Condition & Treatments
/ Azoospermia
Azoospermia: when there is no sperm in the semen
Hearing this is a shock. It does not always mean you can't have your own biological child. In many men, sperm is still being made and can be found.
I N S H O R T
There are two main types: a blockage, where sperm is made but can't get out, and a production problem, where the testes make very little.
A blockage can often be bypassed with microsurgery, or sperm collected directly for IVF by testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA), depending on the site and type of blockage.
Even when production is very low, sperm can often be found in small areas of the testes using microdissection testicular sperm extraction (micro-TESE).
The two types
Obstructive (a blockage)
The testes make sperm, but a blockage stops it coming out. Causes include a previous vasectomy, infection, or being born without the tubes that carry sperm (CBAVD).
Non-obstructive (production)
The testes make little or no sperm. Causes include hormone problems, genetic conditions such as Klinefelter syndrome, previous chemotherapy, and testosterone or steroid use.
How we find out which
Prof Raheem starts with a detailed history and a careful examination, then adds a few targeted tests. Together they show which type you have and what your options are.
A detailed history, including previous surgery such as hernia repair or undescended testes, infections, cancer treatment, testosterone or steroid use, medicines, and any previous pregnancies.
A careful examination of the size and feel of the testes, the epididymis and the vas deferens, and for signs of hormone problems or a varicocele.
A repeat semen test, checking the semen volume and pH
Hormone blood tests, which point towards a blockage or a production problem
Genetic tests, including chromosomes, Y-chromosome deletions and a cystic fibrosis screen, which affect both treatment and any child.
A scrotal ultrasound of the testes, epididymis and vas deferens, and sometimes a transrectal scan if a blockage near the prostate is suspected.
Treatment options
Microsurgical reconstruction
For some blockages. Bypassing the blocked section can restore sperm to the semen, which may allow natural conception.
Testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA)
For blockages that can't be repaired. Sperm is collected with a fine needle under sedation, as a day case, for use in IVF/ICSI.
Microdissection testicular sperm extraction (micro-TESE)
For production problems. Using an operating microscope, Prof Raheem searches the testes for the small areas still making sperm. A day case under general anaesthetic.
Hormone treatment
In selected men, medicines can restart sperm production, sometimes enough to avoid surgery.
A L S O AVA I L A B L E
Prof Raheem can perform sperm retrieval on the same day as your partner's egg collection, so the sperm is used fresh for ICSI, without being frozen and thawed. Why this matters:
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When very few sperm are found, as is common in non-obstructive azoospermia, freezing and thawing can lose some of them or reduce how well they move.
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Some studies report better embryo development and pregnancy rates with fresh testicular sperm, although large reviews find similar overall results with frozen sperm.
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It needs close co-ordination with your IVF clinic, and a back-up plan, such as freezing the eggs, in case no sperm is found. Prof Raheem will help you decide whether fresh or frozen is right for you.
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Built on his own research. At UCLH, Prof Raheem audited ICSI outcomes with fresh versus frozen testicular and epididymal sperm, and presented the results at international urology meetings.
Why this matters to your care
Prof Raheem's research has looked at which men are likely to have sperm found at surgery, and what affects IVF success in men with azoospermia. That means honest, specific advice about your chances before you decide. His UCLH audit also changed how suspected blockages are managed: men first have a 30–60 minute procedure to retrieve sperm and confirm the blockage, and only those with a repairable blockage go on to the 4–5 hour microsurgery. His research also includes salvage micro-TESE in men whose previous microTESE found no sperm.
What are the chances of finding sperm?
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If the cause is a blockage, sperm is found in almost every man. If it is a production problem, sperm is found in around 6 in 10 men having micro-TESE.
Can sperm be frozen at the same time?
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Yes. Any sperm found is frozen during the same procedure, ready for IVF/ICSI.
How long is recovery after micro-TESE?
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Most men are back at a desk job after 2 days, and doing manual work after 2 weeks.