It occurs in 5% of infertile men. If this is the case, then one or both of two conditions may be present:
• There is a problem with sperm production.
• There is a blockage such that sperm production, although normal, cannot reach the ejaculate
A thorough review of medical problems, exposures, past surgery, medications, and family history is undertaken to help define causes of azoospermia. Then, a brief, well-performed physical examination is performed. Blood tests are taken that include testosterone and follicle stimulating hormone (FSH). Two semen samples are analysed and a standard semen analysis is performed. If no sperm are found, then the semen sample undergoes an additional evaluation in which the sample is “spun” down in a centrifuge to concentrate small numbers of sperm at the bottom of the tube. This “pellet” of the ejaculate is then examined thoroughly for sperm by an experienced lab technician. If 10 sperm or even 1 sperm is present in the pellet analysis, then conditions such as reproductive tract obstruction are disproved. Again, the value of finding even a small number of sperm in the pellet analysis is very significant because:
1 It means that complete obstruction is unlikely
2 And men may have the option of using ejaculated sperm for conception with assisted reproduction and may be able to avoid sperm retrieval procedures for this purpose.
If, based on the above evaluation, it is not entirely clear as to whether there is a problem with sperm production or one of a blockage in the ducts of the reproductive tract, then the next step is to examine the testis itself and assess sperm production. Classic approach is to perform a testis biopsy under local anesthesia.
If sperm are not found in the ejaculate, then there is either obstruction or blockage in the reproductive tract or sperm is not being made at levels sufficient to get into the ejaculate. A blockage can be due to prior infection, surgery, prostatic cysts, injury or congenital absence of the vas deferens (CAVD). Except for cases of congenital absence, most cases are of obstruction are repairable with microsurgical or endoscopic reconstruction.
In cases of azoospermia that is not due to blockage, termed nonobstructive azoospermia, medical treatment can help some men develop ejaculated sperm (i.e. those with reversible conditions such as Kallman syndrome, hyperprolactinemia; varicocele); in most instances however, the only hope for building a biological family is to use sperm retrieved from the testis with assisted reproduction. One of the most difficult aspects of nonobstructive azoospermia is that only 50%-60% of men will have usable testicular sperm.
Ideally azoospermic men should undergo a thorough evaluation and be clear on their methods and chances of having their own genetic child.