How is azoospermia diagnosed?

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How is azoospermia diagnosed?

Azoospermia is diagnosed when, on two separate occasions, your sperm sample reveals no sperm when examined under a high-powered microscope following a spin in a centrifuge. A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged seminal fluid, if sperm cells are present, they separate from the fluid around them and can be viewed under a microscope.

As part of the diagnosis, your healthcare provider will take your medical history, including asking you about the following:

  • Fertility success or failure in the past (your ability to have children).
  • Childhood illnesses.
  • Injuries or surgeries in the pelvic area (these could cause duct blockage or poor blood supply to the testicles).
  • Urinary or reproductive tract infections.
  • History of sexually transmitted diseases.
  • Exposure to radiation or chemotherapy.
  • Your current and past medications.
  • Any abuse of alcohol, marijuana or other drugs.
  • Recent fevers or exposure to heat, including frequent saunas or steam baths (heat kills sperm cells).
  • Family history of birth defects, learning disabilities, reproductive failure or cystic fibrosis.

Your healthcare provider will also conduct a physical examination, and will check:

  • Your entire body in terms of signs of/lack of maturation of your body and reproductive organs.
  • Your penis and scrotum, checking for the presence of your vas deferens, tenderness or swelling of your epididymis, size of the testicles, the presence or absence of a varicocele, and any blockage of the ejaculatory duct (via exam through the rectum) as evidenced by enlarged seminal vesicles.

Your healthcare provider may also order the following tests:

  • Measurement of testosterone and follicle-stimulating hormone (FSH) levels.
  • Genetic testing.
  • X-rays or ultrasound of the reproductive organs to see if there are any problems with the shape and size, and to see if there are tumors, blockages or an inadequate blood supply.
  • Imaging of the brain to identify disorders of the hypothalamus or pituitary gland.
  • Biopsy (tissue sampling) of the testes. A normal biopsy would mean a blockage is probable at some point in the sperm transport system. Sometimes, any sperm found in the testes is frozen for future analysis or can be used in assisted pregnancy.

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