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Azoospermia – Know Your Options for Treatment

Azoospermia – Know Your Options for Treatment

Male InfertilityWe 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.

Click here to learn about the most important nutrients for sperm production and health…

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:

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.

*A single, narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens.


Dr. Christine Traxler M.D., OB/GYN
Dr. Christine Traxler M.D., OB/GYN

Dr. Traxler is a University-trained obstetrician/gynecologist, working with patients in Minnesota for over 20 years. She is a professional medical writer; having authored multiple books on pregnancy and childbirth; textbooks and coursework for medical students and other healthcare providers; and has written over 1000 articles on medical, health, and wellness topics.  Dr. Traxler attended the University of Minnesota College of Biological Sciences and University of Minnesota Medical School,  earning a degree in biochemistry with summa cum laude honors in 1981,  and receiving her Medical Doctorate degree (MD) in 1986.

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  1. Avatar

    My sperm production is normal, as determined by a testis biopsy or FNA mapping, my doctor told me it is the azoospermia caused by an obstruction.i need to the cost of treatment for this.

    • Dear Sami,

      What is the cause of the obstruction? If it could be infection, that may need to be addressed medically. It will help you to know this!

      The herbs discussed in this guide are combined in a product called MH5 and Systemic Enzymes in a blend called Fertilica Choice Enzymes are available from the Natural Fertility Shop. The blue links in this guide will help you learn more about the items mentioned.

  2. Avatar

    I need suggestion for azoospermia treatment & how to recover from this problem?

  3. Avatar

    my son has testicular failure from birth he is on testrerone injections I want to know is there no other medicine besides injections

  4. Avatar

    I am a 31 Years old male suffering with azoospermia.

    I went under TESA but found NO Sperm.

    Could you please suggest me what should I do now or how can I be a parent?

    • Dear Abhishek,

      As this guide shared, azoospermia is complicated. It often requires medical evaluation and/or treatment if there is one, and then natural therapies can be used to benefit overall male fertility health. It will be best to talk with your doctor first about the cause and any potential treatment. Feel free to share this guide with him/her to ask if you can use that which you are interested in using.

  5. Avatar

    i want fertility treatment . Kindly give me doctors details to get treatment.My place is tamilnadu,India.

    • Dear Stanley,

      I’m sorry we don’t have a doctor on staff or keep a list of fertility doctors for our clients. Perhaps your healthcare provider can direct or refer you to a fertility specialist near you.

      My best!

  6. Avatar

    Dear Doctor,
    I am 36 years old, I have a daughter who is 4 years old now. I have planned for second child and went to see that doctor after the report it was informed me that I have problem of azoospermia. How do I overcome this issue. Please help. Sam

    • Dear Sam,

      I first must clarify that I am not a doctor, nor do we have one on staff. We are a team of natural fertility specialists, many herbalists.

      This very guide is designed to help you understand how you can support the body in producing healthy sperm. Consider rereading through it. It will also be helpful to know what has caused Azoospermia for you.

      If you are still unsure of where to begin, or how to proceed, please consider working one on one with our fertility herbalist who can lay out an entire natural fertility program for you based on your specific fertility health needs. This is offered through a Fertility Consultation. Learn more and book a Fertility Consultation here…

  7. Avatar

    Just wanted to say thank you Elizabeth Willett.
    That is detailed and informative article for me.
    Stay happy

  8. Avatar

    I had abnormal mass growth in my left testicle and it was surgically removed. After CT Scan they found abnormal growth around my left kidney, so they removed that too. I underwent 8 cycles of chemotherapy. The biopsy report came and we found that the mass was non-malignant. After tests, I came to know I’m now suffering from azoospermia. Please let me know what to do, who to meet, and how to get this sorted?

    • Dear Beta,

      I’m sorry for all you’ve been through and glad to hear the growths were benign!

      You will want to discuss with your doctor the potential for sperm production to return post chemotherapy. There may be cases, sadly when it won’t, but I can not know if this is the case for you. The Natural Options for Azoospermia that we share here could certainly be considered, but working with a doctor if going to give you the best idea of how to move forward.

  9. Avatar

    Hi Dr,
    My recent diagnosis shows I am azoospermic with normal hormone levels, fructose normal, semen volume normal, PH 7.5. age 30. Ultra-sound shows small normal scrotum size,hydrocele sac in my left scrotum. Height 171cm, weight 85kgs. could this be obstructive or non-obstructive azoospermia? could it be retrograde ejaculation? what could possibly be the reason of this?I am really confused. Pls assist.

    • Dear Alpha,

      It could be any of the causes listed. It would be best to ask your healthcare provider if he/she can help you understand the cause as you contemplate the best plan for you.

  10. Avatar

    nil sperm count
    pls suggest what i do

    • Dear Pappu,

      It will first be most helpful to talk to your doctor about what has led to azoospermia for you. Knowing the cause will help him and you create a program to support your fertility health.

      It is important to work with a doctor who specializes in treating men with azoospermia and to boost fertility healthy by eating a nutrient dense whole food diet for men and then consider herbs known to support male hormonal balance and sperm production.

      All my best!

  11. Avatar

    for male fertility, SEmen test result shows Active mobility = 05 % , non active =75 % and sperm count 40 million / ml. i had tested all medicine , but no improve in active mobility. how can i increase active moblity ? and age is 35.please help me

    • Elizabeth Willett, MA, CH

      Hello Siva!

      Dietary and lifestyle factors, even environmental factors, can have an effect on overall sperm health, a part of which is mobility, often referred to as motility, and in other words the sperm’s ability to swim progressively forward.

      You could consider preparing your reproductive system to be better able to support sperm health by doing a Male Fertility Cleanse and then take time to learn how to support sperm health through the information shared in the following two articles…

      The Male Fertility Diet

      I hope this is a helpful start!

  12. Avatar

    Goodday sir. How can one get these herbs?. I have some patients I will like to try it on. Thanks.