Azoospermia: No Sperm Doesn’t Mean No Chance of Fatherhood

Azoospermia, the complete absence of sperm in the ejaculate, is a significant yet often misunderstood cause of male infertility. It accounts for approximately 10% of all cases of male-factor infertility, but a diagnosis of azoospermia doesn’t necessarily mean the end of the road for fatherhood.

In this blog, Dr. Hossam Elzeiny, Victorian Medical Director at City Fertility and leading expert in male infertility, explains azoospermia, the causes and treatments.

Understanding Azoospermia

Azoospermia may be present from birth or may develop later in adolescence or adulthood due to a variety of medical or environmental factors. In many cases, men only discover they have azoospermia when they begin investigating difficulties in conceiving a child.

It’s important to note that azoospermia cannot be detected by simply looking at the semen—a semen analysis performed in a specialised laboratory is required to assess sperm count and quality. At City Fertility, all male patients undergo fertility testing as a routine part of their assessment to determine the most suitable treatment options.

Types of Azoospermia

Azoospermia is classified into three main categories, each with different causes and treatment implications:

1. Obstructive (Post-testicular) Azoospermia – Approximately 40%
   This occurs when there is a blockage in the reproductive tract that prevents sperm from being ejaculated. The testicles may be producing sperm normally, but it is not able to reach the ejaculate.
2. Non-Obstructive (Testicular) Azoospermia – Approximately 60%
   In this case, the problem lies in the testicles themselves. Sperm production is impaired due to congenital conditions, previous infections, cancer treatment, or other testicular dysfunction.
3. Pre-testicular Azoospermia – Less common
   This form is due to hormonal deficiencies or imbalances that prevent the testicles from receiving the hormonal signals necessary for sperm production.

Diagnosis and Genetic Assessment

Dr. Hossam Elzeiny, emphasises the importance of comprehensive evaluation in cases of azoospermia by a fertility specialist. “A detailed semen analysis and hormone profile are just the start,” says Dr. Elzeiny. “In many cases, we recommend genetic testing and counselling, which are crucial for identifying any underlying chromosomal or Y-chromosome microdeletion abnormalities that may contribute to the condition.”

Treatment Options for Azoospermia

Treatment depends on the underlying causes of azoospermia and whether the azoospermia is obstructive or non-obstructive.

1. Surgical Sperm Retrieval – TESA & MicroTESE

• Microsurgical procedures can correct certain blockages or repair ducts to allow sperm to pass through normally.
• TESA and MicroTESE are both forms of testicular biopsy procedure. In cases of obstructive azoospermia which cannot be surgically corrected, fine needle aspiration (TESA) is all that is required. However, cases of non-obstructive azoospermia require more advanced techniques such as microsurgical testicular sperm extraction (MicroTESE) in which sperm retrieval can be achieved directly from the testicular tissue. These procedures are performed under anaesthesia.

2. Hormonal Therapy

• For cases caused by hormonal imbalances, prescription hormone therapy can stimulate sperm production.

3. Assisted Reproductive Technologies (ART)

• Retrieved sperm—even in very small numbers—can be used with ICSI (Intracytoplasmic Sperm Injection), where a single sperm is directly injected into an egg to achieve fertilisation.

There is Hope

While a diagnosis of azoospermia can be emotionally distressing, medical advances now offer hope to many men previously thought to be infertile. With the right diagnosis, personalised treatment plan, and support from a specialist fertility team, fatherhood remains a realistic possibility.

From no Sperm to Twins – an Azoospermia Case Study

Dave Jamieson said he always knew he wanted to be a dad. He was great with kids and his wife Lindsey was all in.

The last thing the pair expected on their path to parenthood was to be told that Dave had Azoospermia, meaning (in his case) he didn’t produce sperm and there was a high chance he’d never father his biological children.

According to the Townsville couple, as devastating as the news was, it was the insensitive delivery of the diagnosis that left Dave devoid of hope, sending him into a deep depression.

While he tried to come to terms with his new normal and what that meant for the pair, Lindsey went into research mode, educating herself furiously. She discovered that 30 per cent of infertility cases are due to a male factor and there were options.

After a period of ‘healing’ time and an assessment of all the ways they could realise their dreams of a family, the pair focussed on their health and sought advice everywhere and anywhere they could.

Finally, Lindsey learned about Dr Hossam Elzeiny and his male-factor infertility expertise through a social media support group.

Dr Elzeiny said: “Lindsey and David Jamieson’s fertility journey was marked by complex challenges. After six years of trying to conceive, they came to me in the hope of finding a path to parenthood, despite facing difficult odds.”

The pair flew to Melbourne and Dave underwent a procedure called MicroTESE, a surgical procedure that retrieves sperm from the testicles of men who don’t produce sperm – this is the best technique for men whose azoospermia is not obstructive azoospermia.

Using Dave’s newly harvested sperm, the team created five embryos. Dave and Lindsey’s twin girls, Annabelle and Abigail, are almost two years old now, and they’re inseparable.

If you’re struggling with male infertility, please don’t hesitate to reach out to Dr Hossam Elzeiny (City Fertility Victoria) by calling 1300 354 354, or you can reach out support team by calling 1300 354 354, or emailing contactus@cityfertility.com.au