When there’s no sperm in a man’s semen, it’s usually one of two things: an obstructure or non-obstructive azoospermia. Obstructive means your sperm is fine, but something’s blocking it from getting out. Non-obstructive means your pipes are clear, but something’s preventing the sperm from being created in the first place. Non-obstructive cases are more difficult to treat.

How it’s tested

A simple test of your sperm count and testosterone levels will help us diagnose you.

If you have obstructive azoospermia, that means the “vas” (the tube connecting your testes to the outside world) is either blocked or not there at all. In other words, the road your sperm must travel down is either missing, or has had a “traffic jam”.

If a man’s vas is blocked, usually he isn’t surprised. That’s because he probably did it on purpose, by having a vasectomy for birth control. However, an obstruction can also be caused unintentionally by previous unrelated surgeries and infections.

If a man’s vas isn’t there at all, it’s called “congenital bilateral absence of the vas deferens”. That’s a condition associated with male carriers of cystic fibrosis.

In both cases, you’ll usually have normal-sized testes and normal testosterone levels. Your sperm is in there, but it can’t get out – so it’s really just a mechanical problem.

Non-obstructive azoospermia is more serious. It means your passageways are open, but there’s still no sperm in your semen. Since the sperm’s path isn’t blocked by anything, their absence suggests that your body is having a significant problem developing your sperm. Some men with this condition have smaller-sized testes and low testosterone levels.

How it’s treated

If you have obstructive azoospermia, there are two types of treatments: repairing the vas, or manually collecting sperm to use in IVF.

Repairing your vas

After a vasectomy, this is simply called a “vasectomy reversal”. It can be a highly successful operation, but the healing can take up to a year. (Don’t worry: physically you’ll feel fine pretty quickly, but it can take a year for the scarring around your repaired tube to completely form.)

There can be two little complications from a vasectomy reversal. First, it’s possible for the tube to gradually “grow over” and close itself again after a reversal. If that’s the case, it’s usually perfectly fine for a period of time after the surgery, but it’s discovered to have re-closed itself a year later. Second, sometimes your sperm counts are reduced after a reversal, and may never bounce back up to maximum numbers.

So if you do have a vasectomy reversal, we routinely suggest freezing some backup samples of your sperm pretty soon after the surgery. It’s a great safety net, so you can maximize your odds of getting pregnant more quickly.

If your sperm counts are low after the operation, your doctor might also suggest intrauterine inseminations or even IVF.

When they can’t repair your vas (or you don’t have a vas)

If it’s too difficult to surgically repair your vas, you don’t have time to wait for your vas to recover, or you don’t have a vas at all – don’t lose hope. As a couple, you may want to opt for PESA.

PESA is short for “percutaneous epididymal sperm aspiration”. It means we’ll put your testicle under local freezing and extract your sperm with a needle. It’s an easy, minor procedure that usually collects hundreds, thousands, or even tens of thousands of sperm!

Sperm have a very hard time swimming into eggs when we obtain them like this, but they can be placed directly into eggs with great success through IVF and ICSI.

Treating non-obstructive azoospermia

If you don’t seem to be producing sperm at all, it’s a tougher journey to find your sperm. Surgery will be required to remove some testicular tissue. One procedure is called “mTESE”. The tissue is sent to a lab, where the technicians dissect it and try to find immature sperm.

What are the odds of finding that immature sperm? It varies hugely from patient to patient. If you have small or scarred testes, low testosterone levels and high FSH (which suggests that your testicles are really struggling), then the odds of finding sperm can be very low. At best, the odds are 50/50.

Immature sperm are totally unable to enter eggs on their own, so as a couple you’ll need to undergo IVF with ICSI.

However, some immature sperm are so young that the health of the ongoing pregnancy could be at risk. It’s important that you talk seriously with your doctor about this before committing to the treatment.


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