an operation that cannot help: when certain parts of the Y chromosome are missing completely, sperm are very unlikely to be found inside the testis.
How is azoospermia treated?
The treatment follows the cause.
- A weak signal from the brain. When FSH and LH are low, hormone injections can restart sperm production in many men. It is slow, often six months or more, and the semen is tested along the way. If sperm return to the semen, trying naturally or IUI may become possible; if only a few return, they can be frozen for IVF with ICSI.
- Medicines that switched production off. Testosterone or steroids are stopped under a doctor's care, and the semen is tested again after some months.
- A blockage. Because the testis is working, sperm can usually be collected directly with a fine needle and used for ICSI. In some men the blocked part can be bypassed by microsurgery so that sperm reach the semen again; whether that suits a couple depends on where the block is and on the wife's age and reports.
- Very low production. Medicines rarely bring sperm back to the semen when the testis itself is failing. The way forward is a search for sperm inside the testis, preferably by micro-TESE, followed by ICSI. A large varicocele is sometimes repaired first, and in some men a few sperm then appear in the semen.
How are sperm collected: PESA, TESA or micro-TESE?
- PESA (percutaneous epididymal sperm aspiration). A fine needle draws fluid from the epididymis through the skin, under local anaesthesia or light sedation. It suits a blockage.
- TESA (testicular sperm aspiration). A needle takes tiny samples from the testis itself. It is used for a blockage when PESA finds no sperm, and in some men with low production.
- TESE and micro-TESE. A small opening is made in the testis to take tissue. In micro-TESE the surgeon examines the testis through an operating microscope and picks out the tubules most likely to hold sperm, removing far less tissue than a blind biopsy. It is the method of choice when production is very low, and it is done under anaesthesia.
Whatever is taken goes straight to the embryologist, who searches it for sperm. Usable sperm are frozen for a later IVF cycle, which can spare a second operation, or used in the same cycle, timed with the wife's egg collection. A sample from the testis holds very few sperm, so it is always used with ICSI: one sperm injected into each mature egg. Heartbeats IVF does sperm retrieval, including micro-TESE, here in Goa, with the embryology laboratory alongside.
PESA and TESA are short, and most men go home the same day. After micro-TESE there is soreness and some swelling for a few days, and your doctor tells you when to return to work and exercise. The possible problems are bleeding, bruising and infection, and after a larger operation on the testis the testosterone level can fall for a while, which is why it is checked.
What if the search finds no sperm?
Sperm are not found in every man, and nobody can say for certain beforehand whether they will be. This is explained before you decide, along with the choices that remain if none are found, and the decision stays with the two of you. Donor sperm, when chosen, comes only from a registered ART bank.
Can azoospermia be passed on to a son?
Some causes can. ICSI works around a missing piece of the Y chromosome rather than repairing it, so a son conceived this way can carry the same difficulty. The cystic fibrosis gene linked to a missing vas deferens matters for the child too, which is why the wife is tested. Where a genetic cause is found, genetic counselling is arranged before you decide, so that the choice is fully informed.
What does azoospermia treatment cost?
IVF with ICSI has its own fixed price, and surgical sperm retrieval is charged separately from it. The fee for retrieval depends on the method, and you are told it before you decide. The full table of what each IVF price covers, with the price-list date, is on our IVF cost in Goa page.
What should you bring to the first visit?
Bring every semen report, old and new, any hormone or genetic reports, the notes of any earlier operation in the groin or scrotum, and a list of every medicine and supplement taken in the past year, including anything for the gym. Bring the wife's reports too: her age and egg reserve shape the plan as much as the semen report does. The wider picture of male fertility care is on our page on male infertility treatment in Goa.
Consultations are at whichever Heartbeats clinic is nearest you: Panjim, Margao, Mapusa or Vasco. Call or WhatsApp us to book.
Who wrote this guide?
The Heartbeats IVF team wrote this guide as general education. It cannot replace advice about your own case: your treatment is decided by your doctor after examining you and reading your reports.
Questions men ask about azoospermia
Is one semen report with no sperm enough to diagnose azoospermia?
No. The test is repeated, and the sample is spun down so that even a few sperm are found. A recent fever or illness can empty a report for a while, so one result is never treated as final.
Does azoospermia affect erections or sex drive?
Usually not. Sperm production and sexual function largely run separately, so most men with azoospermia have normal erections and ejaculation. A hormone problem can affect both, and the blood tests check for it.
Which men with azoospermia are helped by hormone injections?
Mainly men whose brain sends too weak a signal to the testes, seen as low FSH and LH on the blood test. In them, hormone injections given over several months can bring sperm production back. When the testis itself is failing, hormones rarely help, and a search for sperm inside the testis is the usual route.
What is the difference between PESA, TESA and micro-TESE?
PESA draws sperm from the epididymis with a fine needle, and TESA takes tiny samples from the testis with a needle; both suit a blockage. Micro-TESE opens the testis and uses an operating microscope to pick out the tubules most likely to hold sperm, and is used when production is very low.
Do retrieved sperm have to be used straight away?
No. Sperm found at the operation can be frozen and used for ICSI in a later IVF cycle, which can spare a second operation. Sometimes retrieval is planned on the day of the wife's egg collection instead. Your doctor advises which suits your case.
Can testosterone or gym supplements cause azoospermia?
Yes. Testosterone and anabolic steroids switch off the brain's signal to the testes, and sperm production can stop. Tell your doctor about anything you take, even without a prescription. Production often returns some months after stopping, but not in every man.
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What you read here explains fertility care in general terms and cannot replace a consultation. Decisions about your own care should be made with a doctor who knows your history and has seen you. We do not carry out or offer sex determination of any kind, which is prohibited by law in India under the PCPNDT Act.