Azoospermia: Can We Get Sperm Even If the Count Is Zero?

By Dr. Shilpi Khare — Fertility, IVF & Women’s Health Specialist

Azoospermia — the complete absence of sperm in the semen — can be worrying for couples, but it is important to know that zero sperm count does NOT mean zero chances of fatherhood. With advanced reproductive techniques, many men with azoospermia can still become biological fathers.

What Is Azoospermia?

Azoospermia means that no sperm are detected in the semen even after detailed microscopic examination. It may be due to:

1. Obstructive Azoospermia (OA)

Sperm are produced normally but cannot reach the semen due to a physical blockage. Causes include:

• Vasectomy

• Infections

• Ejaculatory duct obstruction

• Absence of vas deferens Good news: Sperm retrieval success is very high.

2. Non-Obstructive Azoospermia (NOA)

Sperm production in the testes is very low or absent. Causes include:

• Hormonal imbalance

• Genetic abnormalities

• Testicular failure

• Chemotherapy or radiation

• Undescended testesEven in NOA, small pockets of sperm often exist.

How Do We Diagnose Azoospermia?

To find the underlying cause, I follow a structured evaluation:

✔ Semen Analysis (done 2–3 times)

Confirms azoospermia accurately.

✔ Hormonal Panel

FSH, LH, Testosterone, Prolactin.

✔ Scrotal Ultrasound

Checks for varicocele, structural issues.

✔ Genetic Testing (for very low or absent production)

Y-chromosome microdeletion, karyotype.

✔ Physical Examination

Detects absence of vas or testicular abnormalities.

This helps us understand whether sperm are being produced inside the testes.

Can We Retrieve Sperm Even If the Sperm Count Is Zero? — YES!

✔ PESA (Percutaneous Epididymal Sperm Aspiration)

Collects sperm from the epididymis — ideal for obstructive cases.

✔ TESA (Testicular Sperm Aspiration)

Extracts sperm-containing tissue through a needle.

✔ TESE (Testicular Sperm Extraction)

Takes small biopsy samples to locate sperm.

Micro-TESE — Gold Standard for NOA

Uses a surgical microscope to find tiny sperm-producing areas. Highest retrieval success in difficult cases.

✔ ICSI (Intracytoplasmic Sperm Injection)

Once sperm are retrieved, just one healthy sperm can fertilize an egg through ICSI, making biological pregnancy possible.

Is Azoospermia Treatable?

✔ Hormonal therapy for endocrine causes

✔ Surgery for ejaculatory duct obstruction

✔ Varicocele repair in selected cases

✔ Lifestyle corrections + antioxidants

✔ Sperm retrieval + ICSI for advanced cases

Treatment is always personalised based on diagnosis.

A Message From Dr. Shilpi Khare

"Azoospermia is not the end of your journey. With modern sperm retrieval techniques and ICSI, many men with zero count successfully achieve fatherhood. My aim is to guide you with clarity, compassion, and evidence-based care."