Azoospermia or “No Sperm in the Ejaculate”

Azoospermia or “no sperm in the ejaculate” is a diagnosis no one wants to hear when trying to start a family. Male fertility specialists at Yale Medicine Urology understand how sensitive this topic is for a man and his partner.

The good news? Having a biological child is still possible. With the right doctor, you can be helped in many cases.

If a man has no sperm in his ejaculate, it can either be from a blockage or a problem with sperm production. A well-trained reproductive urologist can help a couple better understand how to evaluate the situation.

The first step is to repeat the semen analysis. If the results are the same, then a full evaluation is necessary to determine the cause. This includes a medical history, physical exam, and bloodwork. An experienced reproductive urologist should then be able to determine the problem in about 95% of cases.

Anatomy

Possible causes of a blockage include prior surgery (such as a vasectomy), missing the tubes that carry the sperm, or damage in the epididymis from infection or injury. These are treatable in nearly all cases. These cases are called “obstructive azoospermia.”

Medications

Some medications can cause a drop in sperm production to nearly zero! The most common culprit is testosterone. Many doctors or providers are not aware of this side effect. Outside testosterone fools the body into NOT producing its own. The testis need high levels of testosterone near the testes to allow for normal sperm production. When someone takes testosterone, either by injection, through a pill, or in a gel form, it raises the testosterone level in the bloodstream but lowers the levels of testosterone in the testes. This shuts off sperm production. If the azoospermia is a result of exposures to testosterone, usually stopping the testosterone fixes the problem. In most cases, sperm returns to the ejaculate in three to twelve months.

Chemotherapy, radiation, or other toxic medications may also cause long-standing effects on the testicles. Be sure to ask your doctor whether a medication can affect sperm in the ejaculate.

Genetics

Genetic causes may impact low sperm production, as well. Some genetic material may be missing from the Y chromosome, or there can be an abnormality in one of the X or Y chromosomes (such as seen in Klinefelter’s syndrome). A history of undescended testes can also generate issues.

In many situations we do not know the cause of the problem. The only way to tell for sure is to take sample cells from the testicle to see if sperm is present or absent. These patients have “non obstructive azoospermia.”

It is important to find a reproductive urologist who works closely with a sperm processing facility that has significant expertise in identifying sperm from testicular tissue. Typically, this requires a surgical approach that involves a microscopic evaluation of the testicle cells using an operating microscope. There is about a 50-50 chance that sperm will be identified in these cases. Success rates improve when open “microdissection” is performed on a biopsy. At Yale Medicine Urology, we are considered pioneers in the field, with more than 25 years of proven results.

If you are faced with an uncertain diagnosis of azoospermia or no sperm in the ejaculate, don’t panic. Options are available that might allow for a biological pregnancy. Please seek out an appropriate specialist who can help.