What causes a man to have no sperm in his semen?

low sperm

It is perhaps more common than many would think, but around 1% of all men and 15% of infertile men have a condition known as azoospermia, meaning that they have no sperm in their semen. It is a condition that doesn’t really display any symptoms and one that most men wouldn’t even think about. However, if you and your partner have been trying to conceive for some time without success, this could be the cause.

If you are concerned that it is the male partner that has fertility issues, the first thing that you should do is have a male fertility check at a reputable clinic. There are many possible causes of fertility issues, including azoospermia, and after the doctors have conducted a series of tests, they will be able to give you an accurate diagnosis. If for this article, we assume that the problem is that the male has no sperm in their semen. Here is some more information that will help you to understand the condition a little more.

What causes azoospermia?

There are three main types of azoospermia, ranging from the testes not making sperm to problems with sperm leaving the body via ejaculation. It is essential that you understand these different causes but also equally important that you don’t become too worked up about them as stress too can have an impact on sperm production. The main types and causes of the condition are:

  • Pre-Testicular Azoospermia– this is when the testes have developed normally in puberty, but they are not producing any sperm. It is quite rare but can be caused by a variety of factors including hormone imbalances, often low male hormones, or more commonly, after the patient has undergone a course of chemotherapy. It is vital to stress that just because you have undergone chemo, it doesn’t mean that you will automatically be infertile.
  • Testicular Azoospermia– this is when the testicles are damaged after puberty, and this damage prevents them from making sperm or making sufficient sperm. There are several causes for this, including:
    • Infections such as epididymitis or urethritis can cause damage to the reproductive tract as too can sexually transmitted infections (STIs) such as gonorrhoea. It some cases this damage can be reversed while in others, it may have caused permanent damage
    • Childhood illnesses such as mumps or viral orchitis, which is known to cause swelling in one or both testicles can cause permanent damage
    • Certain cancer treatments that involve the use of radiation can result in lower or no sperm production
    • Any injuries to the groin region, such as from sport or a car accident can also impact on sperm production
    • There are a number of potential genetic conditions, including Klinefelter’s syndrome that are known to causes problems. Conditions such as this can usually be identified from a simple blood test
  • Post-Testicular Azoospermia– this is perhaps the most common reason why men have no sperm in their semen and indeed accounts for around 40% of men who have the condition. Post-testicular azoospermia is when the testes produce sperm normally, but something is restricting the sperm from leaving the body through ejaculation. There are several possible reasons for this, including:
    • Some form of blockage in the tubes that carry sperm from the testes to the penis. It could be swelling, physical damage or a lump amongst many other potential factors. This is called obstructive azoospermia, and your doctor will be able to explain the condition in greater detail if this is the cause of your problem.
    • A vasectomy – many men decide that they no longer wish to father children and as such, opt to have a vasectomy which involves deliberately sealing the tubes from the testes to the penis. Thanks to modern medicine, vasectomies can now be reversed.
    • Retrograde ejaculation is when, at the point of orgasm, semen enters the bladder rather than being ejaculated via the penis.

How is azoospermia diagnosed?

If you and your partner are having concerns regarding fertility, you must speak to your doctor. They will ask you a series of questions and conduct a few tests in the clinic. However, in most cases, they will refer you to a fertility clinic that will have the specialist equipment and knowledge to give you a more accurate diagnosis.

At the clinic, the doctor will ask you to produce a sample of semen; this is usually done during your appointment to maintain quality. The semen will be examined under a high-powered microscope to establish the presence of sperm. If the first test proves negative, you will be asked to come back in a few days and give a second sample. If both samples show that there is no sperm present in the semen, it is almost certain that you will have azoospermia. You must avoid ejaculation for at least 24-hour prior to giving the samples.

After diagnosis, the doctor will try to establish the cause. This will involve a full physical examination as well as providing blood samples. Your doctor will also ask you about your medical history and your lifestyle. If nothing transpires from the blood tests, such as hormone abnormalities, your doctor will probably recommend scrotal and transrectal ultrasounds to try and identify any obstruction. Should an obstruction be found, an MRI scan will likely be ordered to confirm the diagnosis. If an obstruction is suspected but not identified, surgery may be required.

Finally, if there is nothing conclusive, your doctor will recommend genetic testing to establish if the problem could have been inherited through your genes.

Treatments and Future Fertility

Even if you have been diagnosed with azoospermia, there are a range of treatments available that can help men father children. If you have an obstruction, it could be treated with antibiotics or alternatively, surgery.

For men suffering from non-obstructive azoospermia as well as those who don’t wish to undergo surgery, the clinic may recommend sperm retrieval. It is a relatively straightforward and painless process whereby a fine needle is inserted into a testicle (under local anaesthetic), and sperm is drawn out. The sperm can then be used for IVF or frozen for use at a later date. Sperm can also be retrieved during a testicular biopsy meaning that there is no need to undergo a second procedure.

More Information

If you would like more information about males having no sperm in their semen or indeed any other fertility issue, you can contact us. Our team will be happy to listen and offer any help and advice they can.

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