Testicular & Scrotal Conditions & Male Infertility
Azoospermia
Azoospermia is the complete absence of sperm in a man’s semen. Whether caused by a blockage or a production issue.
Key Takeaways
- Azoospermia is the complete absence of sperm in a man’s semen. Whether caused by a blockage or a production issue.
- We offer specialist diagnostics and treatments. Book a consultation to discuss your options.
Clinical Overview
Understanding Azoospermia
Azoospermia is diagnosed when a man has no detectable sperm in his ejaculate. In the UK, this is usually confirmed after at least two separate semen analyses to ensure the result is accurate. While it sounds daunting, it affects about 1 in 100 men generally, and up to 15% of men who are already seeing a specialist because they are struggling to conceive.
Doctors generally divide the condition into two main types. Obstructive Azoospermia (OA) is like a "plumbing" problem: your body is making healthy sperm, but they are blocked from leaving the body by a physical barrier or missing tube. Non-Obstructive Azoospermia (NOA) is more of a "factory" issue: the testicles aren't producing enough sperm (or any at all) due to genetic abnormalities, or past illnesses. However often we wont know the cause.
A diagnosis of "zero sperm" is no longer a definitive end to your journey toward fatherhood. Advances in micro-surgical sperm retrieval (mTESE) and reconstructive surgery mean that many men—even those with very low production or complete blockages—can still father their own biological children through assisted treatments like IVF and ICSI.
What to Look For
Symptoms, Causes & Risk Factors
01
Common Symptoms
Inability to conceive: Being unable to start a pregnancy after a year of regular, unprotected sex.
Normal ejaculation: You may not notice any difference in your semen, as sperm only make up a tiny fraction of the fluid.
Low sex drive: Reduced libido or difficulty with erections (if the cause is hormonal).
Testicular changes: Testicles that feel small or firm (common in non-obstructive cases).
Scrotal discomfort: Swelling or a "heavy" dragging sensation in the scrotum. This may be indicative of a varicocoele or dilated veins around the testicle.
No symptoms at all: For many men, the condition is "silent" and only discovered during fertility testing.
02
When to Seek Help
A "zero" test result: If a semen analysis shows no sperm, you should be referred to a male fertility specialist (Urologist) immediately.
One year of trying: If you and your partner haven't conceived after 12 months of regular sex.
Surgical history: If you had surgery (as a child) for undescended testicles or testicular torsion.
Previous surgeries: If you have had hernia repairs, vasectomies, or scrotal surgery in the past.
Past illnesses: A history of mumps (especially after puberty) or cancer treatments like chemotherapy.
03
Potential Causes
Blockages (OA): Caused by past infections, injuries, or surgeries that have scarred the tubes.
CBAVD (Congenital bilateral absence of the vas): A condition where the tubes that carry sperm (vas deferens) are missing from birth (often linked Cystic Fibrosis gene abnormalities).
Hormonal issues: The brain not sending the right signals to the testicles to start sperm production.
Genetic factors: Conditions like Klinefelter Syndrome or Y-chromosome microdeletions.
Testicular damage: From childhood mumps, undescended testicles, or cancer treatments.
Retrograde ejaculation: Where semen travels into the bladder instead of out of the penis.
Previous Vasectomy: The most common intentional cause of obstructive azoospermia.
Surgical history: If you had surgery (as a child) for undescended testicles or testicular torsion.
04
Risk Factors
History of STIs: Untreated infections can lead to scarring and "plumbing" blockages.
Genetic mutations: Being a carrier of certain genes, such as those for Cystic Fibrosis.
Steroid use: Anabolic steroids can shut down sperm production entirely—sometimes permanently.
Cancer treatments: Having had chemotherapy or pelvic radiation.
Importance of Diagnosis
Why Early Diagnosis Matters
Working out exactly why there is no sperm is the most important step. If the problem is "obstructive" (a blockage), the sperm being produced are usually very healthy and can often be retrieved easily or the blockage bypassed. If it is "non-obstructive," you may still be able to have surgery to try and find sperm, but this is a more detailed operation called microTESE.
Azoospermia can also tell us important things about your general health. Genetic tests might uncover conditions like Klinefelter Syndrome or hormonal tests a low testosterone level (hypogonadism), which you may not have known you had. Finding this out is helpful because it can affect other things like your bone density and metabolism. By managing these alongside your fertility, we can protect your long-term health as well.
Importance of Diagnosis
Diagnostic Options & Investigations
To accurately identify the cause of your symptoms, our specialists use a range of targeted investigations. Explore the diagnostic tests below to understand how we confirm a diagnosis and plan your recovery.
Living With Condition
Living With Azoospermia
- Microsurgical Sperm Retrieval (mTESE)
- Percutaneous Epididymal Sperm Aspiration (PESA)
- Vasoepididymostomy (Bypass surgery)
- Hormonal Optimization therapy
- Genetic Counseling
If you are living with azoospermia, focusing on your overall health is a great first step. Eat healthily, lose weight if you are overweight, exercise, and avoid any heat trauma to the testes (such as saunas, steam rooms, hot tubs and hot baths). The emotional side of this diagnosis is huge. Many men feel quite isolated when they first hear the news. There are fantastic support networks and fertility counsellors who specialise in this area. They can help you navigate the "what ifs," including the possibility of surgical retrieval or the option of using donor sperm if retrieval isn't successful.
For men with non-obstructive azoospermia, there is often an option to have surgery to try and retrieve sperm. It is possible to find sperm in approximately 40% of patients, and these sperm are then used for IVF with ICSI.
For men with the "obstructive" type, surgery to bypass the blockage (like a vasovasostomy) can sometimes restore your fertility naturally. For others, "living" with the condition means preparing for an IVF journey. It’s important to remember that with modern ICSI technology, it only takes one healthy, surgically retrieved sperm to create a successful pregnancy.
Short-Term Complications
03- Emotional impact: Feelings of shock, distress, or a blow to your sense of "masculinity."
- Relationship stress: The pressure and emotional toll of going through intensive fertility investigations.
- Need for surgery: The requirement for surgical procedures to check for sperm production, and retrieve sperm for treatment if some is present.
Long-Term Complications
03- The possibility that there are no sperm which can be retrieved and that you will not be a biological father
- Low testosterone: An increased risk of low mood, libido and energy levels, as well as thin bones (osteoporosis) if the condition is linked to low testosterone.
- Metabolic health: A higher risk of weight gain or diabetes in certain genetic types of azoospermia.
Treatment Options
Treatment Options & Care Pathways
Explore the specialist interventions available for Azoospermia. We offer a range of evidence-based treatments designed to address your specific symptoms, focusing on long-term recovery and your personal health goals.
Specialists
Our specialists for Azoospermia
Leading experts for this condition. View profiles to see clinical backgrounds and current availability.
Our Commitment
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Patient Guidance
Frequently Asked Questions
Common questions about specialist referrals and consultations.
3 questions
Think of Obstructive Azoospermia (OA) as a 'plumbing' problem—sperm are being made, but the pipes are blocked. Non-Obstructive Azoospermia (NOA) is a 'factory' problem—the testicles are having trouble producing sperm in the first place. OA usually has a very high success rate for sperm retrieval, while NOA requires more specialized microsurgery (mTESE).
Reviewed 2 Mar 2026
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In many cases, yes. Even in men with severe production issues, there are often 'micro-islands' of sperm production that don't make it into the ejaculate. Using a high-powered surgical microscope (mTESE), we can identify these tiny areas and retrieve enough sperm to perform IVF with ICSI.
Reviewed 2 Mar 2026
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It depends on the cause. If it is caused by anabolic steroids or a hormone imbalance, it is often reversible with medication. If it is caused by a blockage, it can be bypassed surgically. If it is genetic or due to previous chemotherapy, it may be permanent, but surgical retrieval still offers a chance for biological children.
Reviewed 2 Mar 2026
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