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.
Male reproductive tract obstruction. Sperm are still produced, but not ejaculated.
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.
Inadequate production of sperm.
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.
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 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.
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.
*A single, narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens.
- Schlegel, P. N. (2004). Causes of azoospermia and their management. Reproduction, Fertility and Development, 16(5), 561. doi:10.1071/rd03087 Retrieved from: http://www.publish.csiro.au/RD/RD03087
- Hwang, K., Smith, J. F., Coward, R. M., Penzias, A., Bendikson, K., Butts, S., . . . Vernon, M. (2018). Evaluation of the azoospermic male: A committee opinion. Fertility and Sterility, 109(5), 777-782. doi:10.1016/j.fertnstert.2018.01.043 Retrieved from: https://www.fertstert.org/article/S0015-0282(18)30069-4/fulltext
- Azoospermia. (n.d.). Retrieved from: https://my.clevelandclinic.org/health/diseases/15441-azoospermia
- Epididymis. (n.d.). Retrieved from: https://www.merriam-webster.com/dictionary/epididymis