Diagnosing and treating the causes of azoospermia – complete absence of sperm in the ejaculate

The Work-up includes semen cultures, and blood tests for Chlamydia antibodies, measurement of FSH/LH and Testosterone blood levels and selective testicular biopsy to confirm the diagnosis and plan treatment. If the FSH/LH is high (much over 12MIU/ml) then it is likely that this is a testicular failure and probably little could be done to improve matters. If the FSH/LH levels are in the normal range (4-9 MIU/ml), especially if the testosterone blood level is also normal, obstruction of both sperm ducts (vasa deferentia) becomes a distinct possibility. Confirmation would require a thorough urological exam and treatment would be TESE/ ICSI. If the FSH/LH is on the low side (<4MIU/ml), especially if this is accompanied by a blood testosterone level below normal, it is suggestive of under-stimulation of sperm production and could be amenable to improvement through stimulation with Clomiphene or gonadotropins.