Is azoospermia treatable in 2024? Google’s top questions, covered

Azoospermia – the absence of sperm in semen – affects approximately: 

• 1 per cent of all men, and
• around 10 per cent of those struggling with infertility

But, is azoospermia treatable? While a diagnosis can be overwhelming – particularly if it comes out of the blue – solutions and pathways forward do exist, and there are many conversations to be had with your team. 

To demystify this topic, we’re welcoming back (by popular demand – catch his brilliant male infertility questions round-up from last year) Dr. Ishola Agbaje, PhD, MRCOG. Based with nationwide clinic network TFP Fertility at their Belfast location, Dr. Agbaje is a consultant gynaecologist and subspecialist in reproductive medicine and surgery. 

He brings deep expertise in male and female infertility, reproductive endocrinology, and advanced fertility treatments – we’ve covered everything from sperm abnormalities and sexual dysfunction to underlying health problems previously, so add those to your reading list before diving in.

Understanding azoospermia: Insights from Dr. Ishola Agbaje

TFP Fertility combines cutting-edge diagnostics with compassionate support, making them a trusted TRB partner in addressing complex issues, like azoospermia. 

It’s a topic close to our foundations – CEO Eloise Edington’s husband was diagnosed with azoospermia at the very start of their own treatment journey – and one we’re keen to support you with. Do DM us with any questions that pop up, as you read. 

Today, Dr. Agbaje unpacks the many facets of azoospermia, from understanding its causes and diagnosis through state-of-the-art techniques to exploring treatment options – like hormonal therapies, surgical sperm retrieval, and the role of advanced IVF methods like Intracytoplasmic Sperm Injection (ICSI).  

Covering Google’s top azoospermia questions one by one, let’s hand over to Dr. Agbaje and TFP Fertility.

What is azoospermia?

I’ll keep this pretty simple, as we get into quite a lot of detail further in! Azoospermia is defined as the absence of sperm in a man’s semen. (By the way, if you’re looking for definitions – our 50 fertility terms glossary might be useful to have on hand, while you’re navigating).

How common is azoospermia?

Now in 2024, we see that azoospermia occurs in approximately 1 per cent of all men but around 10-15 per cent of infertile men.

How do you know if you have azoospermia?

To diagnose azoospermia, we need to examine a semen sample under a microscope. If we can’t see any sperm, the laboratory scientist will ensure even very small numbers of sperm aren’t present by spinning the sample at high speed in a centrifuge. This will ‘concentrate’ any sperm present into a pellet, which we then look at again, under a microscope. 

As you can see, it’s quite the process. So, you really can’t tell if you have azoospermia without having your semen sample tested. 

However, some men will describe their semen as looking ‘watery’ or may have factors that put them at risk. These can include anabolic steroid use, undescended testis as a child or mumps as an adult, which can affect the testicles.

Can azoospermia be temporary?

Yes – sperm counts can vary dramatically in all men, between samples. 

And, azoospermia can be temporary secondary to an illness such as a recent flu or other virus. In addition, men taking some gym supplements or anabolic steroids can cause azoospermia which will often reverse when these are stopped. 

There are also some reversible medical causes of azoospermia, such as when the normal signals to produce sperm from the pituitary gland in the brain are lacking. These can be easily treated by replacing these hormones.

Can low testosterone cause azoospermia?

This is a common question for me in clinic, because testosterone is required for sperm production. Low levels of testosterone are associated with azoospermia, but not a direct cause. 

Men with azoospermia often have lower levels of testosterone, either because of problems with: 

• the testis (with the production of sperm and testosterone), or 
• the hormones from the pituitary gland in the brain, that stimulate both sperm and testosterone production.

Can obesity cause azoospermia?

Severe obesity – a body mass index (BMI) over 40 kg/m2 – has been associated with azoospermia or more commonly a reduction in sperm count (oligozoospermia). 

This is thought to be due to a combination of factors, including: 

• increased levels of the female hormone oestrogen
• a direct effect on the cells that help produce sperm 
• an increase in testicular temperature.

Can stress cause azoospermia?

Psychological stress or physical stress (e.g during or after severe illness) are rarer causes of azoospermia. These types of stress can alter the signals from your pituitary gland – our pituitary stimulates sperm production in the testis, so the signals being ‘off’ can potentially reduce sperm production.

Can varicocele cause azoospermia?

Varicoceles have been associated with impaired semen parameters and azoospermia – we estimate this may affect 4-14 per cent of men with infertility. The first reported pregnancy after repair of a varicocele was in 1952 – but even now in 2024, optimal management of varicoceles is still controversial.

Is azoospermia treatable?

Yes, in some cases. But there’s quite a bit to it, so let’s unpack.

Some causes of azoospermia are reversible – for example, by stopping anabolic steroid use – in which case, you may be able to conceive naturally after a period of recovery. 

Occasionally, men who have deficiencies in the hormones responsible for sperm production can have these replaced. After some time, sperm production resumes and you can try to conceive naturally.

Your sperm count does not have to be ‘normal’ to achieve a pregnancy, especially if your partner is healthy. For some men, sperm can be retrieved surgically from the reservoir on the testicle that stores sperm (epididymis) or from the testicles themselves by undertaking a biopsy. This sperm can then be stored and used in a type of IVF treatment called ICSI.

Can azoospermia be cured? Or reversed?

Some causes of azoospermia are reversible – as we’ve covered, you can stop something like anabolic steroid use, and possibly go on to conceive naturally after a recovery period.

Occasionally, men who have deficiencies in the hormones responsible for sperm production can have these replaced – after some time, sperm production can resume and a natural pregnancy can occur. 

For some men, sperm can be retrieved surgically from the reservoir on the testes that stores sperm (the epididymis) – this is known as a Percutaneous Epididymal Sperm Aspiration (PESA). In others, we might try retrieval from the testicles themselves by undertaking a biopsy – this is called a Testicular Sperm Extraction (TESE). 

This sperm can then be stored and used in a type of IVF treatment called ICSI.

Does azoospermia cause erectile dysfunction?

Azoospermia is not a cause of erectile dysfunction. 

However, it can be associated with erectile difficulties – this is because men with some forms of azoospermia do have lower testosterone levels. Normal testosterone levels are important in driving a man’s libido and sexual function, and if the levels of testosterone are low, erectile difficulties can be a problem. 

Similarly, erectile dysfunction is not a cause of azoospermia. Instead, it’s more likely that men who have erectile difficulties will find it more difficult to become aroused and ejaculate, so may not produce semen, even with the sensation of orgasm. 

This is called ‘anejaculation’, and doesn’t mean no sperm are present.

Can azoospermia cause cancer?

Azoospermia does not cause cancer. However, men who have some forms of azoospermia may be at an increased risk of testicular and some other cancers. 

Although the risk of developing cancer in men with azoospermia may be up to three times higher, the absolute risk remains low. Nevertheless, it is important for men with male factor infertility to examine themselves regularly, and report any concerns.

Are there any natural therapies I can use?

There aren’t any natural remedies or treatments for azoospermia. 

In contrast, it’s actually important to avoid certain natural treatments or supplements which may increase or boost testosterone – this may make things worse or delay a recovery in some cases. 

My top tip for forming an action plan is booking in with a fertility specialist for a comprehensive evaluation. They’ll take a history, perform an examination and organise blood tests and scans if required. 

Azoospermia doesn’t mean the end of the road, in many cases – the key thing is getting an accurate diagnosis and working with a specialist on a treatment path built just for you, to get your goals for fertility underway. 

Connect with the team at TFP Fertility to get started – we regularly support men navigating azoospermia, and are ready to help you put a plan in place. 

Up next on your reading list: Sperm test results explained, and what to do next.