Azoospermia (No Sperm in the Semen)

Azoospermia means no sperm are found in the ejaculate on at least two properly examined semen samples. It affects about one in a hundred men and around one in ten of those investigated for infertility.

There are two kinds. In obstructive azoospermia sperm are made normally but cannot get out. In non-obstructive azoospermia the testicles make very few or none. The distinction decides both the treatment and the honest chance of finding sperm.

Symptome

• Inability to conceive, usually the only sign
• Normal erections, ejaculation and semen appearance in most men
• Small or soft testicles in non-obstructive cases
• Low sex drive, reduced beard growth or breast tissue if testosterone is low
• A history of undescended testicles, mumps, groin surgery, chemotherapy or vasectomy

Ursachen und Risikofaktoren

Obstructive causes include vasectomy, previous infection, hernia or scrotal surgery, and congenital absence of the vas deferens, which is linked to cystic fibrosis gene variants. Non-obstructive causes include Klinefelter syndrome (47,XXY), microdeletions of the Y chromosome, undescended testicles, chemotherapy or radiotherapy, and testosterone or anabolic steroid use, which switches off sperm production and is often reversible. Pituitary hormone deficiency is a rare but treatable cause. In many men no cause is found.

Wie es diagnostiziert wird

• Repeat semen analysis with centrifugation: Confirms that there truly are no sperm, and measures volume and pH, which hint at obstruction.
• Hormone tests: FSH, LH, testosterone and prolactin. A high FSH with small testicles suggests a production problem.
• Genetic tests: Karyotype, Y chromosome microdeletion analysis and, where the vas is absent, CFTR testing. Some deletions predict that no sperm will be found.
• Examination and scrotal ultrasound: Assess testicular size, the vas and any varicocele.

Behandlungsmöglichkeiten

• Stopping testosterone or steroids: Sperm production often returns within 6 to 12 months.
• Hormone treatment: Gonadotrophin injections for men with pituitary deficiency can restore sperm in the ejaculate.
• Surgical reconstruction: Vasectomy reversal or bypass of an epididymal blockage in selected men.
• PESA or TESA: Needle retrieval of sperm for obstructive cases, used with ICSI.
• Micro-TESE: Microsurgical search of the testicle for small islands of sperm production in non-obstructive cases. Sperm are found in roughly 40 to 60 per cent, depending on the cause.
• Donor sperm or adoption: Options when no sperm can be retrieved. Donor sperm treatment is not legal in Türkiye.

Wenn es dringend ist

Azoospermia itself is never an emergency. A new lump in a testicle, or sudden severe testicular pain, needs prompt local assessment. After a retrieval procedure, increasing swelling, fever or spreading redness should be checked the same day.

Reisen nach Türkiye zur Behandlung

This is a common and sensible reason to travel, because micro-TESE and ICSI can be coordinated in one visit of around two to three weeks, or sperm can be retrieved and frozen on a shorter trip. Complete the hormone and genetic tests at home first, since some results mean retrieval should not be attempted. Turkish law allows treatment only for married couples using their own eggs and sperm, so donor options must be sought elsewhere.

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