Infertility is often viewed as a women’s health issue, but nearly half of all infertility cases involve male factors. Among these, azoospermia, the complete absence of sperm in a man’s ejaculate, is one of the most serious yet treatable causes of male infertility.  Let’s understand what azoospermia is, the causes behind it, signs that may indicate its presence, and the diagnostic steps needed to identify the underlying problem.

Causes of azoospermia

Here are some causes of azoospermia:

Pre-testicular causes

It involves hormonal or endocrine disorders that interfere with the brain’s control of sperm production. It commonly happens due to low levels of FSH or LH hormone, hypogonadotropic hypogonadism, pituitary gland dysfunction or tumours.

Testicular causes

These are intrinsic problems in the testes themselves that prevent sperm production.

Common factors include genetic defects, mumps infection after puberty, testicular torsion or injury. Damage from radiation, toxins, or chemotherapy is also a reason.

Post-testicular causes

In this case, sperm are produced but cannot be adequately transported due to blockage or ejaculatory duct issues. It is caused due to congenital absence of the vas deferens, scarring after surgery or infection or ejaculatory duct obstruction.

Symptoms of azoospermia

Most men discover the condition only after undergoing a semen analysis as part of infertility testing. However, sure signs may indicate an underlying reproductive or hormonal problem:

• Low semen volume or watery ejaculation.
• Sexual difficulties such as low libido or erectile dysfunction.
• Pain, swelling, or lumps in the testicles.
• Decreased facial or body hair
• Small or soft testicles.

If you and your partner have been trying to conceive for more than a year without success, consulting a fertility specialist is the best step forward.

How is azoospermia diagnosed?

Diagnosis begins with a detailed medical history, physical examination, and semen analysis:

Semen analysis

Two or more semen samples are examined under a microscope. If no sperm are detected, the samples are centrifuged to check for sperm in the sediment. Persistent absence confirms azoospermia.

Hormonal evaluation

Blood tests measure levels of key reproductive hormones. Elevated FSH and LH levels suggest testicular failure, and low levels may indicate hypothalamic or pituitary dysfunction.

Scrotal ultrasound

Ultrasound imaging helps detect blockages, testicular abnormalities, or varicoceles that may be affecting sperm production or transport.

Treatment Options After Diagnosis

Treatment depends on the root cause of azoospermia:

• Hormonal therapy for endocrine-related cases.
• Surgical repair or sperm retrieval is recommended for obstructive cases.
• IVF with ICSI using retrieved sperm or donor sperm for conception.
• And if you are wondering how to increase sperm motility, you can begin with lifestyle modifications. Start by maintaining a healthy weight, avoiding heat exposure, quitting smoking, and reducing alcohol intake.

Conclusion

Azoospermia may sound daunting, but it is important to remember that many men with zero sperm count can still become biological fathers with the help of modern fertility treatments. Early diagnosis, accurate identification of the underlying cause, and timely medical intervention are key to improving outcomes.