Azoospermia or "No Sperm in the Ejaculate"

Azoospermia or “no sperm in the ejaculate” is a sentence that a couple never wants to hear. This can be a devastating finding from a semen analysis result. Male Fertility specialists at Yale Urology have an outstanding understanding of how sensitive this topic is for a man and his partner.

If a man has no sperm in his ejaculate it is either caused by a blockage or a problem with sperm production. The good news is, there are still options for having a biological child. A well-trained reproductive urologist can help a couple better understand how to evaluate this particular situation and find solutions.

The first step is to repeat the semen analysis. If the results are the same, then a full evaluation, which includes a personal history, physical examination, and bloodwork is necessary to determine the cause of the problem.

An experienced reproductive urologist should be able to determine if there is a blockage or a problem with production in about 95% of cases based on a history, physical examination, and several blood tests.

Possible causes of a blockage include prior surgery, including a vasectomy, missing the tubes that carry the sperm, or a blockage in the epididymis from infection or injury. These are treatable in almost ALL cases. These cases are called “obstructive azoospermia.”

Problems that result in sperm production issues include genetic causes such as missing some genetic material from the Y chromosome or an abnormality of one of the X or Y chromosomes such as Klinefelter’s syndrome, history of undescended testes, etc. Sperm production issues may also result from long-standing effects on the testicles such as chemotherapy, radiation, or in certain cases may result from short term or long-term use of testosterone. If it is deemed caused by exposures to testosterone, it is usually a fixable by stopping the testosterone. In most cases, sperm may return to the ejaculate within 3-12 months.

However, in some situations we do not know the cause of the problem and the only way to determine would be a formal exploration to 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. In these cases, this requires a surgical approach that uses a microscopic evaluation of the cells in the testicle through an operating microscope.

Overall, there is about a 50-50 chance that sperm will be identified. Success rates improve when open “microdissection” is performed over a biopsy with a needle only, as well as in situations where both the reproductive urologist and the lab have expertise in teasing out sperm from testicular tissue. At Yale Urology, we have more than 25 years’ experience doing these procedures, and we are pioneers in this field with a track record of excellent results.

If you are faced with an uncertain diagnosis of azoospermia or no sperm in the ejaculate, do not panic! There are several options that are available that might allow for a biological pregnancy. Please seek out the appropriate specialist who can review the options with you and your partner and help you.