MBBS, MS (Surgery), DNB (Urology), MCh (Genito-Urinary Surgery) · 25+ years of experience
What Is Azoospermia (Zero Sperm Count)?
Azoospermia means that no sperm are found in the semen. It is seen in roughly 1 in 100 men, and in about 10 to 15 in every 100 men who are being evaluated for infertility. The diagnosis can be a shock, but it does not always mean a man cannot have his own biological child. The right treatment depends on why there are no sperm in the semen.
At Urogyn Centre in Rohini, Delhi, urologists and IVF specialists work together, so the male evaluation, sperm retrieval and fertility treatment (ICSI) can be planned as one process.
Types of Azoospermia
Obstructive Azoospermia
Sperm are being produced but are blocked from entering the semen due to obstructions in the pathways.
Non-Obstructive Azoospermia
Reduced or absent sperm production within the testes due to hormonal, genetic, or environmental factors.
| Obstructive | Non-obstructive | |
|---|---|---|
| Sperm production | Usually normal | Low or absent |
| Common causes | Past infection, previous vasectomy, injury or surgery, congenital absence of the vas deferens | Genetic conditions, hormonal problems, undescended testis, varicocele, mumps, chemotherapy or radiation |
| Typical findings | Normal testis size, normal FSH | Often small testes, FSH often raised (but not always) |
| Main treatment | Reconstructive surgery, or sperm retrieval (TESA/PESA/MESA) with ICSI | Hormonal therapy where suitable, varicocele surgery in selected men, micro-TESE with ICSI |
Causes and Symptoms
Most men with azoospermia have no symptoms other than difficulty in conceiving. Erections, ejaculation and sexual desire are usually normal, and the semen may look normal. Some men notice signs of a hormonal problem, such as low sex drive, small or soft testes, reduced facial or body hair, or tiredness.
Common causes include:
- Blockage: infection of the epididymis or genital tract, earlier vasectomy, hernia or scrotal surgery, or the vas deferens being absent from birth.
- Genetic causes: Klinefelter syndrome and Y-chromosome microdeletions.
- Hormonal causes: low LH and FSH from the pituitary gland (hypogonadotropic hypogonadism).
- Testicular causes: undescended testis, mumps orchitis, injury or torsion, chemotherapy or radiation, and varicocele.
In some men no cause is found even after complete testing.
How Azoospermia Is Diagnosed
Our aim is to find the exact cause, because that decides which treatment can work. The evaluation usually includes:
- Repeat semen analysis: at least two tests, with the sample spun down and the pellet examined under the microscope before reporting "no sperm".
- History and physical examination: testis size, vas deferens, varicocele, past infections, surgeries and medicines.
- Hormone tests: FSH, LH, testosterone and prolactin.
- Imaging: scrotal Doppler ultrasound and, when needed, transrectal ultrasound.
- Genetic tests: karyotype, Y-chromosome microdeletion and CFTR gene testing, followed by genetic counselling where indicated.
- Testicular biopsy: in selected cases, to confirm whether and where sperm are being made.
Why Finding the Cause Matters
In the past, azoospermia was often treated by moving straight to donor sperm. Today, genetic testing and microsurgical techniques make it possible to look for the husband's own sperm first.
Many couples want a child who is genetically their own, and with a careful work-up this is possible for a good number of men. Donor sperm remains an option if no sperm can be found and the couple chooses it.
Modern ART (Assisted Reproductive Technology) makes it possible for many men with zero sperm count to have a biological child.
Azoospermia Treatment Options
Treatment for obstructive azoospermia
- Vasectomy reversal (vasovasostomy) when the blockage is from a previous vasectomy.
- Vaso-epididymal anastomosis, a microsurgical bypass when the blockage is in the epididymis.
- Endoscopic treatment of blocked ejaculatory ducts in suitable cases.
- Sperm retrieval (TESA, PESA or MESA) followed by ICSI, when surgery is not suitable or has not worked.
Treatment for non-obstructive azoospermia
- Hormonal therapy for men whose problem is low pituitary hormones; sperm can return in many of these men.
- Varicocele surgery in selected men, where it may help sperm production.
- Micro-TESE to find sperm inside the testes, followed by ICSI.
- Genetic counselling so you understand the chance of success and any risk to the child.
The treatment plan is made for each couple after the evaluation. Your doctor will explain the chances of success for your particular cause.
Micro-TESE and Sperm Retrieval
In micro-TESE (microdissection testicular sperm extraction), the surgeon uses an operating microscope to find the tiny areas of the testis that are making sperm, and removes only small amounts of tissue. It is mainly used for non-obstructive azoospermia. Sperm can be found in roughly half of these men, but the chance varies widely with the cause; for some genetic causes it is very low.
The procedure is done under anaesthesia and most men go home the same day. The sperm found are used with ICSI as part of an IVF cycle, so the timing of sperm retrieval is planned together with the woman's treatment. Where needed, sperm can be frozen for later use.
Cost of Azoospermia Treatment in Delhi
The cost depends on the cause and on which treatment is needed: hormonal medicines, varicocele surgery, reconstructive surgery, sperm retrieval, and whether ICSI is required. After your evaluation, the doctor will give you a clear estimate for your case. See the consultation fee and appointment page or contact us to book.
Frequently Asked Questions
Meet Your Doctor
Dr. Ashok K. Gupta
Senior Consultant Urologist & Andrologist
Head, Department of Urology, Jaipur Golden Hospital and Maharaja Agrasen Hospital
- MBBS, MS (Surgery), DNB (Urology), MCh (Genito-Urinary Surgery)
- 25+ years of experience in male infertility and advanced andrology
- Hormonal evaluation and surgical sperm retrieval for azoospermia
- Microsurgical procedures for male reproductive health
- Works together with the IVF team for conception
Book an azoospermia evaluation in Rohini, Delhi
Bring your previous semen reports and any hormone or scan reports to the first visit.
Toll Free: 1800-843-4334 | WhatsApp Support: +91 8051101664
This page is for general information and is not a substitute for medical advice. Treatment depends on each person's tests and history.