Overview

Azoospermia is the complete absence of sperm in the ejaculate on at least two separate analyses. It affects ~1% of all men and 10–15% of infertile men. In the GCC, rates may reach 6% in some populations, partly due to consanguinity. Crucially, azoospermia does not always mean no biological child — in many cases sperm can be surgically retrieved.

Types

• Obstructive (OA) — sperm produced normally but blocked from ejaculate; causes include vasectomy, prior infections, CBAVD
• Non-obstructive (NOA) — testicles produce little or no sperm; causes include genetic conditions, hormonal failure, prior cancer treatment

Causes & Risk Factors

• Klinefelter syndrome (47,XXY) — most common genetic cause
• Y-chromosome microdeletions (AZF regions)
• CBAVD — congenital absence of vas deferens (CFTR gene mutations)
• Vasectomy — most common cause of obstructive azoospermia
• Prior infections — mumps orchitis, epididymo-orchitis
• Anabolic steroids — shut down sperm production
• Chemotherapy or radiotherapy

Diagnosis

• Two centrifuged semen analyses to confirm true azoospermia
• Hormone profile — FSH, LH, testosterone
• Scrotal ultrasound
• Karyotype and Y-chromosome microdeletion testing
• Testicular biopsy — to guide sperm retrieval planning

Treatment

• PESA — percutaneous epididymal sperm aspiration (obstructive)
• TESA — testicular sperm aspiration
• Micro-TESE — gold standard for NOA; highest success rates
• Vasectomy reversal — vasovasostomy; best within 10 years
• Gonadotropin therapy — for hypogonadotropic hypogonadism
• All surgical sperm retrieval combined with ICSI

Diagnosed with azoospermia? Book a consultation today