Azoospermia means no sperm in the ejaculate. The news of azoospermia can be devastating to men who have this finding. Very often, there is no clue, no suspicion that this is the reason for failure to conceive until a semen analysis reveals the unexpected result.
In other cases, men may have reason to be suspicious of this finding depending on their personal history. In either case, no sperm in the ejaculate does not necessarily mean nothing can be done. In fact, for the majority of patients I see in my practice, we are able to find a path to pregnancy.
Patients who are azoospermic undergo an evaluation. The medical history may offer some clues. Is there a history of testicular trauma or groin surgery? Did the patient have mumps earlier in his life? Has he been taking testosterone supplementation? What medications is the patient taking? Depending on the background information, there may be clues as to which of the two major categories of azoospermia the patient situation is most likely to be: Obstructive or non-obstructive.
Obstructive azoospermia means that there is a blockage preventing the sperm from coming out. Normally, sperm travel from the testicles to the epididymis and convoluted vas (deferens) where they are stored. With ejaculation, sperm are propelled through the straight vas into the ejaculatory ducts and then out the urethra and penis. Blockage can occur at the level of the epididymis, vas or ejaculatory ducts. Prior severe infection or history of surgery for testicular torsion may relate to epididymal obstruction. Scarring from hernia surgery can (rarely) cause vasal obstruction. Ejaculatory duct obstruction is typically congenital. In the setting of obstructive azoospermia, certain surgical procedures may appropriate to either correct the underlying condition or to retrieve sperm from the testicles.
The other form of azoospermia is non-obstructive azoospermia which occurs in the setting of no sperm production or very low sperm production (so low that there are not enough sperm being made to fill the epididymis and then enter the ejaculate). This can happen in the setting of a variety of underlying medical conditions, associated with certain genetic causes or happen for reasons that are embryologic in origin.
Evaluation generally includes bloodwork related to fertility hormones as well as genetic tests. Scrotal imaging is also commonly performed. In non obstructive azoospermia there are medical and surgical treatments which can sometimes result in either return of sperm to the ejaculate or the surgical retrieval of sperm from the testicles. I perform close to one hundred surgical sperm retrieval procedures each year.
In conclusion, a finding of azoospermia does not have to mean game over; instead, it can mean time for evaluation and hopefully, treatment.