Azoospermia or no spermatozoa in semen – How can be managed?

Azoospermia or no spermatozoa in a man’s semen is a definite cause of infertility and this condition must be excluded before any invasive test performed in the woman partner.

This condition may be either due to
i) Testicular failure or,
ii) Obstruction in the passage particularly vas deferens

Normal sized testes with turgid epididymis and a normal serum FSH (Follicle stimulating hormone) suggest there is obstruction.

On the other hand small testes and flabby epididymis along with high FSH level usually suggest testicular failure.

Though, sometimes testicular failure may also have normal sized testes and normal FSH. Many a times these findings may be equivocal and a testicular biopsy is needed to get the final answer.


Currently, the needle method of testicular biopsy is preferred to an open biopsy. Often multiple biopsies are taken to map the testis properly. This helps identifying a sub-group of men with testicular failure who have focal spermatogenesis; in these men sperm can be retrieved from the testis and used for ICSI.
Men with obstructive azoospermia can be treated by microsurgical reconstruction to relieve the obstruction, or by sperm aspiration and Intra Cytoplasmic Sperm Injection ( ICSI).

The choice of procedure will depend on the wife's age and the expertise available.

This article is also published in India study Channel