Difference Between Aspermia and Azoospermia

Most men do not open up about their fertility issues, even after the fact that these are common. The reasons can be hesitation, social stigma, or lack of awareness. In this guide, we will be discussing two such fertility issues, named aspermia and azoospermia, that men can experience and require medical attention. While these terms may sound similar, they are two different conditions and a careful diagnosis is required to confirm them.

Understanding Aspermia

Aspermia is a condition where there is an absence of semen during ejaculation, even if the body is producing sperm normally. The problem may lie with the process of ejaculation or semen production and not with sperm production. If there is no semen, the transport of sperm out of the reproductive tract may become difficult, affecting natural conception.

Causes of Aspermia

The following factors can lead to aspermia:

• Retrograde ejaculation: The most common cause of aspermia, in this condition, the semen, instead of coming out of the penis, flows back into the bladder. This could be due to diabetes, spinal cord injuries, pelvic surgeries, nerve damage, or medications used for prostate or blood pressure problems.
• Ejaculatory duct obstructions: A blockage in the ducts prevents semen from mixing and flowing out. Presence of cysts, infections, inflammation, or congenital abnormalities may be the cause.

• Structural Issues: If a man is born without seminal vesicles or has underdeveloped ejaculatory structures, this could lead to the absence of sperm because these glands contribute most of the semen volume.

• Nerve-related issues: Surgeries involving the prostate or bladder may damage nerves needed for ejaculation. Spinal cord injuries can also impact ejaculatory function.

• Psychological problems: Severe stress, anxiety, trauma, or sexual performance concerns can interfere with the brain signals responsible for ejaculation.

• Certain medical treatments: Radiation or chemotherapy for cancer can affect semen production and the ejaculatory pathways.

Symptoms of Aspermia

Absence of semen during ejaculation itself is the most obvious symptom of aspermia. However, depending on the underlying cause, men may observe:

• Cloudy urine after sex, which may indicate retrograde ejaculation
• Reduced force or sensation during orgasm
• Mild pelvic discomfort
• Difficulty achieving orgasm
• Infertility due to a lack of semen for sperm transport

In certain cases, there are no symptoms and the issue is discovered only when couples are trying to conceive.

Types of Aspermia

Aspermia is not the same for everyone. It is broadly classified into:

Orgasmic aspermia	Anejaculatory aspermia
Men experience orgasm normally, but no semen is released.	There is no ejaculation at all, even though sexual arousal and erection may be normal. This is often linked to nerve damage or psychological causes.

Understanding Azoospermia

Azoospermia is a condition in which semen is produced without sperm in it. Unlike aspermia, where the semen itself is not released, in azoospermia, the semen is present but does not contain sperm, which is important for fertilisation. About 1 in 100 men and up to 15 per cent of infertile men have azoospermia. It is often discovered during a semen analysis when couples face difficulty conceiving.

Causes of Azoospermia

The causes depend upon the type of azoospermia, whether it is obstructive or non-obstructive.

Obstructive azoospermia

In this type of azoospermia, there is normal production of sperm in the testicles, but a physical blockage prevents them from reaching the semen. The reasons can be any of the following:

• Vasectomy: a surgical procedure for male sterilisation
• Infection of the reproductive tract
• Blocked ejaculatory ducts
• Congenital absence of the vas deferens
• Scarring from sexually transmitted infections

Non-obstructive azoospermia

In this type, the problem is not a blockage, but the testicles themselves are not producing sperm adequately. This can occur due to:

• Genetic conditions like Klinefelter syndrome
• Hormonal imbalances
• Varicocele
• History of mumps involving the testicle
• Radiation therapy or chemotherapy
• Testicular failure due to injury or infection

Symptoms of Azoospermia

Azoospermia usually does not cause visible symptoms, though men may have:

• Normal ejaculation, but failed conception
• Smaller testicular size in some cases
• Low libido or erectile issues if hormones are low
• Reduced body hair or muscle mass in hormonal cases

Types of Azoospermia

Azoospermia is classified into three clinical types:

Pre-testicular azoospermia	Testicular azoospermia	Post-testicular azoospermia
The brain is unable to send proper hormonal signals (FSH, LH) to the testicles, leading to reduced sperm production.	The testicles themselves are affected by genetic, structural, or acquired conditions.	Sperm is produced normally, but is blocked on its way out.

Aspermia Vs Azoospermia: Key Differences

Many people confuse aspermia with azoospermia, but these are two different conditions. Here is how:

Aspermia	Azoospermia
No semen during ejaculation, but sperm may still be produced Problem with ejaculation or semen production Affects fertility due to a lack of semen transport	Semen is present but contains no sperm Problem with sperm production or blockage Natural conception becomes difficult due to a lack of sperm

Diagnosis of Aspermia and Azoospermia

These conditions can be detected by:

• A detailed medical examination to analyse symptoms, previous medical history, and any structural abnormalities.
• Semen analysis, the gold standard for detecting male infertility issues. It confirms the absence of semen (aspermia) or the absence of sperm (azoospermia).
• Post-ejaculatory urine test may be advised to detect retrograde ejaculation by checking sperm in urine.
• Hormonal blood tests are conducted to assess testosterone, FSH, LH, and prolactin levels linked to sperm production.
• Scrotal ultrasound checks for testicular health, varicocele, and reproductive tract structures.
• Transrectal ultrasound (TRUS) identifies ejaculatory duct obstruction and seminal vesicle issues.
• Genetic testing screens for chromosomal or Y-chromosome abnormalities affecting sperm production.
• A testicular biopsy or micro-TESE determines if sperm production exists inside the testicles.

Treatment for Aspermia Based on Its Type

For retrograde ejaculation, the treatment may include:

• Medications to tighten the bladder neck.
• Adjusting medications that may cause the issue.
• Managing diabetes or nerve-related conditions.
• Collecting sperm from urine for IVF or ICSI.

For ejaculatory duct obstruction, the treatment may include:

• Minor surgery to open the blocked ducts.
• Treatment for infections or inflammation.
• Assisted reproductive techniques, if required.

For anejaculation due to nerve issues, the treatment may include:

• Vibratory stimulation or electroejaculation.
• Psychological counselling if it is stress-related.
• Hormonal therapy for specific deficiencies.
• Sperm retrieval directly from the testicle, if needed.

For congenital abnormalities, the treatment may include:

• Surgical options, wherever possible.
• IVF with surgical sperm extraction for conception.

Treatment for Azoospermia Based on Its Type

Pre-testicular Azoospermia

Treatment focuses on correcting the hormonal imbalance:

• Hormone therapy (FSH, LH, hCG) to restart sperm production
• Treatment of pituitary or hypothalamic disorders
• Managing thyroid, prolactin, or metabolic issues
• Lifestyle changes to support hormone balance

Testicular Azoospermia

Treatment focuses on improving or recovering sperm production:

• Varicocele repair (if present)
• Hormone optimisation (in selected cases)
• Antioxidants and lifestyle modification
• Micro-TESE to retrieve even small pockets of viable sperm for IVF-ICSI

Post-testicular Azoospermia

Treatment focuses on removing the obstruction or bypassing it:

• Microsurgical reconstruction of blocked reproductive ducts
• Vasectomy reversal
• Surgery to treat ejaculatory duct obstruction
• Sperm retrieval techniques (PESA, TESA, TESE) followed by IVF-ICSI

Even in severe cases, men can often father a biological child using modern sperm retrieval techniques.

The Closing Note

Are you trying to conceive for over a year without success? It’s time for a fertility assessment of both partners, because now we have understood that male factors can also contribute to infertility. Finding the right cause is, therefore, important for the right treatment. Aspermia and azoospermia may sound similar, but they are two different male infertility conditions that require different approaches to manage them. While aspermia is primarily a problem of ejaculation, azoospermia involves the absence of sperm.

Consult our leading fertility specialists at Birla Fertility & IVF and step closer to your parenthood journey with the clarity and guidance you need.

FAQs

1. How common are aspermia and azoospermia?

Azoospermia affects around 1% of all men and 10–15% of infertile men.
Aspermia is less common but seen in men with pelvic surgeries, diabetes, or nerve-related conditions.

2. What is the normal range of semen analysis to get pregnant?

A normal semen analysis, as per WHO guidelines, includes:

• Semen volume: 1.5 ml or more
• Sperm concentration: 15 million/ml or more
• Total motility: 40% or more
• Progressive motility: 32% or more
• Morphology: 4% normal forms or more

3. Do lifestyle factors impact sperm abnormalities?

Lifestyle plays a major role. Factors that negatively impact sperm include:

• Smoking
• Excess alcohol
• Obesity
• Stress
• Poor sleep
• Exposure to heat (laptops, hot baths)
• Steroid or drug use
• Sedentary lifestyle

4. Can aspermia and azoospermia be treated?

While many men successfully embrace fatherhood with the timely intervention, the treatment largely depends on the cause:

• Obstructive causes can often be corrected surgically
• Hormonal imbalances can be treated with medication
• Retrograde ejaculation can be managed effectively
• Non-obstructive azoospermia may allow sperm retrieval for IVF-ICSI

5. How Do Aspermia and Azoospermia Affect Male Fertility?

In aspermia, there is no semen to transport sperm to the egg. Assisted reproductive technology is used to retrieve sperm and then fertilise the egg.

In azoospermia, there is no sperm in the semen, so natural pregnancy is not possible. The impact depends on whether the cause is blockages or sperm production issues. With treatments like micro TESE, even a small number of sperm can be used for ICSI, giving couples a good chance of pregnancy.