“Azoospermia” / “No sperm seen”
Zero sperm was found in the sample, including after centrifugation. The finding should usually be confirmed on a second semen analysis before treatment planning.
Azoospermia Specialist · Chennai, India
Azoospermia Treatment with Dr. Arun Muthuvel
A zero sperm count does not always mean biological fatherhood is impossible. Get a specialist diagnosis and a personalised plan for TESA, PESA, Micro-TESE or IVF-ICSI.
MBBS, MD (OBG), Fellowship in Reproductive Medicine · Internationally trained in Andrology and Micro-TESE
80-90%
Retrieval success (OA)
40-60%
Retrieval success (NOA)
89+
Iswarya centres
Dr. Arun Muthuvel
Azoospermia · Andrology · Micro-TESE
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What is Azoospermia?
Azoospermia is the medical condition where a man's semen contains no measurable sperm. It affects approximately 1% of all men and accounts for around 10-15% of male infertility cases. While the diagnosis can be distressing, it is important to understand that azoospermia is not the same as sterility — many men with this condition can still father biological children with the right treatment.
Azoospermia is diagnosed when two separate semen analyses, conducted at least 2 weeks apart, confirm the complete absence of sperm even after centrifugation of the sample. A thorough evaluation is then performed to determine the cause and the best treatment approach.
Types of Azoospermia
Understanding the type is critical — it determines the treatment approach and success rates
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Obstructive Azoospermia (OA)
Sperm is produced normally but a physical blockage prevents it from reaching the semen. Common causes include vasectomy, prior infections (epididymitis, STIs), congenital absence of the vas deferens (CAVD), or previous surgeries. Sperm retrieval is highly successful.
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Non-Obstructive Azoospermia (NOA)
The testes do not produce sperm or produce very few. Causes include hormonal disorders, genetic factors (Klinefelter syndrome, Y-chromosome microdeletions), radiation or chemotherapy exposure, varicocele, or undescended testes. Sperm retrieval is possible in 30-60% of cases.
Causes of Azoospermia
Identifying the underlying cause guides the most effective treatment
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Genetic Factors
Klinefelter syndrome (XXY), Y-chromosome microdeletions, cystic fibrosis gene mutations (CFTR)
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Infections
Epididymitis, orchitis (mumps), sexually transmitted infections causing scarring and blockage
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Hormonal Imbalances
Low FSH, LH, or testosterone; hypogonadotropic hypogonadism; pituitary gland disorders
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Varicocele
Enlarged veins in the scrotum that raise testicular temperature, impairing sperm production
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Prior Vasectomy
Surgical sterilisation that can be reversed or bypassed via sperm retrieval + IVF-ICSI
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Radiation / Chemo
Cancer treatments that damage sperm-producing cells in the testes
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Undescended Testes
Cryptorchidism treated late may cause reduced or absent sperm production
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Previous Surgery
Hernia repair, bladder or prostate surgery causing obstruction or retrograde ejaculation
Diagnostic Evaluation
A systematic evaluation to pinpoint the exact cause
1
Semen Analysis (×2)
Two separate semen analyses confirming zero sperm in ejaculate, taken at least 2 weeks apart
2
Hormonal Profile
FSH, LH, testosterone, prolactin, and inhibin B to determine testicular function and identify hormonal causes
3
Scrotal Ultrasound
Identify varicocele, obstruction, testicular volume, and structural abnormalities
4
Genetic Testing
Karyotype (chromosome analysis), Y-chromosome microdeletion assay, CFTR mutation screening
5
Testicular Biopsy
In select cases to determine if sperm production is occurring — guides retrieval procedure choice
6
Post-Ejaculatory Urinalysis
Checks for retrograde ejaculation where sperm enters the bladder instead of being ejaculated
Understanding your results
What Your Azoospermia Reports May Mean
A report needs to be interpreted alongside your history, examination and hormone results. These are common clues your specialist will review.
Semen volume and pH
Low volume with acidic pH may suggest an obstruction or absent vas deferens, helping the specialist distinguish obstructive azoospermia.
FSH, LH and testosterone
These hormone values help indicate whether the problem is sperm production, hormonal signalling or a physical blockage.
Genetic test reports
Karyotype and Y-chromosome microdeletion results can guide Micro-TESE counselling and identify whether a condition may be inherited.
Have your reports reviewed by Dr. Arun's team
Send your semen analysis, hormone and genetic reports securely on WhatsApp for the next-step guidance.
Sperm Retrieval Procedures
World-class sperm retrieval techniques performed by our experienced embryologists and urologists
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TESA
Testicular Sperm Aspiration
Success Rate
80-90% (OA)
A fine needle is used to aspirate sperm directly from the testis under local anaesthesia. Minimally invasive, minimal recovery time. Best for obstructive azoospermia.
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PESA
Percutaneous Epididymal Sperm Aspiration
Success Rate
80-90% (OA)
Sperm is aspirated from the epididymis — the tube attached to the testis where sperm matures and is stored. Suitable for men with obstruction in the vas deferens or epididymis.
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Micro-TESE
Microsurgical Testicular Sperm Extraction
Success Rate
40-60% (NOA)
Under high-power microscopy, seminiferous tubules that appear to contain sperm are identified and extracted. The gold standard for non-obstructive azoospermia. Maximises sperm yield while minimising testicular tissue removal.
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TESE
Testicular Sperm Extraction
Success Rate
40-70%
Small biopsy samples are taken from multiple areas of the testis to locate sperm. Used when TESA is not successful or when a larger sample is needed.
What happens after sperm retrieval?
Retrieved sperm is immediately used with IVF-ICSI (Intracytoplasmic Sperm Injection) — where a single healthy sperm is directly injected into the egg. Any extra sperm can be cryopreserved (frozen) for future cycles. The female partner undergoes ovarian stimulation, egg retrieval, and embryo transfer in a coordinated cycle.
Advanced sperm retrieval
How Micro-TESE Works
Microdissection TESE is commonly considered for non-obstructive azoospermia. It uses magnification to identify small areas that may still be producing sperm while limiting unnecessary tissue removal.
Specialist-led planning matters
The chance of finding sperm varies with the underlying diagnosis, hormone levels, genetics, previous procedures and testicular history.
- 1
Pre-operative evaluation
Hormone profile, genetic screening, examination and counselling are reviewed before the procedure.
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Day-care anaesthesia
Micro-TESE is usually performed under general or regional anaesthesia, with discharge commonly possible the same day.
- 3
Microsurgical exploration
The testicular tissue is examined under a high-power operating microscope to identify tubules more likely to contain sperm.
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Targeted sampling
Only small, selected tissue samples are removed to minimise unnecessary tissue loss.
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Real-time laboratory review
An embryologist examines samples during the procedure and updates the surgical team when sperm is identified.
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Freezing or fresh ICSI
Retrieved sperm may be cryopreserved or coordinated with the partner’s egg retrieval for IVF-ICSI.
Your azoospermia specialist
Why Consult Dr. Arun Muthuvel?
Dr. Arun Muthuvel
MBBS, MD (OBG), Fellowship in Reproductive Medicine
Dr. Arun combines reproductive-medicine training, andrology experience and embryology coordination to evaluate complex obstructive and non-obstructive azoospermia cases. Every plan is tailored to the diagnosis rather than using the same retrieval procedure for every patient.
M.Ch in Reproductive Medicine & Surgery
Advanced IVF training at Boston IVF, USA
Andrology and Micro-TESE training at the University of Miami
PGD, IVF and embryo-biopsy training at Cleveland Clinic
Oral presentation at the American Society for Reproductive Medicine
Radiocity Chennai City Icon and Times Health Young Achiever awards
The Complete Treatment Journey
From diagnosis to holding your baby — here is the complete process
1
Initial Consultation & Semen Analysis
Two semen analyses are conducted to confirm azoospermia. Detailed medical history is reviewed.
2
Hormonal & Genetic Testing
Blood tests for FSH, LH, testosterone. Karyotype analysis and Y-chromosome microdeletion testing if indicated.
3
Imaging & Biopsy (if needed)
Scrotal ultrasound to assess testicular volume and anatomy. Fine needle aspiration biopsy to check for sperm production.
4
Sperm Retrieval (TESA / PESA / Micro-TESE)
Appropriate sperm retrieval procedure is performed. Retrieved sperm is evaluated by our senior embryologists.
5
IVF-ICSI
Female partner undergoes ovarian stimulation and egg retrieval. ICSI is performed — a single sperm is injected into each mature egg.
6
Embryo Culture & Selection
Embryos are cultured for 3-5 days in our state-of-the-art lab. Best-quality embryo is selected for transfer using AI-assisted grading.
7
Embryo Transfer & Pregnancy Test
Selected embryo is gently transferred into the uterus. Beta-hCG blood test 12-14 days later confirms pregnancy.
Doctor-led education
Watch Dr. Arun Explain Azoospermia
Clear explanations in English and Tamil about zero sperm count, treatment choices and the path to biological fatherhood.
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Azoospermia Success Stories
The same real-family gallery featured by Dr. Arun, optimized for faster loading on Iswarya
Frequently Asked Questions
Answers from our fertility specialists
Yes. In obstructive azoospermia, success rates for sperm retrieval are 80-90%. In non-obstructive azoospermia, sperm can be found and retrieved in 30-60% of men. Retrieved sperm is used with IVF-ICSI to achieve pregnancy. Many men with azoospermia have successfully become biological fathers at Iswarya Fertility.
TESA involves aspirating sperm using a needle — it is less invasive and suitable for obstructive azoospermia. Micro-TESE uses a surgical microscope to identify and extract specific tubules likely to contain sperm — it is the preferred approach for non-obstructive azoospermia where sperm production is impaired.
TESA and PESA take 15-30 minutes under local anaesthesia. Micro-TESE is a surgical procedure performed under general anaesthesia and takes 1-2 hours. Recovery time is 1-3 days for TESA/PESA and 3-5 days for Micro-TESE.
Retrieved sperm is used immediately with IVF-ICSI (where a single sperm is directly injected into an egg) or cryopreserved for future use. The female partner undergoes ovarian stimulation, egg retrieval, and embryo transfer simultaneously or in a coordinated cycle.
Men with Klinefelter syndrome (XXY) can still father biological children. Micro-TESE successfully retrieves sperm in approximately 40-60% of cases. Genetic counselling is recommended before treatment to understand the risk of passing on chromosomal abnormalities.
Sperm retrieved from men with azoospermia can be tested using Pre-Implantation Genetic Testing (PGT/PGS) on the embryo to check for chromosomal abnormalities. This is especially recommended for men with Y-chromosome microdeletions or Klinefelter syndrome.
When high-quality sperm is retrieved, IVF-ICSI success rates are comparable to standard IVF — typically 50-70% for women under 35. The combined success (retrieval + IVF-ICSI pregnancy) depends on the type of azoospermia, female age, and egg quality.
Some genetic causes of azoospermia (Y-chromosome microdeletions, CFTR mutations) may be passed to male offspring. Genetic counselling and PGT are recommended. Y-chromosome deletions are typically transmitted only to sons, not daughters.
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