No Sperm Count (Azoospermia)

No Sperm Count or Zero Sperm Count (Azoospermia) Causes, Symptoms and Treatment

By Martin Bastuba, MD, FACS

Azoospermia, also known as a zero or no sperm count, is a male fertility issue that occurs when there is sperm in a man’s ejaculate. Azoospermia is present in 2% of the general male population, and as such, is a frequent factor involved with the inability to conceive¹ (Jarow et al. 2011. AUA).

What Does "A Zero Sperm Count" Mean?

By definition, Azoospermia means that a man does not have a measurable amount of sperm in his ejaculate. The condition is typically diagnosed when a patient and their partner are experiencing difficulty conceiving and seek testing and diagnosis from a fertility specialist. A semen analysis will be performed in order to determine the number of viable sperm found in the male patients’ ejaculate. If virtually no sperm is found, your doctor may suggest additional testing as necessary² (Jarow et al. 2011. AUA). This testing can include a semen analysis at a fertility laboratory such as The Fertility Center of California (FCC), the partner laboratory of The Male Fertility Specialists. A fertility lab, like FCC, with a technique called high speed centrifugation (HSC), a few sperm can often be found that may have been missed by testing in some of the larger, less-specialized laboratories or by “at-home” sperm count tests. Indeed, HSC can find sperm in approximately 15% of specimens initially thought to have zero sperm. Other tests would likely include genetics testing and hormonal tests.

What Causes Azoospermia?

Azoospermia can be caused by a variety of conditions³ (ASRM and SMRU. 2018. Fertility and Sterility), these include but are not limited to:

• A blockage in the genitalia, also known as “obstructive azoospermia”
• An infection within the male reproductive system
• Injury to the genitalia
• Effects from surgery to the male reproductive system - including effects from radiation and chemotherapy treatments
• Genetic causes as identified by Karyotype cystic fibrosis, and Y-chromosome microdeletion testing.
• Other potential causes include: undescended testes (also known as cryptorchidism) varicocele, medications such as steroids and antibiotics, excessive alcohol consumption, and illegal drug use.

Does Azoospermia Have Any Symptoms?

A comprehensive semen analysis, inclusive of HSC is required in order to verify a zero sperm count diagnosis. However, there are a few symptoms that are recognized in relation to having abnormal semen. Symptoms of abnormal semen can include semen that has an unusual color quality such as red or brown tinted (may indicate blood), semen that is thicker or thinner in consistency, ejaculate having a strong odor and/or is of a low volume. Very occasionally, there is little or no volume at the time of ejaculation associated with a condition known as ejaculatory duct obstruction. More common causes of painful ejaculation not associated with a zero sperm count (azoospermia) would include prostate infection (prostatitis) and sexually transmitted infections (STI).

Can I Still Get My Partner Pregnant If I Have a Zero Sperm Count?

Whether or not you can impregnate your partner is dependent on the diagnosis made by your fertility specialists. A Fellowship trained male fertility specialist will advise you on the cause of your azoospermia and what treatment options are available to help you conceive.

It is important NOT to give up until you are certain that a fully trained male fertility specialist feels that NO sperm is present. Even when no sperm is found in the ejaculate, about 50% of the time there is sperm in the testicles that can be retrieved and used for IVF. Dr. Bastuba and the Male Fertility Specialists Team in conjunction with Fertility Center of California have helped achieve pregnancies in cases where only a handful of sperm were present inside a man’s testicle. Do NOT give up.

Is There A Cure for Azoospermia?

Treatment options for azoospermia are entirely dependent on the type and cause of the condition. If the zero sperm count is caused by a blockage then your doctor can occasionally attempt to remove the source of this blockage through a surgical procedure.

If there is sperm production in the testicles, it can be retrieved for use with IVF / ICSI
(intracytoplasmic sperm injection). With the ICSI form of IVF, a single sperm is inserted into each egg. This means that even a handful of sperm may be enough for a couple to have a successful outcome.

If there is normal sperm production that cannot get out, then the sperm retrieval process may be a simple office based procedure such as a Testicular Sperm Aspiration (TESA) or Testicular Sperm Extraction (TESE). If the sperm production is low or very low, following a mapping process known as Testicular Fine Need Aspiration (TFNA) used to identify the location of the sperm, a procedure known as Micro Testicular Sperm Extraction (micro-TESE) is the required technique⁴ (ASRM and SMRU. 2019. Fertility and Sterility).

It is important to seek out a surgeon that is very experienced in these techniques to have the best chance for success.

If the issue is more hormonal in nature, then your doctor may prescribe medications to correct hormonal imbalances and promote sperm production. If infection is a cause then antibiotic treatment would be initiated.

Where Can I Go to Receive Azoospermia Treatment?

• First, start with a urologist who has done additional advanced training known as a Fellowship. Dr. Bastuba received his Fellowship training, 1992-1993, from the University of Boston.
• Then, make sure this physician has dedicated themselves to using this advanced training and all of the latest techniques with many different IVF centers.
• Make sure that the doctor has laboratory experience to be able to examine, freeze (cryopreserved) and store sperm that is found at the time of retrieval. Dr. Bastuba is the medical director of the Fertility Center of California and has developed special techniques for all of these functions.

Dr. Bastuba, founder of Male Fertility & Sexual Medicine Specialists and Fertility Center of California is renowned for using first-rate medical technology and state-of-the-art techniques in order to fulfill the dreams of patients who wish to have a family. Contact the Male Fertility Specialists for a consultation to discuss your concerns at 619-286-3520.