Updated by the Progyny Clinical Team — September 2025.
Azoospermia means there is no sperm in the semen. A semen analysis can show whether sperm are present in a sample. Most doctors will have you repeat the test to confirm results. A reproductive urologist is the specialist who investigates the cause.
Azoospermia can happen when the testes are not making any sperm (non-obstructive) or when the testes are making sperm, but a physical blockage prevents sperm from mixing with semen during ejaculation (obstructive). Obstructive azoospermia accounts for about 40% of all azoospermia cases. It can be caused by a vasectomy, injury, or a condition present from birth.
Evaluation
People with obstructive azoospermia often have:
- Low-volume ejaculate – The rest of the reproductive tract still makes semen, but the volume is lower and doesn’t contain sperm.
- Normal-size testes – The testes still make sperm, but the sperm cannot pass through the reproductive tract.
- Normal hormone levels – Hormone signals from the brain are working and sperm are being made, but a blockage prevents release.
Causes of Obstructive Azoospermia
Obstructive azoospermia can result from issues in the ducts that carry sperm or problems with ejaculation, including:
- Ducts that are surgically tied or sealed (vasectomy).
- Blockages from trauma or infection.
- Being born without ducts that carry sperm (congenital absence of the vas deferens). This is often linked to mutations in the cystic fibrosis gene. Even carriers can be affected.
- Cysts that are present from birth or grow large enough to block the ducts.
Treatments
Treatment depends on the underlying cause. In some cases, surgery can remove the blockage and restore fertility. For example, a vasectomy reversal reconnects the ends of the duct so sperm can pass into the semen.
Success depends on several factors, including how long it has been since the vasectomy and the age of the partner with ovaries. According to the American Society for Reproductive Medicine, 20% to 40% of male/female couples conceive without further fertility treatment after a reversal.
Options for building a family
If surgery isn’t an option, you still have effective ways to build your family. Sperm can often be retrieved directly from the testicle or epididymis through a minor surgical procedure.
Because fewer motile sperm are usually retrieved this way, the sample is often used for in vitro fertilization with intracytoplasmic sperm injection (ICSI). In ICSI, a single sperm is injected directly into an egg in the lab to help fertilization. This approach has transformed treatment for sperm-related infertility.
Key takeaways
Obstructive azoospermia means no sperm are present in the semen because of a blockage. Surgery, such as vasectomy reversal, may correct the problem. If surgery isn’t possible, sperm retrieval combined with IVF and ICSI is an effective alternative.
Even with this diagnosis, you still have options for family building. Your fertility team can explain the cause and guide you toward the treatment plan that fits your goals.
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Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.