What If Your Partner Has No Sperm: Is IVF Still an Option?
Finding out your partner has azoospermia (no sperm in his ejaculate) can feel devastating, but modern fertility treatments still offer hope for biological parenthood. Here’s what you need to know about IVF options when facing zero sperm count.
Types of Azoospermia
There are two main categories of azoospermia:
Obstructive Azoospermia: The testicles produce sperm, but there’s a blockage preventing them from being ejaculated. Common causes include vasectomy, congenital absence of the vas deferens (as seen in some men with cystic fibrosis), or scarring from infection or surgery.
Non-Obstructive Azoospermia: The testicles are not producing enough (or any) sperm due to hormonal imbalances, genetic conditions, or testicular damage.
Is IVF Still Possible?
Yes! Modern technology has advanced techniques like Intracytoplasmic Sperm Injection (ICSI). IVF can still be successful even with very low sperm counts or sperm retrieved directly from the testes. Don’t be discouraged, check out this story by Brienne and Eric Alves!
How Sperm Is Retrieved
If no sperm is found in the ejaculate, fertility specialists (urologists) may attempt one of the following surgical sperm retrieval methods:
TESA (Testicular Sperm Aspiration): A needle is inserted into the testicle to extract sperm directly.
TESE (Testicular Sperm Extraction): A small piece of testicular tissue is removed surgically, and sperm is extracted from the sample.
Micro-TESE: A more advanced and precise version of TESE using a surgical microscope to locate sperm-producing tubules in the testes. This is often used in men with non-obstructive azoospermia.
MESA (Microsurgical Epididymal Sperm Aspiration): Specifically used for obstructive azoospermia, MESA involves retrieving sperm directly from the epididymis—a small, coiled tube where sperm mature and are stored. MESA is performed under a microscope to locate and extract high-quality sperm in greater quantities, often suitable for cryopreservation and multiple IVF attempts.
If viable sperm are retrieved, they can be used to fertilize eggs via ICSI during an IVF cycle. In ICSI, a single sperm is injected directly into each mature egg to maximize the chance of fertilization.
Typically, the male patient has to undergo surgery while he is awake. The urologist performs one of the 3 surgical methods, and then they will pass this along to an onsite embryologist or offsite clinic for analysis. There will be significantly fewer sperm than traditional ejaculate, but only one sperm is required for ICSI fertilization!
What If No Sperm Is Found?
In rare cases, especially with severe non-obstructive azoospermia, no sperm can be retrieved, even surgically. If this happens, couples may consider:
Donor Sperm IVF: Using donor sperm to fertilize the partner's eggs through IVF.
Embryo Donation: Receiving donated embryos from another couple.
Adoption: Exploring non-biological paths to parenthood.
Stem cell-derived sperm (clinical trials ongoing)
Spermatogonial stem cell transplantation (future potential)
These options are deeply personal and often require counseling and emotional support. Do not be discouraged, as these are extremely rare cases, and the surgical procedures are usually successful.
Genetic Considerations
If azoospermia is due to a genetic cause, such as Y-chromosome microdeletions or Klinefelter syndrome, genetic counseling is recommended. Some conditions may be inherited and could affect the future child, especially if ICSI is used. Testing can help assess risks and guide decision-making.
Can TESA/TESE/MESA Sperm Be Frozen?
Yes! Leftover tissue/sperm is always frozen if the sample has viable sperm. Vitrification and warming survival rate of sperm is not 100%, but still high enough to get viable sperm for ICSI. This process is very common, and labs understand that the process of finding sperm may be long and difficult, but still possible with proper preparation.
Bottom Line: Yes, IVF Is Still Possible
✔ Obstructive cases have excellent outcomes with retrieval + ICSI
✔ Non-obstructive cases still have a ~50% chance of finding sperm with microTESE
✔ Donor sperm remains a reliable backup option
A diagnosis of “no sperm” can feel like a roadblock, but it’s not necessarily the end of your fertility journey. IVF combined with advanced sperm retrieval techniques gives many couples the chance to conceive even under these challenging circumstances. With the guidance of an experienced fertility team, including reproductive urologists and embryologists, there are multiple paths forward!
“Just because the swimmers didn’t show up doesn’t mean the race is over. IVF has workarounds. Hope is still on the menu!”
