Azoospermia – Can a Man Actually Have Zero Sperm Count?

By BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 02/01/2021

Azoospermia, commonly referred to as zero sperm count, is described as the absence of measurable sperm in the ejaculate (semen). Depending on the cause, it can be classified into two types: secretory or non-obstructive azoospermia, and obstructive azoospermia.

The chances of achieving pregnancy with azoospermia are dependent on the type, too. If it is obstructive azoospermia, sperm can be collected with a testicular biopsy to be used for ICSI. However, in cases of secretory azoospermia, retrieving sperm is more complicated, and the man might need to use donor sperm to have a baby.

Definition & diagnosis

A semen analysis or seminogram is the most common test to check fertility in males. To perform this test, a sperm sample is collected and then evaluated in the laboratory in order to check the sperm count and motility.

When the semen analysis report is available, sperm count is compared with the diagnostic reference values provided by the World Health Organization (WHO):

Azoospermia
No sperm in the semen.
Cryptozoospermia
Less than 100,000 sperm per milliliter of semen.
Oligozoospermia
Less than 15 M/ml.
Normozoospermia
All sperm parameters are normal.

Considering this classification, azoospermia can be defined as a sperm disorder in which the male lacks sperm cells in the ejaculate. In other words, this means that no sperm is produced. It is estimated that, out of all male infertility problems, azoospermia is present in between 3 and 10 percent of the cases.

Azoospermia is a medical condition that has no noticeable symptoms. This is the reason why, for its diagnosis, it is necessary to perform a semen analysis.

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Determining FSH hormone levels might be useful as well. This hormone is produced by the brain and is responsible for spermatogenesis (production of spermatozoa) in the testes. If FSH levels are too high, it translates into a decreased level or the absence of stem cells in the sperm sample. A testosterone and fructose test is advisable, too.

Causes

The fact that the man has no sperm in the semen can be due to two main causes:

Secretory or non-obstructive azoospermia
The testes are incapable of producing sperm.
Obstructive azoospermia
Sperm are produced, but the cannot be expelled with the ejaculate due to an obstruction in the ejaculatory ducts.

Carrying out a testicular biopsy is necessary in order to determine the type of azoospermia. It consists of taking a tissue sample from each testicle in order to check if it produces sperm (obstructive azoospermia) or not (secreting azoospermia). Getting your hormones tested might also help to determine the type of azoospermia. If the levels of hormones that play a role in spermatogenesis are altered, the diagnosis will be secretory azoospermia. However, this method is not so accurate as a testicular biopsy to determine whether a few sperms could be retrieved and used during fertility treatment.

Secretory or non-obstructive azoospermia

Secreting or non-obstructive azoospermia is the most severe, frequent type of azoospermia, being present in 70% of cases. It can be congenital (condition existing at birth) or acquired (due to an illness or treatment with toxic medicines). These are the most common causes:

  • Undescended testicles
  • Exposure to toxic substances: drugs, radiotherapy, and chemotherapy.
  • Genetic disorders such as alterations in genes related to spermatogenesis.
  • Hormonal imbalances such as hypogonadotropic hypogonadism (deficiency of the hormones released by the pituitary gland and responsible for stimulating sperm production in the testicles)
  • Testicular diseases: mumps, trauma, inflammations, and severe varicocele.

If you are interested in the subject, we recommend you visit the following article: What is secretory azoospermia? - Causes and treatments.

Obstructive azoospermia

Obstructive azoospermia is due to a problem in the sperm ducts which transport the sperm from the testicles to the urethra, in which the ejaculate occurs. The most common causes of this type of azoospermia are:

  • Absence of vasa deferentia, owing to either congenital reasons or after a surgical procedure.
  • Inflammations or trauma in the testes, epididymis, vasa deferentia, or prostate.

For more details, keep on reading here: Obstructive Azoospermia - Causes & Treatment Options.

Azoospermia and varicocele

The relationship between azoospermia and varicocele is rather common since 5% of varicocele cases end up developing azoospermia. However, this only occurs among the most severe cases of varicocele.

Want to learn more about your options of conceiving with varicocele? Read more: Achieving Pregnancy with Varicocele.

Varicocele is defined as the dilation of the veins that form the spermatic cord and directly affects spermatogenesis, that is, the production of sperm. The more severe the dilation of the veins, the more affected the production of sperm and the higher the risk of azoospermia.

Patients with secretory azoospermia who undergo surgery for correcting varicocele (varicocelectomy) usually recover 50% of their testicular tissue. In addition, sperm motility after ejaculation is recovered in 55% of cases.

Azoospermia through vasectomy

Vasectomy is a method of male sterilization with which the absence of sperm in the ejaculate is achieved. It involves inducing obstructive azoospermia voluntarily through the cutting of the vas deferens, thus preventing the passage of sperm from the testicle to the urethra.

Since the vas deferens are blocked, the sperm will be stored in the epididymis and eventually reabsorbed by the body itself.

Vasectomy does not affect sperm production, although it is true that, over time, the body may decrease sperm production or it may be slightly altered.

Treatments

To be able to start treatment it is essential to know the type of azoospermia, that is if it is secretory or obstructive azoospermia. In addition, it should be noted that some types of azoospermia have no solution and it will not be possible to obtain any sperm.

In those males diagnosed with obstructive azoospermia, performing a testicular biopsy could be a solution for obtaining sperm. Furthermore, microsurgery by removing the obstruction and joining the ducts, epididymovasostomy, or vasovasostomy would also make it possible to treat the azoospermia and obtain sperm in the male.

On the contrary, patients with secretory azoospermia will be given hormonal treatment.

If you want more information about the different treatments, visit the following link: Treatment for Non-Obstructive & Obstructive Azoospermia.

FAQs from users

Is there any preventive treatment for azoospermia?

By Sergio Rogel Cayetano MD (gynecologist).

Most of the times the problem of azoospermia is due to a constitutional cause, either by genetic failure or congenital affection, the male is born without germ line. In these cases, azoospermia cannot be prevented.

Other causes of azoospermia occur as a consequence of testicular damage (trauma, radiation, surgery, toxins, tumors...). In these situations, healthy lifestyle habits (balanced diet, non-extreme sport, avoidance of toxins) can prevent azoospermia. Likewise, the male testicle should be protected in procedures that involve the absorption of ionizing radiation in the area.
Read more

What is the difference between cryptozoospermia and azoospermia?

By Zaira Salvador BSc, MSc (embryologist).

It is not unusual that, when seeing that the sperm count is zero, sperm samples are diagnosed with azoospermia instead of cryptozoospermia.

The difference between azoospermia and cryptozoospermia is decisive, since a wrong diagnosis may lead to a testicular biopsy or epididymal sperm aspiration to retrieve sperm when there are viable sperms in the ejaculate, but only a few. The difficulty here is being able to find this few sperm in order not to be mistaken.

To avoid errors and provide the patient with the appropriate diagnosis of cryptozoospermia, the most advisable is to repeat the semen analysis. This time, the semen sample should be examined after having gone through a centrifugation process.

Is azoospermia the same as aspermia?

By Rebeca Reus BSc, MSc (embryologist).

No, they are not. Azoospermia equals having no sperm in the semen, but the man does not have issues with ejaculating. Conversely, aspermia refers to absence of ejaculation ability. In other words, aspermia does not affect sperm.

Is pregnancy possible with IUI in cases of azoospermia?

By Rebeca Reus BSc, MSc (embryologist).

No, it is not. The main requirement for IUI to be possible is to have a normal sperm count. Unfortunately, azoospermia patients have no sperm in the ejaculate.

Can a man with zero sperm count get a woman pregnant?

By Rebeca Reus BSc, MSc (embryologist).

The only possible way for males with secretory azoospermia to cause a pregnancy is by means of a hormonal treatment, as long as it leads to the recovery of spermatogenesis. However, this is unlikely in many cases, so the answer to this questions is that it depends on the cause of azoospermia.

If my sperm count is zero but I have obtained few sperms with a testicular biopsy, what are my chances of success with ICSI?

By Zaira Salvador BSc, MSc (embryologist).

As explained earlier, a single sperm per egg retrieved is enough, so there is no need for it to have an excellent quality. This is the reason why obtaining viable embryos is possible by removing the sperms directly from the testis.

Suggested for you

If you wish to learn more about all the types of sperm disorders that may occur in males, my advice is that you visit this comprehensive guide to all of them: Sperm Disorders that Cause Male Infertility – Causes & Treatment.

Throughout this post, we have mentioned that IVF with ICSI is the only treatment option for males with secretory azoospermia wishing to have children. Want to get more info on this technique? Read: What Is ICSI Technique? – Process, Success Rates & Cost.

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

Andrology-Male Reproductive Health and Dysfunction. Nieschlag E, Behre HM (eds). Berlin: Springer Verlag, 1997.

Comhaire FH, De Kretser D, Farley TMM et al. 1987 Towards more objectivity in diagnosis and management of male infertility: results of World Health Organization multicentre study. International Journal of Andrology 10, 1–53.

Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update 2010;16:231-45.

Fogle RH, Steiner AZ, Marshall FE, et al. Etiology of azoospermia in a large nonreferral inner-city population. Fertil Steril 2006;86:197-9.

Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989;142:62-5.

Krausz C, Genetic Aspects of Male Infertility, European Urological Review, 2009;3(2):93-96.

Male infertility best practice policy committee of the American Urological Association (AUA). The optimal evaluation of the infertile male. AUA Best Practice Statement. Revised, 2010.

Matsumiya K, Namiki M, Takahara S, et al. Clinical study of azoospermia. Int J Androl 1994;17:140-2.

WHO Manual for standardized investigation and diagnosis and management of the infertile male. Cambridge: Cambridge University Press, 2000.

FAQs from users: 'Is there any preventive treatment for azoospermia?', 'What is the difference between cryptozoospermia and azoospermia?', 'Is azoospermia the same as aspermia?', 'Is pregnancy possible with IUI in cases of azoospermia?', 'Can a man with zero sperm count get a woman pregnant?' and 'If my sperm count is zero but I have obtained few sperms with a testicular biopsy, what are my chances of success with ICSI?'.

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Authors and contributors

 Rebeca Reus
Rebeca Reus
BSc, MSc
Embryologist
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
MD
Gynecologist
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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