Treatment for Non-Obstructive & Obstructive Azoospermia

By BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 12/14/2018

The first thing to do when it comes to determining the best treatment for an azoospermic man is to determine the type of azoospermia he suffers from. Azoospermia can be obstructive or non-obstructive or secretory.

Moreover, we must take into account that there exist multiple cases of untreatable azoospermia, that is, situations where no sperm can be found in the ejaculate in spite of trying with different treatment options.

Natural treatment

Males with non-obstructive azoospermia caused by a stressful situation or the consumption of some kind of drug can recover fertility with just eliminating the causal agent (reducing stress levels or quitting taking a particular medication). In these cases, the testicles recover their function again after the few months in almost all cases.

Another natural option is Maca root, a plant that grows in the central Andes (Peru and Bolivia) that is popular for its aphrodisiac properties and benefits for male fertility. In Latin America, it is believed to improve testosterone levels and be the solution in cases of secretory azoospermia.

In cases of long-term azoospermia that is not due to stress or medications, there exist no natural remedy that can cause the testis to produce sperm.

Also, there is no home remedy that can unblock the ejaculatory ducts in cases of obstructive azoospermia.

Hormone treatment

When the patient is a man with non-obstructive azoospermia who has no problem at testicular level but his FSH (follicle-stimulating hormone) levels are low, azoospermia could be reversed by administering FSH artificially.

Azoospermia due to low FSH levels occurs when the pituitary gland does not produce enough amounts of this hormone as to trigger sperm production in the testis. This disorder is called hypogonadotropic hypogonadism.

If the problem is caused by an absence or imbalance of other hormones such as GnRH or testosterone, an individualized hormone replacement therapy could help recover spermatogenesis (sperm production).

In cases of azoospermia due to testicular failure, unfortunately there exists no direct hormonal treatment that could make the testicle produce sperm to help recover sperm production.

Hormone treatments do not work with obstructive azoospermia, since the hormone levels of males with this type of azoospermia are normal. In cases of obstructive azoospermia, there exists an anatomical problem.

Fertility treatments, like any other medical treatment, require that you trust the fertility specialists that will be by your side during your journey. Logically, each clinic has a different work methodology. Our Fertility Report will offer you a selection of recommended clinics, that is, fertility centers that have passed our rigorous selection process. Moreover, our system is capable of comparing the costs and conditions of each one so that you can make a well-informed decision.

Surgical treatment

Obstructive azoospermia is due to a blockage in the ejaculatory ducts, vasa deferentia, or epididymis. In most cases, a surgical procedure can fix the blocked vasa deferentia or ducts, allowing passage of the sperm from the testes to the ejaculate again.

It is the case, for instance, of males who wish to revert their vasectomy (permanent birth control method for men). Reversal surgery, called vasovasostomy, involves reconnecting the tied seminal ducts again.

If the surgical procedure is successful, after a reasonable period of time, the man will be able to expel sperm with the ejaculate and even have children naturally, without undergoing fertility treatment.

As for non-obstructive or secretory azoospermia, there are no surgical options to solve the problem, as it is commonly due to an endocrine disorder.

Although it is not very common, sometimes testicular disorders hinder spermatogenesis. An example is varicocele or testicular torsion. In this case, the appropriate surgical procedure can help solve the problem.

FAQs from users

Is a vasectomy reversal painful?

By Andrea Rodrigo BSc, MSc (embryologist).

No, vasectomy reversal is carried out using anesthesia, which means the patient does not feel pain during the procedure. However, mild discomfort or pain can be felt once anesthesia has worn off.

If treatment for azoospermia fails, what are my options to have a baby?

By Andrea Rodrigo BSc, MSc (embryologist).

If none of the options to treat azoospermia works, there exist other alternatives to have children with azoospermia. In cases of obstructive azoospermia, a technique called ICSI (Intracytoplasmic Sperm Injection) can be used with sperm that has been directly collected from the testis, either through testicular biopsy, or epididymal or testicular aspiration.

With non-obstructive/secretory azoospermia, or when ICSI is unsuccessful, sperm donation is the most recommendable option. See also: What Is Sperm Donation?

Suggested for you

As one shall see, the most adequate treatment for azoospermia depends on the type the man suffers from. Do you want to learn more on the differences between secretory and obstructive azoospermia? Find them out here: What Is Azoospermia?

If treatment is successful, the patient will recover sperm production and subsequently sperm quality. However, when it is unsuccessful, there exist other alternatives to achieve pregnancy such as ICSI or sperm donation. This post will show you other alternatives for azoospermic males to have children: Can a Man with Azoospermia Achieve Pregnancy?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Baker K, Sabanegh E Jr. Obstructive azoospermia: reconstructive techniques and results. Clinics (Sao Paulo). 2013;68 Suppl 1:61-73.

Esteves SC. Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl. 2015 May-Jun;17(3):459-70.

Esteves SC, Miyaoka R, Roque M, Agarwal A. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl. 2016 Mar-Apr;18(2):246-53.

Kumar R. Medical management of non-obstructive azoospermia. Clinics (Sao Paulo). 2013;68 Suppl 1:75-9.

Ustuner M, Yilmaz H, Yavuz U, Ciftci S, Saribacak A, Aynur BS, Yasar H, Culha MM. Varicocele Repair Improves Testicular Histology in Men with Nonobstructive Azoospermia. Biomed Res Int. 2015;2015:709452.

Vij SC, Sabanegh E Jr, Agarwal A. Biological therapy for non-obstructive azoospermia. Expert Opin Biol Ther. 2018 Jan;18(1):19-23.

FAQs from users: 'Is a vasectomy reversal painful?' and 'If treatment for azoospermia fails, what are my options to have a baby?'.

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Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
Adapted into english by:
 Sandra Fernández
Sandra Fernández
BA, MA
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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