Can a man with azoospermia father a child?
Often, yes. A result showing no sperm tells you what is happening, not why — and the reason decides which route to fatherhood is open to you.
Azoospermia means there are no sperm in the ejaculate. It does not necessarily mean there are no sperm in the testicles, and it does not automatically mean donor sperm is the only way to start a family. It affects around 1% of all men and up to 15% of men with fertility problems, and what it means for you depends almost entirely on why it has happened.
Can a man with zero sperm count get a woman pregnant?
Not through sex while his ejaculate contains no sperm, but many men with azoospermia can still father a biological child, through treatment or through sperm retrieval and ICSI.
There are three broad routes, and which are open to you depends on the cause:
- Restoring the natural route. If a blockage can be bypassed surgically, sperm can return to the ejaculate and conception can happen at home.
- Restarting production. If the cause is hormonal — a pituitary problem, or suppression by testosterone or anabolic steroids — stopping the cause and appropriate hormonal treatment can restore sperm production.
- Retrieving sperm directly. Sperm can be collected surgically from the epididymis or testis and used to fertilise your partner’s eggs in the laboratory with ICSI.
Before any of that, the diagnosis itself should be secure. Azoospermia should be confirmed on at least two properly performed, centrifuged samples examined by an experienced andrology laboratory, because some men told they have no sperm in fact have very small numbers that a less thorough laboratory missed. The semen analysis guide explains how the test works.
What causes azoospermia?
There are two fundamentally different kinds of cause: a blockage that stops normally made sperm getting out (obstructive azoospermia), or a problem with sperm production itself (non-obstructive azoospermia).
Obstructive causes
A previous vasectomy is the most common. Others include infection, hernia or scrotal surgery in childhood, and congenital absence of the vas deferens, which is closely associated with cystic fibrosis gene mutations. Men with obstructive azoospermia usually have normal-sized testicles and normal hormone levels.
Non-obstructive causes
Here the tubes are open, but the testicles make very little sperm or none. Causes include genetic conditions such as Klinefelter syndrome and Y chromosome microdeletions, previous chemotherapy or radiotherapy, undescended testicles, testicular torsion and mumps orchitis; in many men no single cause is found. The testicles are typically smaller and softer, FSH is raised and testosterone is sometimes low.
Hormonal causes and medication
Sperm production is driven by signals from the pituitary gland in the brain. A pituitary problem, or anything that switches those signals off, can stop production even when the testicles themselves are healthy. A common and reversible culprit is testosterone itself: taken as a medicine, it switches off the pituitary signal that drives sperm production, and counts commonly fall to zero. The NHS lists reduced sperm count, infertility and shrunken testicles among the effects of anabolic steroids in men, and BAUS warns that many protein shakes may contain chemicals not listed on the label, and that steroids or growth hormones taken alongside them can harm fertility. I see men every year whose azoospermia was caused by a prescription, or by a gym supply, that nobody warned them about.
Telling these groups apart matters because the outlook differs completely. With an obstruction, sperm can almost always be obtained; hormonal suppression is frequently reversible; and production failure needs a specialist search of the testis.
Tell your doctor about testosterone, steroids and supplements
If you have ever used testosterone, anabolic steroids or bodybuilding supplements, say so at your first appointment, however long ago it was. It is a common cause of azoospermia, it is often reversible, and it changes the whole plan. If you want children now or in future, do not start testosterone without a fertility discussion first.
Are you born with azoospermia?
Some men are born with a cause of azoospermia, but it is usually only discovered in adulthood, when a semen test is done because a pregnancy has not happened.
Conditions present from birth include Klinefelter syndrome, in which a man is born with an extra copy of the X chromosome (XXY); Y chromosome microdeletions, where small sections of the Y chromosome are missing; and congenital absence of the vas deferens. Klinefelter syndrome is one of the typical situations in which I perform microTESE; the NHS likewise notes that fertility options include ICSI using sperm removed during a small operation, or donor sperm. Undescended testicles in childhood are another early-life cause. Many other cases are acquired later, after a vasectomy, infection, cancer treatment, testicular injury or torsion, or the use of testosterone or steroids.
Can azoospermia be temporary?
Yes, sometimes. Azoospermia caused by testosterone or anabolic steroids, by a hormonal problem or by chemotherapy can recover, although recovery may be slow and is not guaranteed.
- Testosterone and anabolic steroids. After testosterone treatment, production returns in most men once it is stopped, but this can take many months, sometimes years, and is occasionally incomplete. After prolonged or high-dose anabolic steroid use the system does not always restart on its own, and treatment aimed at restarting your own production may be needed.
- Cancer treatment. Sperm production can recover after chemotherapy, sometimes taking two to five years and occasionally longer, so repeat testing over time is worthwhile rather than relying on one early result. If treatment has not started yet, freezing sperm beforehand is far preferable — see onco-fertility.
- Recent illness. BAUS lists a recent illness with fever among the things that can affect sperm production. Each cycle of sperm production takes about 74 days, which is why BAUS recommends semen tests at least three months apart rather than relying on a single result.
Production failure from a genetic cause, or from testicular tissue that has been destroyed, does not recover on its own.
Is azoospermia curable, or can it be reversed?
It depends on the cause: some blockages can be bypassed and hormonal suppression often reversed, but genetic causes and testicular failure can only be worked around.
Where the level of a blockage allows it, microsurgical reconstruction can restore sperm to the ejaculate and allow natural conception. After a vasectomy that means a vasectomy reversal. A blockage in the epididymis can sometimes be bypassed by joining the vas directly to it, and a blocked ejaculatory duct caused by a scar or cyst can sometimes be opened through the urethra (TURED). Whether reconstruction or retrieval is better depends on your partner’s age, how many children you hope to have and, after a vasectomy, the time since it was done.
For genetic causes, BAUS is clear that the problem itself cannot be reversed, but it may be overcome by retrieving sperm directly from the testicle, with a lower chance of finding sperm than in obstruction. The same is true where testicular tissue has been destroyed, for example by chemotherapy or torsion. In men with no reversible cause and no sperm in the ejaculate, BAUS reports that microTESE finds sperm in approximately half.
What medication is used to treat azoospermia?
Medication helps only where the cause is hormonal. No tablet clears a blockage, and hormonal treatment does not work where the cause is genetic or the testicular tissue has been destroyed.
Where the pituitary signal is low — because of a pituitary disorder, or suppression from testosterone or steroids — the first step is to stop the drug causing the suppression, which should be planned with your doctor if it was prescribed. Hormonal treatment can then stimulate your own production. The NHS lists gonadotrophins — hormones of the type the pituitary uses to drive the testicles — as medicines that may improve fertility in men, and other medications can raise your own testosterone while maintaining sperm production. That is the opposite of testosterone replacement, which shuts production down. I cover this in more depth on the low testosterone page.
In non-obstructive azoospermia, a period of hormonal treatment is sometimes recommended before surgery where blood tests show hormone levels that can be improved.
How is azoospermia investigated?
Investigation has two aims: to establish whether the cause is obstructive or non-obstructive, and to look for a treatable or inheritable condition behind it.
- Confirmation. Repeat semen analysis with extended preparation, looking specifically for rare sperm.
- Examination. Testicular size, whether the vas deferens can be felt on both sides, fullness of the epididymis, and any varicocele. Examination alone frequently changes the diagnosis.
- Hormone tests. FSH, LH, testosterone and prolactin, taken in the morning. FSH is the single most useful test for telling obstruction from production failure.
- Genetic tests. Karyotype and Y chromosome microdeletion analysis, with cystic fibrosis gene testing where the vas is absent.
- Imaging. Scrotal ultrasound, and transrectal ultrasound where a blocked ejaculatory duct is suspected.
If a genetic cause is found, genetic counselling is arranged before treatment, because some conditions can be passed to a son conceived through ICSI. All of this sits within a wider male infertility assessment, with your partner assessed in parallel. The azoospermia page has more on each test.
How do sperm retrieval and ICSI work?
Sperm are collected surgically from the epididymis or testis, then a single sperm is injected into each of your partner’s eggs in the laboratory, a technique called ICSI.
In obstructive azoospermia, a needle technique (PESA or TESA), usually under local anaesthetic, is normally enough, and BAUS puts the chance of finding sperm close to 100%. In non-obstructive azoospermia, microTESE under the operating microscope gives the best chance with the lowest risk of damaging the remaining tissue. I compare the techniques in microTESE vs TESA vs PESA. Retrieved sperm can be used fresh on the day of egg collection or frozen in advance, and because they are few and may be immature, they are used only with ICSI. Your partner’s age and fertility then have a large bearing on the chance of a pregnancy, so your partner’s assessment matters as much as yours.
How do you cope with a diagnosis of azoospermia?
By giving yourselves time, getting the full picture before deciding anything, and facing the decisions together; there is no right way to feel about a diagnosis like this.
Azoospermia is a frightening diagnosis to be given, and it is frequently explained badly. A first result tells you that there are no sperm, not why, or what can be done, so try not to make decisions about donor sperm, IVF or surgery on the strength of it. Fertility is a couple’s issue: partners are welcome at consultations, and the big decisions — whether to have surgery, when, and what to do if no sperm are found — are better made jointly. If an operation is planned, talk through every possible outcome beforehand rather than in recovery. You may find it helpful to talk to a fertility counsellor, or to a patient support charity such as Fertility Network UK.
When is donor sperm discussed?
Donor sperm is discussed when no sperm can be obtained, or when a couple decides it is right for them. Ideally that conversation happens before any surgery, so you are prepared for every outcome.
BAUS describes donor insemination as the only viable option where there are no sperm at all and no blockage that can be relieved surgically. Donors are screened for infections and selected to have attributes similar to yours. Donors who registered in the UK after 1 April 2005 cannot remain anonymous: a child conceived with their sperm can find out who the donor is at 18. Adoption, and choosing not to pursue treatment further, are equally legitimate decisions.
Who should you see about azoospermia?
A urologist who specialises in male infertility — an andrologist — ideally before decisions about IVF, ICSI or donor sperm are made.
BAUS recommends a full assessment by a urologist in all cases of male-factor infertility, because investigation may reveal a reversible cause. Bring your previous semen analyses and blood test results with you; it saves repeating them. You can book a consultation in person or by video.
Sources and further reading
Frequently asked
Can azoospermia be passed on to my children?
Some causes can. Certain genetic conditions behind azoospermia can be passed to a son conceived through ICSI, and men born without a vas deferens often carry cystic fibrosis gene mutations, so genetic counselling and screening are important because a child could be at risk of cystic fibrosis. Blockages caused by a vasectomy or infection are not inherited. Counselling before treatment lets you decide with full information.
How long does it take to find out the cause?
Usually a few weeks to a few months. Genetic tests in particular can take from a few weeks to months to be finalised, according to BAUS, and a second semen analysis may be needed to confirm the diagnosis. Starting the investigations early, rather than waiting, is the best way to avoid losing time.
Can lifestyle changes cure azoospermia?
Not on their own in most cases, because lifestyle cannot open a blockage or repair a testicle that cannot make sperm. The exception is drug-related azoospermia, where stopping anabolic steroids, recreational drugs or (with your doctor’s guidance) prescribed testosterone can allow production to return. BAUS’s general advice for men with poor sperm counts — stop smoking, keep alcohol low, maintain a healthy weight and avoid excess heat — still applies.
Does azoospermia affect my general health?
It can be a sign of something that matters beyond fertility. A semen abnormality is occasionally the first sign of a hormonal disorder, a genetic condition or testicular cancer, and men with non-obstructive azoospermia sometimes have low testosterone, which affects energy, mood, bone health and sexual function. That is one reason the cause should be investigated even if you are unsure about having children.
How do we decide whether a sperm retrieval operation is worth it?
By weighing your individual chance of success against what the operation involves and what you would do if no sperm were found. Genetic results are important: some Y chromosome microdeletions predict that no sperm will be found, which can spare you surgery. Your partner’s age and fertility, how many children you hope for, and cost all count too, and are discussed before anything is booked.
Will I still ejaculate normally with azoospermia?
Usually, yes. Azoospermia means the semen contains no sperm, not that there is no semen, and most men with fertility problems feel entirely well. Problems with ejaculation itself, such as retrograde ejaculation, where semen passes backwards into the bladder, are a separate issue and are checked for with a urine test after ejaculation.
I have fathered a child before. Can I still have azoospermia?
Yes. Fathering a child in the past shows you were fertile then, but several causes of azoospermia are acquired later in life: a vasectomy, chemotherapy or radiotherapy, infection, testicular injury or torsion, and the use of testosterone or anabolic steroids. A previous pregnancy is a useful clue, because it makes some causes present from birth less likely.
Speak to my team
Appointments at The Shard and Canary Wharf are arranged by my PA, Jeanette Bush. Tell us briefly what the problem is and we will find the right clinic slot for you.