Azoospermia: causes, examination and treatment in Tashkent

Other names: Отсутствие сперматозоидов в эякуляте, обструктивная азооспермия, необструктивная азооспермия

Azoospermia is the complete absence of sperm in the ejaculate. For a man, this sounds like a death sentence, but in reality, the diagnosis only means the beginning of the examination, and not its end. The key question is why there are no sperm: because they are not produced or because they are formed but cannot be released. Both treatment and the chances of becoming a biological father, which in modern conditions a significant proportion of such men have, depend on the answer.

🧾 МКБ-10: N46 🏥 Where it is treated: 2 Two fundamentally different formsDiagnosis by two testsPaternity is often possible

👨‍⚕️ Which doctor

Andrologist, reproductologist

🔬 Diagnostics

Spermogram twice, FSH, LH, genetics, ultrasound

💊 Treatment

Patency restoration, TESE, ICSI

📈 Prognosis

Depends on the shape

⚠️ At risk

Cryptorchidism, infections, steroids, genetics

⏱ When to see a doctor

Routine examination

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Полное отсутствие сперматозоидов, подтверждённое повторно
Уменьшение объёма яичек
Отсутствие или недоразвитие вторичных половых признаков
Увеличение грудных желёз
Резкое уменьшение объёма эякулята
Приём анаболических стероидов или тестостерона в прошлом

What does diagnosis mean?

Azoospermia is said to occur when sperm are not detected in the ejaculate even after special centrifugation of the sediment. The diagnosis is made by at least two tests performed several weeks apart, since a single result may be erroneous.

The absence of sperm does not mean the absence of ejaculate: the volume of sperm is usually normal, since the bulk of it is produced by the prostate and seminal vesicles. That is why azoospermia is not felt at all and is detected only during an examination for infertility.

Two forms: obstructive and non-obstructive

Obstructive - sperm are formed normally, but cannot be released due to an obstruction in the path of the vas deferens. The testicles are usually of normal size and FSH is normal. The prognosis is more favorable
Non-obstructive - the very formation of sperm in the testicular tissue is impaired. The testicles are often reduced, FSH is increased. The prognosis is more complicated, but even here spermatozoa can often be found in certain areas of testicular tissue

Ориентировочные признаки обструктивной формы: нормальный объём яичек, нормальный уровень ФСГ, отсутствие вторичных изменений. Но окончательное разграничение иногда возможно только по результатам биопсии яичка.

Causes of obstructive form

Congenital absence of the vas deferens - often associated with mutations in the cystic fibrosis gene
Consequences of past infections: epididymitis, STIs, tuberculosis
Complications after operations in the groin area and scrotum, including hernia repair in childhood
Vasectomy in the past
Obstruction at the level of the ejaculatory ducts, including due to prostate cysts
Injuries

Causes of non-obstructive form

Genetic: Klinefelter syndrome, microdeletions of the AZF region of the Y chromosome, other chromosomal abnormalities
History of cryptorchidism, even successfully operated on in childhood
Post-existing orchitis due to mumps
Chemotherapy and radiation therapy
Taking anabolic steroids and testosterone drugs is a common and largely reversible cause.
Hypogonadotropic hypogonadism - insufficient stimulation of the testicles by pituitary hormones
Pituitary tumors, increased prolactin
Pronounced varicocele
History of testicular torsion
Severe systemic diseases and intoxications

Separately, it is worth noting the use of anabolic steroids: it suppresses the production of pituitary hormones and can completely stop spermatogenesis. After withdrawal, recovery takes months, sometimes requiring special therapy, but most often it is possible.

Survey

Repeated spermogram with examination of sediment after centrifugation
Examination by an andrologist with measurement of testicular volume and assessment of the vas deferens
FSH, LH, total testosterone, prolactin, estradiol
Ultrasound of the scrotum with Doppler sonography
TRUS of the prostate and seminal vesicles - to identify obstruction of the ejaculatory ducts
Karyotype and analysis for microdeletions of the AZF region
CFTR gene analysis for suspected congenital absence of ducts
Urine analysis after ejaculation - exclusion of retrograde ejaculation
Diagnostic testicular biopsy - if necessary, clarify the presence of spermatogenesis
MRI of the pituitary gland for hormonal disorders of central origin

Treatment and options

Surgical restoration of patency of the vas deferens in obstructive form
TUR of the spermatic tubercle with obstruction at the level of the ejaculatory ducts
Hormonal stimulating therapy for hypogonadotropic hypogonadism is one of the few forms in which spermatogenesis can be restored with medication
Withdrawal of anabolic steroids and testosterone followed by recovery
Microsurgical varicocelectomy for severe varicocele
Surgical collection of sperm from epididymis or testicular tissue for use in an ICSI program
Micro-TESE - microsurgical search for areas of spermatogenesis in testicular tissue; the most effective method for non-obstructive forms
Cryopreservation of obtained spermatozoa
Discussion of donor sperm or adoption if own sperm cannot be obtained

Важный практический момент: при необструктивной азооспермии сперматозоиды нередко удаётся найти в отдельных участках ткани яичка даже тогда, когда в эякуляте их нет совсем. Именно поэтому диагноз азооспермии today не равнозначен невозможности иметь биологических детей.

What is important to know before the examination

Обязательно сообщите врачу о приёме анаболических стероидов, тестостерона или любых препаратов для спорта — даже если это было несколько лет назад
Расскажите об операциях в паховой области и на мошонке, включая детские
Вспомните, болели ли вы паротитом и в каком возрасте
Сообщите о перенесённой химиотерапии или лучевой терапии
Уточните, было ли у вас неопущение яичка в детстве
Не сдавайте спермограмму на фоне лихорадки или сразу после болезни
Не начинайте самостоятельно принимать гормональные препараты — это исказит картину и может ухудшить ситуацию

Where to get examined in Tashkent

Examination for azoospermia requires a laboratory with the correct spermogram, hormonal studies, ultrasound of the scrotum and TRUS, as well as the possibility of surgical treatment of obstructive forms.

In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic; sperm retrieval and IVF programs are implemented jointly with reproductive specialists.

Do not make a decision based on one test: azoospermia is confirmed by at least two studies, and further tactics are determined by hormones and ultrasound. Clinic contacts are below on the page.

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

🔬 Diagnostics

Первичный приём урологаfrom 200 000 Биопсия яичка с гистологическим исследованиемfrom 1 950 000

💊 Treatment

ТУР семенного бугоркаfrom 7 500 000 Микрохирургическая варикоцелэктомия (операция Мармара)from 5 150 000 Micro-TESE — микрохирургическая экстракция сперматозоидов of яичкаfrom 6 300 000 Micro-TESE двусторонняяfrom 7 100 000 MESA — микрохирургическая аспирация сперматозоидов (амбулаторно)from 4 750 000 MESA двусторонняя (амбулаторно)from 5 500 000

Frequently asked questions: Azoospermia

Does Azoospermia mean you won't have children?+

No. Modern methods make it possible to obtain sperm directly from the epididymis or testicular tissue and use them in the ICSI program. In the obstructive form, sperm are almost always found; in the non-obstructive form, sperm are found in a significant proportion of men. In addition, some forms can be treated to restore sperm in the ejaculate.

Why do you need to take a spermogram twice?+

Because a single result may turn out to be erroneous: there are single spermatozoa and do not end up in the test sample, and the quality of the analysis depends on the laboratory and the correctness of collection. The diagnosis of azoospermia is made by at least two studies with an interval of several weeks, always with the study of sediment after centrifugation.

How to distinguish obstructive form from non-obstructive?+

They focus on testicular volume, FSH level, ultrasound data and medical history. In the obstructive form, the testicles are usually of normal size and FSH is within normal limits; with non-obstructive testes, the testicles are often reduced and FSH is increased. In doubtful cases, a testicular biopsy is performed, which gives a definitive answer.

Will spermatogenesis recover after stopping steroids?+

Most often, yes, but it takes time - from several months to a year or more, and sometimes special stimulating therapy is needed. Be sure to tell your doctor if you are taking steroids: without this information, the diagnosis may be incorrect and the wrong treatment may be prescribed.

What is micro-TESE?+

This is a microsurgical operation in which testicular tissue is examined under high magnification, and the surgeon specifically selects the tubules in which spermatogenesis is most likely to occur. This approach is much more effective than conventional biopsy for non-obstructive azoospermia and allows us to minimize the volume of tissue removed.

Is genetic testing necessary?+

For azoospermia - yes, it is included in the standard. Karyotype and analysis for microdeletions of the AZF region of the Y chromosome affect the prognosis of sperm production and are important for counseling the couple, since some changes can be passed on to the son. If congenital absence of the vas deferens is suspected, the CFTR gene is additionally examined.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated azoospermia в Ташкенте

Разграничение обструктивной и необструктивной азооспермии требует гормонального обследования, УЗИ мошонки и ТРУЗИ, а иногда биопсии яичка. В Ташкенте такое обследование, а также хирургическое лечение обструктивных форм, проводят в медицинском центре UROLOGIC COMPLEX и в clinicsе Tashkent Medical Park.