Azoospermia: Here's what it means to produce semen without sperm and remedies

Azoospermia means that there is no measurable sperm in a man’s ejaculate. To put some numbers behind it, a normal sperm count is 15 million sperm or more per millilitre (mL).

Low sperm count (oligozoospermia or oligospermia) is usually defined as below 15 million sperm per mL. A count below 5 million per mL is considered severe oligospermia. Azoospermia is no measurable sperm count.

Types of azoospermia

There are two main types of azoospermia :

Obstructive azoospermia: a missing connection or a blockage is not allowing sperm to make it to the ejaculate even if the testicles produce healthy sperm. Approximately 40% of those with azoospermia have obstructive azoospermia.

Non-obstructive azoospermia: poor or no production of sperm is taking place. This could be due to a condition in the testicles or in the hormone balance that triggers sperm production.

It takes a little over two months for sperm to grow and mature. Problems at different points during this process can lead to azoospermia. The causes of azoospermia fall into three categories:

Pre-testicular azoospermia

Pre-testicular azoospermia is a non-obstructive type (no blockage) of azoospermia caused by hormone or genetic issues.

Testicular azoospermia

Testicular azoospermia occurs when something in the testicles stops or slows the production of sperm.

Post-testicular azoospermia

Post-testicular azoospermia is an obstructive form of azoospermia that involves blockages that can keep sperm from making it into the ejaculate. In cases of post-testicular azoospermia, the sperm are typically healthy.

Blockages usually occur in the epididymis, vas deferens, or ejaculatory ducts.

Symptoms of azoospermia

The first sign of azoospermia is often when a couple finds they cannot conceive despite trying. But some causes of azoospermia, such as hormonal issues and blockages, may also cause other symptoms, such as:

No or little hair on the face or body (a sign of a hormone imbalance)
Erectile dysfunction
Decreased libido
Swelling, discomfort, or a lump in the testicles (a sign of blockage).

What to do when you have azoospermia

Treating azoospermia is based on its cause. Sometimes a condition can be treated, and sperm can return, allowing for normal conception. Other times, the best chance of conceiving involves extracting sperm for use in an assisted reproductive technology procedure such as in vitro fertilization.

Ultimately, how a medical provider treats azoospermia comes down to whether it’s obstructive or non-obstructive.