On rare occasions, there may be a total absence of sperm production – a condition called “azoospermia”.
Some types of azoospermia are caused by a blockage in the male genital tract, whereas other types are caused by problems within the testicles themselves. In addition to the male infertility evaluation, men with this condition will also need to have some genetic testing to rule out abnormalities in either the Y chromosome or one of several other genes that can cause azoospermia.
Even in cases where we have no sperm in the ejaculate to work with, a variety of more invasive treatments including micro surgical epididymal sperm aspiration (MESA) or testicular epididymal sperm extraction (TESE) may still be successfully performed. These procedures involve obtaining sperm through an incision in the scrotum and/or aspirating fluid directly from the either the tubules that come off the testicles or the testicles themselves. Sperm obtained through such procedures can then be utilized in combination with ICSI to produce healthy children. Even if no sperm can be obtained through these procedures, men still have an opportunity to produce children using donor sperm.
In summary, a thorough evaluation of the male is an integral part of the overall fertility evaluation. Diagnostic testing is easy, and there are many effective treatments available – even in the most severe cases.