Zero Sperm Count - Azoospermia – NIL count

Azoospermia – Nil report, still FULL hopes.

Azoospermia means the complete absence of sperm in the ejaculated semen. It obviously leads to infertility in men because, in the absence of sperm, there can be no fertilization. It is important to confirm this diagnosis by at least three semen tests at a reliable laboratory.

BFI has a very vast experience of successfully treating a lot of azoospermic men and helping them become a father with their own sperm. Highly personalized, need-based treatment is offered to explore even the rarest or difficult chance of success. Medical, surgical, IVF ICSI or combination treatment is customized for every individual to optimize his chance.

Neither virility, normal development of beard, moustaches, built, muscle etc., nor normal sexual performance – intercourse, means normal sperm count. Only a microscopic examination of semen can diagnose the presence of sperm in semen.

Many azoospermic men can father their own children with their own sperm. If this finding is confirmed, we need to diagnose the cause and evaluate the possibility of treatment with medicines, surgery or ART – IVF and ICSI. Correct diagnosis and treatment at a really expert and experienced centre are crucial.

Men who have voluntarily and consciously been sterilized for family planning (Vasectomy) can also regain their fertility by opening their blocked vas or by IVF plus ICSI.

Azoospermia can’t be said ‘untreatable’ till a thorough diagnosis, including biopsy of both the testes, is made.

Diagnosis of azoospermia

The diagnosis of azoospermia is made during an infertility consultation, which in men systematically includes a spermogram. This examination consists of analyzing the content of the ejaculate (semen), evaluating various parameters and comparing the results with the standards established by the WHO.

In the event of azoospermia, no sperm is found after centrifugation of the entire ejaculate. To make the diagnosis, however, it is necessary to perform one or even two other spermograms, each 3 months apart, because spermatogenesis (sperm production cycle) lasts about 72 days. In the absence of sperm production over 2 to 3 consecutive cycles, the diagnosis of azoospermia will be made.

Various additional examinations will be carried out to refine the diagnosis and try to identify the cause of azoospermia:

  • A clinical examination with palpation of the testes, measurement of testicular volume, palpation of the epididymis, of the vas deferens;
  • Seminal biochemistry (or biochemical study of sperm), in order to analyze various secretions (fructose, zinc, citrate carnitine, acid phosphatases, etc.) contained in seminal plasma and originating from the various glands of the genital tract (seminal vesicle, prostate, epididymis ). If the pathways are obstructed, these secretions can be disturbed, and biochemical analysis can help to locate the level of the obstacle;
  • A hormonal assessment by a blood test, comprising, in particular, a determination of FSH (follicle-stimulating hormone). A high FSH level indicates testicular damage. A low FSH level indicates the poor function of the hypothalamic-pituitary axis.
  • Testosterone, thyroid hormones and prolactin to evaluate the hormonal status
  • Serology by a blood test, in order to look for an infection, such as Chlamydia, which may or may cause damage to the excretory tract;
  • A scrotal ultrasound to check the testes and detect abnormalities of the vas deferens or the epididymis;
  • A blood karyotype and genetic tests to look for a genetic abnormality;
  • A testicular biopsy consisting of collecting, under local anaesthesia, a piece of tissue inside the testis;
  • An X-ray or MRI of the pituitary gland is sometimes offered if an upper pathology is suspected.

Genetic testing

  • Genetic counselling and chromosome analysis are recommended before starting treatment. The chromosome analysis is made from a blood sample and carried out by a human geneticist. The result is available after about two weeks. Apart from checking for the normal chromosomes, micro deletion of the Y chromosome is also checked. A Z F region on the Y chromosome in male is responsible for sperm production. Detection of abnormality in this region can help us diagnose and prognosticate the treatment..
  • A gene defect causing cystic fibrosis disease of the lung is common in patients with absent vas. The gene is studied before using the sperm from a man with absent vas to rule out this possibility.

Azoospermia treatment

Treatment by medicines

Hormone deficiency

Fortunately, we have hormones available as medicines that can be given as replacement or supplement for hormone deficiency.

It has to be given for a minimum of 3 months and can be continued as per the progress.

It gives excellent results in properly selected patients.

Normal and natural sperm production is established.

Man can conceive naturally with natural intercourse..

External hormone-dependent sperm production stops when treatment is stopped..

Semen can be frozen. It can be used in future also at a time when he wants to conceive..

Treatment can be repeated if needed..

BFI has successfully treated many such patients and has helped them father their child naturally.


Infection can be diagnosed by history, examination and semen culture test.

Drug sensitivity of the infection can be diagnosed.

A long course of appropriate drug can help cure the infection.

Treatment by surgery

Vas opening operations

Vas deference is a very long and thin pipe, which transport sperm from the testes to semen.

A vas can be blocked anywhere in its entire length. That is why it is very difficult to find the exact block location.

It is also difficult and risky to reach most part of the vas for corrective surgery.

The damage causing blockage of the vas does not give good results even if the vas might be opened.

It is a major surgery that is very fine and requires exceptional skill and experience.

It has to be done with a microsurgical technique under the microscope.

After the advent and excellent success of IVF ICSI, it is more preferred over surgical correction.

Patients who have undergone voluntary sterilization – vasectomy can try this and can get an excellent result with good surgery.


The dilatation of veins in the scrotum is called varicocele. Varicocele rarely causes azoospermia. However, surgical correction of a gross varicocele in very selected patients may increase the chances of sperm recovery.

Testes fixation surgery

In some man, testes have not reached their final place, scrotum. They are stuck somewhere higher, in the inguinal canal or abdomen. A timely fixation of testes in the scrotum can save its function. Fixation after adulthood hardly helps.

IVF ICSI with sperm from epididymis or testes

If we can’t get sperm in the semen, but the man has sperm in his testis, we can take it out and use it for fertility. The procedure of the Sperm collection from epididymis or testes is called “Sperm Retrieval”.

If sperm can be detected in the testicular tissue, the testicular tissue is frozen immediately, in several portions (cryopreservation) in order to use in multiple treatment cycles, if needed. This helps us avoid repeated biopsies. Sperm collected through testis/ epididymis can then be used for fertilization in IVF by the technique of ICSI or IMSI. Various advanced sperm selection and fertilization techniques can be used to make fertilization more successful with these non ejaculated sperm.

It is a simple operation that is performed on an outpatient basis, under local anaesthesia, by our fertility experts.

The pieces of tissue from the testicles are processed in our fertility centre immediately during operation and examined under the microscope for the presence of sperm. If sperm are detected, all removed tissue pieces are frozen (cryopreservation) and stored directly on-site in our fertility centre. The patient is informed immediately whether the sperm was recovered or not.

On the day of egg retrieval, one of the frozen testicle samples is thawed in the laboratory. An attempt is made to select the best out the available, as many sperm required from the piece of tissue as the number of egg cells removed. All testicle samples that have not been used remain frozen and are available for further fertility treatments.

If no sperm are found in the testicular tissue of an azoospermia patient, there is, unfortunately, no hope for the man to have a genetically own child. We can offer these couples inseminations with donor sperm (donor inseminations) in our fertility centre.

BFI offers a wide range of fully tested, excellent quality sperm donors through its affiliated semen bank, ‘ SANTAN ART BANK.’

Success rates


If sperm can be detected in the testicle sample and the egg cells can be successfully fertilized, then the success rate of ICSI treatment is almost equivalent to normal ejaculated sperm in your case; the rate of successful pregnancies per treatment cycle is accordingly around 55 to 60 per cent but variable as per other fertility factors.

BFI offers you the best possible success, thanks to our excellent embryology team with vast experience in handling testicular sperm.

Sperm Retrieval

Depending upon the expected place of sperm recovery, various procedures are used for sperm recovery.

BFI’s fertility experts perform ALL sperm retrieval procedures with minimum invasion, and maximum try to get sperm. One side is checked first, and the tissue is examined. The second side is done only if we don’t get sperm on one side. We choose the least invasive method first as per the suitability of the case.

PESA (percutaneous epididymal sperm aspiration)

A fine needle is put in the epididymis. Gentle suction is applied, and fluid from the epididymis is aspirated. If we get sperm, if needed, multiple aspirations can be done immediately for recovering adequate sperm.

There is no cut, stitch or even dressing.

You are back to normal work immediately.

TESA (Testicular Sperm Aspiration)

A fine needle is put in testis. A gentle aspiration is done. A few tubules – fine pipe-like structure containing sperm – are collected.

If we get sperm, if needed, multiple aspirations can be done immediately for recovering adequate sperm.

There is no cut, stitch or even dressing.

You are back to normal work immediately.

TESE (Testicular Sperm Extraction – testicular biopsy)

A very small cut is put on the testis. Adequate tubules are collected with forceps. Since the pieces of tissue removed are very small, the risk of subsequent impairment is rather very low.

There is a very small cut and one stitch. It dissolves on its own.

You are back to normal work from the next day.

Micro TESE (Microscopic Testicular Sperm Extraction)

This procedure is done under spinal or general anaesthesia. The testis is cut open. The tubules are examined under a microscope. The tubules which appear to have sperm are removed and examined. Almost the whole of the testis is scanned for such ‘ FULL’ tubules.


  • This technique has the highest chances of getting sperm.


  • It is a major operation
  • It requires major anaesthesia
  • It requires more exploration of the testis; hence chances of negative effect on testicular function are more.

BFI has an excellent microscope, expert and experienced microsurgeon to give you a maximum chance with minimum trauma.

Our Locations