Semen Without Sperm: What Causes Azoospermia?

Men who don’t have sperm in their semen have a condition called azoospermia. It happens to about 1% of all men and 15% of infertile men. There aren’t really any symptoms that you’d notice, but if you’ve been trying to get your partner pregnant without success, this condition could be the cause.

What Causes It?

You might have a problem that keeps your testicles from making sperm or that stops sperm from getting out of your body. There are three main types of azoospermia:

Pretesticular azoospermia: Your testicles are normal, but your body can’t get them to make sperm. It might happen because of low hormone levels or after you’ve had chemotherapy. This type is pretty rare.

Testicular azoospermia: Damage to your testicles keeps them from making sperm normally. It can happen because of:

  • An infection in your reproductive tract, such as epididymitis and urethritis
  • A childhood illness such as viral orchitis, which causes swelling of one or both testicles
  • A groin injury
  • Cancer or its treatments, like radiation
  • Genetic conditions, such as Klinefelter’s syndrome

Post-testicular azoospermia: Your testicles make normal sperm, but something keeps them from getting out, like:

  • A blockage in the tubes that carry sperm from your testicles to your penis. This is called obstructive azoospermia.
  • A vasectomy
  • Retrograde ejaculation, when semen goes into your bladder instead of out of your penis during an orgasm

About 40% of men with azoospermia have the post-testicular type.

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How Do You Know if You Have Azoospermia?

If you’ve been trying without luck to get your partner pregnant, your doctor might check you for this condition.

First, you’ll give samples of your semen, and a lab will examine them with a high-powered microscope. If the results show no sperm in your semen on two separate occasions, then you’ve got azoospermia.

Your doctor will then try to figure out what’s causing the problem. She’ll give you a complete physical exam, ask you about your medical history, and test your blood to measure your hormone levels.

Your doctor may also want to do a biopsy on one or both of your testicles to check for signs of abnormal sperm. She’ll give you medicine to numb the area, then make a small cut in your scrotum and get a bit of tissue to study under a microscope.

Vasography, an imaging test using an X-ray and special dye, and other scans can show if you have a blockage that’s causing azoospermia. Sometimes, surgery is the only way to find the obstruction.

If you don’t have a blockage, genetic tests can find out if you have a problem in your genes.

Treatments and Your Fertility

There are a few types of treatment that can help men with azoospermia who want to have children.

If you have the obstructive type, surgery can remove the blockage. The more recent your blockage, the more likely it is that the surgery will be successful. If you’ve had one for less than 3 years, the chance of restoring your sperm flow is 97%, and the chance of getting a woman pregnant is 76%.

Sperm retrieval can help men with nonobstructive azoospermia or those who have a blockage but don’t want surgery. One way to do this is to use a tiny needle to draw sperm from a testicle. Then, you can freeze the sample to use later in in vitro fertilization (IVF).

If you have a testicular biopsy, your doctor can retrieve sperm at the same time, so you won’t need a second surgery.

WebMD Medical Reference Reviewed by Neha Pathak, MD on March 06, 2017

Sources

SOURCES:

American Urological Association: “The Evaluation of the Azoospermic Male: AUA Best Practice Statement.”

American Family Physician: “Epididymitis and Orchitis: An Overview.”

UCSF: “In Vitro Fertilization,” “Intracytoplasmic Sperm Injection.”

Reproduction, Fertility and Development: “Causes of azoospermia and their management.”

The Urology Clinics of North America: “Obstructive Azoospermia.”

Clinics: “Obstructive azoospermia: reconstructive techniques and results.”

Indian Journal of Urology: “Surgical Sperm Retrieval: Techniques and Their Indications.”

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