Varicocele as a Cause of Azoospermia: Can Repair Restore Sperm Production?

Azoospermia means that no sperm is seen in the semen sample. This result can be worrying, but it does not always mean that biological fatherhood is impossible.

A varicocele may be one possible factor in selected men. However, in most cases varicocele may reduce sperm counts and usually do not cause azoospermia. Repair may help sperm production in very very few cases, but it cannot guarantee that sperm will return.

What Is Azoospermia?

Azoospermia is usually confirmed with another carefully examined semen sample. It may happen because sperm is being produced but cannot reach the semen because of blockage, or because the testicles are producing very little or no sperm or rarely because of no hormones are produced from the brain.

Knowing the type is important because the treatment options are different.

What Are the Reasons for Azoospermia?

Possible reasons for azoospermia include:

• A blockage in the reproductive tract
• Hormone problems
• Genetic conditions
• Earlier infection, injury or surgery
• Undescended testicles
• Cancer treatment
• Use of testosterone or anabolic steroids
• A serious problem with sperm production
• Varicocele in some men

The cause needs to be understood before treatment is recommended.

What Is a Varicocele?

A varicocele is an enlargement of veins around the testicle. It may affect the temperature and function of the testicle. Some men with a varicocele have fertility problems, while many do not.

This is why a varicocele should not automatically be considered the cause of azoospermia.

Can Repair Restore Sperm Production?

In very few selected men with non-obstructive azoospermia, sperm may appear in the semen after varicocele repair. This does not happen in every case, and improvement may take several months.

Usually testicular biopsy by TESA/ microTEST followed by IVF-ICSI remains the first choice treatment in men with azoospermia.

The chance depends on hormone levels, genetic findings and how well the testicles are producing sperm. Even if sperm returns, IVF with ICSI may still be required.

What If Sperms Do Not Return?

Usually a testicular biopsy is performed alongside varicocele repair. If sperms are found in this biopsy the sperm are frozen.

If sperms do not return after varicocele surgery these frozen sperms from biopsy are used for IVF-ICSI.

If during the biopsy at time of varicocele repair no sperms are found, specialists may discuss repeat surgical sperm retrieval in a few suitable cases with TESA or microTESE . Sperm retrieval is also not guaranteed, and the result depends on the underlying condition.

If all attempts at retrieving the sperm are unsuccessful , donor sperm treatment with IUI or IVF-ICSI may be recommended.

At Bavishi Fertility Institute, azoospermia is evaluated carefully before any procedure is advised.

Speak with our fertility specialists if your semen report shows azoospermia or you want to know whether varicocele treatment may suit your case.