Azoospermia or “No Sperm in the Ejaculate”

Frequently asked Questions

How many semen analyses should I have done to know for sure if I have no sperm in the ejaculate?

We recommend at least 2 semen analyses. We recommend that you have at least one semen analysis done using advanced sperm technology. This can be done at our lab or oftentimes at a lab associated with an in vitro fertilization center. Labs using advanced sperm technology perform a more extended and comprehensive sperm test that may show sperm in 10% of cases in which sperm were previously felt to be absent. This finding may prevent a patient from needing surgery to extract sperm.

What are the possible explanations for no sperm in the ejaculate?

In general, there are four explanations.

1. The testis are making sperm, but there is a blockage.

2. The brain is not stimulating the testis to make sperm.

3. The testis is not producing any sperm.

4.The testis may be producing a tiny amount of sperm, but it is not coming out in the ejaculate.

How can a urologist tell which one of these situations apply to me?

Finding an experience urologist is most critical.  With a thorough discussion and physical examination, an experienced reproductive urologist can help diagnose the source of the azoospermia in approximately 90% of cases. 

Are there other tests that should be done in this situation?

Blood tests looking at hormone levels and genetic information can be helpful to diagnose the problem.

How do I choose a urologist to evaluate my situation and perform procedures if necessary?

You should choose a urologist like Dr. Honig,  who has expertise in evaluating patients with no sperm. The urologist should be an expert in microsurgical procedures. Having a urological microsurgeon with this experience increases your chances of having a child.

If there is evidence of a blockage, what are my chances of getting pregnant?

Very good. If there is a reversible blockage, this can sometimes be fixed with a minor procedure. If there is not a reversible problem such as a missing vas deferens (tube that carries the sperm), success rates of retrieving sperm approach 100%. Pregnancy rates in this situation are usually greater than 50% with in vitro fertilization depending in part on the age and health of the female partner.

If I have no sperm in the ejaculate and there does not appear to be a blockage or a brain issue, can I still get my partner pregnant?

Yes. Men with no sperm in their ejaculate who likely have a problem with sperm production, can achieve pregnancy.

How is this possible?

Sperm may be retrieved with either a minor procedure or a more extensive procedure based on your particular situation. Success rates in retrieving sperm are usually about 50% in this situation.

Are there any genetic risks with using sperm extracted from the testis?

If genetic testing done in preparation for a sperm retrieval procedure is abnormal (5-10% of cases), discussion with a genetic counselor is recommended. If the genetic testing is normal, rates of birth defects appear to be the same as the general population.

Is there any medication that can be used to stimulate sperm production in these situations?

In some men who have low  brain hormone or testosterone levels, medication can either result in sperm in the ejaculate or improve your chances of having a successful sperm retrieval.

In men who have sperm production problems, there is some evidence that medication can improve sperm retrieval success rates. Please ask your doctor if these medications are reasonable for you.