No Sperm Count (Azoospermia)

No Sperm Count or Zero Sperm Count (Azoospermia) Causes, Symptoms and Treatment

Azoospermia, also known as a zero or no sperm count, is a male fertility issue that occurs when
there is sperm in a man’s ejaculate. Azoospermia is present in 2% of the general male population, and
as such, is a frequent factor involved with the inability to conceive.

What Does "A Zero Sperm Count" Mean?

By definition, Azoospermia means that a man does not have a measurable amount of sperm in his
ejaculate. The condition is typically diagnosed when a patient and their partner are experiencing
difficulty conceiving and seek testing and diagnosis from a fertility specialist. A semen analysis will be
performed in order to determine the number of viable sperm found in the male patients’ ejaculate. If
virtually no sperm is found, your doctor may suggest additional testing as necessary. This testing can
include a semen analysis at a fertility laboratory such as The Fertility Center of California (FCC), the
partner laboratory of The Male Fertility Specialists. A fertility lab like FCC, with a technique called high
speed centrifugation (HSC), a few sperm can often be found that may have been missed by testing in
some of the larger, less-specialized laboratories or by “at-home” sperm count tests. Indeed, HSC can
find sperm in approximately 15% of specimens initially thought to have zero sperm. Other tests would
likely include genetics testing and hormonal tests.

What Causes Azoospermia?

Azoospermia can be caused by a variety of conditions, these include but are not limited to:
A blockage in the genitalia, also known as “obstructive azoospermia”
An infection within the male reproductive system
Injury to the genitalia
Effects from surgery to the male reproductive system - including effects from radiation and
chemotherapy treatments
Genetic causes as identified by Karyotype cystic fibrosis, and Y-chromosome microdeletion
testing.
Other potential causes include: undescended testes (also known as cryptorchidism) varicocele,
medications such as steroids and antibiotics, excessive alcohol consumption, and illegal drug
use.

Does Azoospermia Have Any Symptoms?

A comprehensive semen analysis, inclusive of HSC is required in order to verify a zero sperm count
diagnosis. However, there are a few symptoms that are recognized in relation to having abnormal
semen. Symptoms of abnormal semen can include semen that has an unusual color quality such as red
or brown tinted (may indicate blood), semen that is thicker or thinner in consistency, ejaculate having a
strong odor and/or is of a low volume. Very occasionally, there is little or no volume at the time of
ejaculation associated with a condition known as ejaculatory duct obstruction. More common causes of
painful ejaculation not associated with a zero sperm count (azoospermia) would include prostate
infection (prostatitis) and sexually transmitted infections (STI).

Can I Still Get My Partner Pregnant If I Have a Zero Sperm Count?

Whether or not you can impregnate your partner is dependent on the diagnosis made by your fertility
specialists. A Fellowship trained male fertility specialist will advise you on the cause of your
azoospermia and what treatment options are available to help you conceive.
It is important NOT to give up until you are certain that a fully trained male fertility specialist feels that
NO sperm is present. Even when no sperm is found in the ejaculate, about 50% of the time there is
sperm in the testicles that can be retrieved and used for IVF. Dr. Bastuba and the Male Fertility
Specialists Team in conjunction with Fertility Center of California have helped achieve pregnancies in
cases where only a handful of sperm were present inside a man’s testicle. Do NOT give up

Is There A Cure for Azoospermia?

Treatment options for azoospermia are entirely dependent on the type and cause of the condition. If
the zero sperm count is caused by a blockage then your doctor can occasionally attempt to remove the
source of this blockage through a surgical procedure.
If there is sperm production in the testicles, it can be retrieved for use with IVF / ICSI
(intracytoplasmic sperm injection). With the ICSI form of IVF, a single sperm is inserted into each egg.
This means that even a handful of sperm may be enough for a couple to have a successful outcome.
If there is normal sperm production that cannot get out, then the sperm retrieval process may be a
simple office based procedure such as a Testicular Sperm Aspiration (TESA) or Testicular Sperm
Extraction (TESE). If the sperm production is low or very low, following a mapping process known as
Testicular Fine Need Aspiration (TFNA) used to identify the location of the sperm, a procedure known
as Micro Testicular Sperm Extraction (micro-TESE) is the required technique.
It is important to seek out a surgeon that is very experienced in these techniques to have the best
chance for success.
If the issue is more hormonal in nature, then your doctor may prescribe medications to correct
hormonal imbalances and promote sperm production. If infection is a cause then antibiotic treatment
would be initiated.

Where Can I Go to Receive Azoospermia Treatment?

1.First, start with a urologist who has done additional advanced training known as a Fellowship. Dr.
Bastuba received his Fellowship training, 1992-1993, from the University of Boston.
2.Then, make sure this physician has dedicated themselves to using this advanced training and all of the
latest techniques with many different IVF centers.
3.Make sure that the doctor has laboratory experience to be able to examine, freeze (cryopreserved)
and store sperm that is found at the time of retrieval. Dr. Bastuba is the medical director of the Fertility
Center of California and has developed special techniques for all of these functions.
(https://www.malefertility.md/male-infertility/sperm-disorders/azoospermia-treatment)
Azoospermia – Know Your Options for Treatment
We hear it too often, “My husband was diagnosed with azoospermia, can you help me and what is
this?” This complicated medical condition has a variety of causes and can be challenging to treat,
especially naturally. Few cases will be able to be successfully helped through natural means alone.
Let’s get down to the facts first, since so many people aren’t quite sure what azoospermia is.
Azoospermia is a male medical condition, diagnosed when there is an undetectable amount of sperm in
a man’s semen. This condition affects 1% of the male population and it is estimated that up to 10-15%
of cases of male infertility are due to azoospermia, according to the Cleveland Clinic.
There are three different classifications of azoospermia, falling under either obstructive or non-
obstructive azoospermia. This is where we will get into some medical names and terminology that may
be hard to understand. I will do my best to explain.
Obstructive azoospermia
Male reproductive tract obstruction. Sperm are still produced, but not ejaculated.
Posttesticular azoospermia
This is where sperm are still produced, but a blockage in the genital tract is preventing ejaculation. This
condition affects 7-51% of azoospermia cases.
Causes of posttesticular azoospermia:
Congenital absence of the vas deferens, idiopathic epididymal* obstruction. Congenital reproductive
tract obstruction should have cystic fibrosis (CF) gene mutation analysis performed prior to going for IUI
or IVF, because these men are at a higher risk for carrying CF gene mutation.
Acquired from infection due to vasectomy, or other injury to the male reproductive tract.
Non-obstructive azoospermia
Inadequate production of sperm.
Pretesticular azoospermia
This is defined as inadequate stimulation of otherwise normal genital tract and testicles. Follicle-
stimulating hormone (FSH) is typically low. FSH is needed to stimulate the testes to produce sperm.
Testicular azoospermia
Sperm production is severely disturbed or completely absent due to abnormal, atrophic (decreased
size, atrophy of the testicular tissues), or absent testes. FSH levels are typically elevated because of an
interruption in the hormonal feedback loop. Elevated FSH level in men is known as testicular failure and
is responsible for 49-93% of azoospermia cases. High FSH levels lead to low production of sperm or
complete absence of mature sperm because this alters spermatogenesis, which is the maturation of
sperm.

Causes of Testicular Failure:

Genetic conditions
Infection due to STD’s or surgery
Surgery/trauma (vasectomy, cancer, radiation, chemotherapy)
A common reaction from surgery may be mast cells that work to release inflammatory mediators,
which may lower sperm motility (forward movement).
It is recommended that men diagnosed with elevated levels of FSH and azoospermia for unexplained
reasons ask their doctor about a referral for a chromosomal evaluation.
Idiopathic azoospermia
Idiopathic simply means “unknown cause”. Doctors and researchers are working to figure out why, in
some cases, men may still be diagnosed with non-obstructive azoospermia with no known cause. Some
new research has shown a connection between azoospermia and being overweight to obese. The odds
of an overweight man having azoospermia is a ratio of 1:1, whereas it is 1:3 for obese men.
Treatment for Azoospermia
A doctor will be able to provide information on medical options specific to diagnosis. Since the cause of
azoospermia can be varied, there will be different treatment options, depending on the cause.
For men with genetic causes of azoospermia, treatment may be limited to non-existent, depending on
the type of genetic defect. In the case of testicular failure, doctors may be limited to treating a man
with hormonal medications. Obstructive azoospermia may be able to be treated with surgery to
remove the blockage.
Several tests will be run to determine if there is any sperm cell production, if there is, the sperm may be
extracted for IVF.
For some men with obstructive azoospermia, according to P. N. Schlegel of The New York Presbyterian
Hospital, Weill Medical College of Cornell University, treatment may include:
“microsurgical reconstruction or transurethral resection of the ejaculatory ducts, depending on the level
of obstruction”
sperm retrieval via assisted reproductive technology, with success rates ranging from 25% to 65%
Natural Options for Azoospermia
To be honest there are very limited natural options for men with azoospermia. First and foremost, it is
important to work with a doctor who specializes in this condition. Second, it is a well-known fact that
the male body requires a wide variety of nutrients to produce balanced hormones and healthy sperm.
For men working to reverse azoospermia, eating a nutrient-dense whole food diet is going to be very
important. Today’s modern diet often doesn’t nourish the body properly and that is where nutritional
supplementation can be useful in improving sperm production.
For men who are overweight or obese with azoospermia, getting on a weight loss program is going to
be imperative to restoring sperm production.
There are a variety of herbs that have been shown to help support men’s hormonal balance and sperm
production. These herbs may be worth considering as part of a healing plan for azoospermia caused by
non-genetic, non-obstructive azoospermia. As always, it would be best to find a natural healthcare
practitioner, skilled in the use of botanical medicine to work with, alongside a medical doctor.
Herbs to improve hormonal balance and sperm production in men:
American Ginseng root (Panax quinquefolius)
Cordyceps mushroom (Cordyceps sinensis)
Maca root (Lepidium meyenii)
Saw Palmetto berries (Serenoa repens)
Schisandra fruit and seed (Schisandra chinensis)
Tribulus aerial parts and fruit (Tribulus terrestris)
Important Note: We do not suggest combining any herbs for fertility while also taking medications for
fertility treatments.
Systemic Enzyme Therapy is a natural option that may be considered after surgical treatment. For men
who plan to have surgery to remove an obstruction causing azoospermia, they will want to consider
ways to prevent additional scar tissue and inflammation. Systemic Enzyme Therapy may be a good
option. Specific systemic enzymes may help support the health and proper healing post-surgery by
aiding the immune system’s inflammatory response. This may help prevent excessive scar tissue
formation. Excessive scar tissue formation may cause the area treated to become blocked again.
Systemic Enzyme Therapy may also be useful for those who have developed antisperm antibodies due
to vasectomy or other surgery.
Managing stress and sadness surrounding medical testing, treatments and diagnosis, along with facing
the possibility of infertility, should also be considered. There are a variety of natural options to help
manage stress.
Closing Thoughts
For the vast majority of men diagnosed with azoospermia, natural treatment options are going to be
important for supporting the overall health and function of the body and reproductive system, but
cannot be relied on as the sole solution. Men with azoospermia need to work closely with their medical
doctor on solutions unique to the cause. Some men may find that improving diet and lifestyle choices
will be all it takes to aid the body in producing sperm once again but, to be honest, this is very rare.
In the case of irreversible testicular azoospermia, sperm extraction for IUI or IVF may be required.
(https://natural-fertility-info.com/treatment-of-azoospermia.html)

Azoospermia
Azoospermia is a condition in which there is no sperm in the ejaculate. Azoospermia is present in 1% of
men in the general population and in 15% of men with infertility.
Azoospermia is not the same as aspermia, which is the complete absence of seminal fluid upon
ejaculation. A patient has azoospermia if microscopic examination of two separate concentrated semen
samples reveals no sperm.
Azoospermia may be caused by a variety of different diseases or conditions. The potential causes of
azoospermia may be divided into three categories: pre-testicular, testicular, and post-testicular. In pre-
testicular azoospermia, the testicles and genital tract are normal but are not appropriately stimulated
by the hormonal system to produce sperm. In testicular azoospermia, the testicles themselves are
abnormal and unable to produce sperm. Together, pre-testicular and testicular azoospermia are called
nonobstructive azoospermia. In post-testicular azoospermia, also called obstructive azoospermia,
sperm is produced by normal testicles but is not ejaculated due to an obstruction of the genital tract.
Obstructive azoospermia is intentionally induced by physicians performing a vasectomy.

Causes:
Pretesticular azoospermia is associated with poor nutrition, the use of certain medications (e.g.,
particular chemotherapies, narcotics), pituitary tumors, trauma, and low testosterone (hypogonadism).
It may also be caused by other disorders of the pituitary gland, including hypopituitarism and
hyperprolactinemia. Another important cause of pre-testicular azoospermia is the use of testosterone
replacement therapy and/or the abuse of anabolic steroids. Anabolic steroids suppress natural
testosterone synthesis, inhibiting sperm production.

Treatment:
The specific therapy to correct pre-testicular azoospermia depends on the underlying cause of the disorder.
Pretesticular azoospermia is often amenable to treatment by physician-supervised hormone replacement
therapy.

(https://www.med.unc.edu/urology/patientcare/adult-non-cancer/male-fertility/azoospermia/)