Here’s a quick lesson in how the body works: Sperm is made in the testicles. It travels through the reproductive tract and mixes with the fluid that’s found in the seminal ducts. Together, the sperm and this fluid make semen the thick, white ejaculate that comes out of the penis.

With azoospermia, the sperm is taken out of the equation. You may have ejaculate, but it doesn’t contain sperm. You may be familiar with the term “low sperm count” — but azoospermia, on the other hand, is referred to as “no sperm count.”

There are three types of azoospermia:

• Pre-testicular azoospermia (non-obstructive) is caused by impaired production of the hormones responsible for creating sperm.
• Testicular azoospermia (non-obstructive) is caused by any abnormalities in the function or structure of the testicles.
• Post-testicular azoospermia (obstructive) is caused by problems with ejaculation due to an obstruction of some sort in the reproductive tract.

Each type of azoospermia has its own set of possible causes or associated conditions. Overall, genetic conditions that affect the Y chromosome may cause between 10 and 15 percent of cases of no or low sperm count.

Pre-testicular azoospermia

This non-obstructive type may be brought about by certain genetic disorders. For example, Kallmann syndrome affects the body’s ability to produce gonadotropin-releasing hormone (GnRH) and can, in turn, impact sperm production.

Issues with the brain, specifically damage to the hypothalamus or pituitary gland, may also cause this type of azoospermia. Taking certain medications or having radiation treatments for cancer can contribute as well.

Testicular azoospermia

This non-obstructive type may happen due to:

• the absence of testicles (anorchia)
• testicles that haven’t dropped (cryptorchidism)
• testicles that don’t produce sperm (sertoli cell-only syndrome)
• testicles that don’t produce mature sperm (spermatogenic arrest)

Klinefelter syndrome is another possibility, and may result when a person is born with chromosomes XXY instead of XY.

Other causes include:

• having the mumps in late puberty
• tumors
• radiation
• diabetes
• prior surgery
• reactions to certain medications
• varicocele (when the veins coming from testicles are dilated/wide)

Post-testicular azoospermia

This obstructive type is present in about 40 percent of azoospermia cases. Obstruction may happen due to a missing connection somewhere, like in the epididymis or vas deferens tubes that move and store sperm.

Congenital conditions may also cause obstruction. For example, congenital bilateral absence of the vas deferens (CBAVD) is a genetic condition where the vas deferens ducts that carry sperm from the testes may be missing. It’s associated with either having or carrying genes for cystic fibrosis.

Other causes of obstructive azoospermia include things like previous or current infection, cysts, injury, or vasectomy.

You may not have any symptoms or even know you have azoospermia until your efforts conceive are unsuccessful. Any other signs or symptoms you encounter may be more related to the underlying causes, like hormonal imbalances or genetic chromosomal conditions.

Otherwise, possible symptoms might include:

• low sex drive
• erectile dysfunction
• lump, swelling, or discomfort around the testicles
• decreased hair on the face or body

The most basic way you might be diagnosed with azoospermia is through a semen analysis. Your doctor will ask you to ejaculate into a cup and submit the specimen to a lab for testing. If no living sperm is observed in the ejaculate, it’s possible you may have azoospermia.

Along with a physical exam, your doctor will be interested in your medical history. They may ask questions about:

• your fertility history (whether or not you’ve conceived children)
• your family history (like cystic fibrosis or fertility issues)
• illnesses you had as a child
• different surgeries or procedures you’ve had to the pelvic area or reproductive tract
• history of infections, like urinary tract infections (UTIs) or sexually transmitted infections (STIs)
• prior or current exposure to things like radiation or chemotherapy
• prior or current medication use
• any possible misuse of drugs or alcohol
• recent illness that involved fever
• recent exposure to high heat

Other diagnostic tools might include:

• blood tests to evaluate hormone levels or genetic conditions
• ultrasound to visualize the scrotum and other parts of the reproductive tract
• brain imaging to look for issues with the hypothalamus or pituitary gland
• biopsies to more closely examine sperm production

Obstructive azoospermia may be treated by either reconnecting or reconstructing the tubes or ducts that aren’t allowing the sperm to flow. This may mean surgery or other procedures. Hormonal treatments and medications may also help if the underlying cause is low hormone production.

Non-obstructive azoospermia may or may not respond to medical treatment. But there’s some good news: You may still be able to achieve pregnancy with a biological child through in vitro fertilization or intracytoplasmic sperm injection.

How? Your doctor can extract sperm from the testes using a tiny needle. This retrieval may be done during a biopsy as well. This procedure may work even if you only have a few sperm present in your testicles.

If you choose to go this route, it’s important to receive genetic counseling to understand the root cause and how it may impact any biological children.

Home methods to help with sperm production may or may not work with azoospermia. While low sperm count may respond well to certain herbs and dietary changes, sperm that’s absent due to an obstruction or genetic condition may not respond in the same way (if at all).

That isn’t to say that taking care of yourself by eating a well-balanced diet, getting plenty of rest, drinking enough fluids, and keeping stress in check can’t help. Aside from caring for your general well-being, consider working closely with your doctor to determine what if any natural remedies may help in your case.

Things to try:

• Eat a diet full of whole, nutrient-dense foods to foster sperm production
• Exercise regularly. Doing so may help boost testosterone levels
• Try yoga or meditation to lower your stress levels. Cortisol (stress hormone) can impact testosterone production
• Ask your doctor about herbs and supplements that may promote male fertility, like Tribulus terrestris, black seed, Coenzyme Q10, folic acid, horse chestnut, L-carnitine, Panax ginseng, and zinc.

There are some ways you can protect sperm production in cases of azoospermia that are caused by things like injury or certain medications.

Try to:

• Stay away from any activities, like rough contact sports, that may harm your testes and reproductive tract.
• Limit your exposure to radiation.
• Speak with your doctor about the benefits and risks of medications that may impact sperm production.
• Avoid activities that may expose your testes to high temperatures, like saunas or steam baths.

Being diagnosed with azoospermia or hearing the words “no sperm count” can be scary. Take a deep breath having this condition doesn’t necessarily mean you can’t have biological children.

It’s important to first understand what’s causing the issue. After discussing and addressing the cause, your doctor may have different treatment options that correct the blockage. Otherwise, procedures like IVF may help you achieve pregnancy with your partner.

What’s normal?

Understanding your semen analysis

Why does sperm count matter?

Research shows that male infertility affects up to 6 percent of men in North America. But what causes it? Several factors could contribute:

• anatomical or genetic abnormalities
• systemic or neurological diseases
• infections
• trauma
• gonadotoxic radiation therapy
• sperm antibodies

When you’re feeling the sting of another letdown, you may start weighing the pros and cons of home fertility tests. These lists give you a full picture:

The pluses

• A home kit relieves you of the stress of providing a sperm sample in the doctor’s office.
• Your concerns remain private.
• The kits are inexpensive, as well as quick and easy to use.
• A good kit, like SpermCheck Fertility can reliably tell you whether your sperm count is typical, low, or very low. This will help you plan your next step.

Shop for SpermCheck Fertility online.

The minuses

• Home kits won’t give you all the information you need. While they can tell you if your sperm count is normal or not, these numbers are only one factor in male fertility.
• The range for low and optimal sperm counts varies between the kits.
• Some kits don’t measure sperm counts below certain levels.

For these reasons, while a home kit might be a helpful first step, you’ll need to be medically evaluated by a doctor for a more complete picture of your fertility.

You’ve booked the initial appointment. Knowing that you’re prepped will ease any tension you may be feeling. Here’s a breakdown of what to expect.

First comes the physical exam. The medical practitioner will examine your penis and testicles.

Next, you’ll be asked questions about your:

• medical history
• lifestyle
• sex life

Questions about your medical history may include:

• Which medications do you take?
• Have you had any sexually transmitted infections?
• Have you had past surgeries?

Questions about your lifestyle may include:

• How much do you exercise? (Give an honest answer!)
• Do you smoke or take recreational drugs?

When it comes to your sex life, you can expect a frank discussion that includes any problems you may have, such as:

• erectile dysfunction (ED)
• delayed ejaculation
• retrograde ejaculation

After the physical exam and the questions, you’ll be asked to provide a semen sample.

How semen analysis is done

Semen samples are given in two different ways.

You can ejaculate into a special container at the doctor’s office. If this isn’t an option because of your religious or cultural beliefs, you can use a special condom during intercourse.

Be prepared to possibly provide several samples, because sperm counts do fluctuate from one specimen to the next.

What semen analysis shows about fertility

You’ve done your part by providing the sample. Now it’s up to the clinician to analyze it. According to a 2015 study done in India, as much as 2 percentTrusted Source of all men have sperm measurements that aren’t optimal.

So what is your doctor looking for? In a nutshell:

• Signs of infection. The presence of certain bacteria in semen can indicate infection.
• Volume of semen. This is a measurement of how much semen in total is in your sample.
• Sperm concentration. The World Health Organization (WHO) classifies sperm counts at or above 15 million spermTrusted Source per milliliter of semen as average.
• Vitality. This examines what percentage of sperm are alive.
• Motility. Are the sperm moving? Above 63 percentTrusted Source motility indicates fertility, while less than 32 percent of sperm with motility indicates subfertility.
• Morphology. How are the sperm shaped? Believe it or not, the majority of sperm in your sample won’t be perfect. But if more than 12 percentTrusted Source are of normal size and shape, it indicates fertility. A sample with less than 9 percent normal morphology could mean sub- or infertility. (Between 9 and 12 percent is inconclusive.)

So much for the numbers. Now let’s crunch them.

While the numbers help to distinguish between fertility, subfertility, and indeterminate fertility, none of them actually diagnoses infertility. That said, here are two things to keep in mind:

• A semen sample with a decreased sperm concentration often also shows abnormalities in sperm motility and morphology.
• The percentage of sperm with normal morphology is perhaps the best indicator of healthy semen.

Sometimes, sperm cells pass all the standard medical tests for fertility, but you still have trouble growing your family.

That could indicate a condition called normozoospermic infertility, meaning that the sperm cells themselves are infertile. Here’s where urinalysis comes in.

How urinalysis is done

At the doctor’s office or the testing facility, you’ll be given a plastic cup and asked to be provide a small, clean urine sample. Use the cleaning wipe you’ve been given to wipe around your urethra to prevent bacteria on your penis from entering the cup.

What urinalysis shows about fertility

A 2014 study shows that doctors can now test for normozoospermic infertility by tracking the levels of five biomarkers (small molecules) in urine.

While standard fertility tests may capture 75 percent of cases, the researchers were able to correctly identify 86 percent of the infertile men and 87 percent of the fertile men.

What does that mean for you? While there’s still more research needed in this area, researchers suggest that the variant levels of these biomarkers may point to physiological problems as the root of normozoospermic infertility.

Making sperm is an energy-intensive process and any spoke in the production wheel could disrupt proper sperm production. The more we learn about the biomarkers, the easier it will be to fix any physiological problems.

The pituitary gland, hypothalamus, and testicles work together when it comes to sperm production.

Follicle stimulating hormone (FSH) and luteinizing hormone (LH) — acting together with testosterone, which is produced in the testicles — are involved in the process.

A simple blood test will show the level of these three important hormones in your blood.

FSH

This hormone contributes to sperm production.

High levels may indicate that your testicles aren’t functioning properly or have been damaged by disease, X-rays, or chemotherapy. Low levels may show that you aren’t producing sperm.

LH

This is produced in the pituitary gland. In the testes, LT binds to receptors in the Leydig cells to release testosterone, which is needed to produce sperm.

LH levels can also be measured after giving an injection of gonadotropin releasing hormone (GnRH). The advantage to measuring LH this way is that your doctor can then pinpoint whether the problem is with your pituitary gland or another part of your body.

Testosterone

Healthy testosterone levels for men range between 300 to 1,000 nanograms per deciliter (ng/dL). Keep in mind that after the age of 40, testosterone levels decrease by an average of around 1 percent every year.

In some cases, your doctor may ask for imaging to check that your anatomical structure is OK and that there are no obstructions.

Scrotal ultrasound

In this exam, a handheld probe is swept across your scrotum. The scan uses high-frequency sound waves to check for:

• infections
• cysts
• a collection of fluids inside the testicles
• tumors

The test also checks for testicular torsion and varicoceles. While many adult men have a varicocele and are never bothered by it, if you’re dealing with infertility, your doctor may recommend surgery.

Transrectal ultrasound

A small, lubricated wand is inserted into your rectum. The imaging helps your doctor to check your prostate and check that there are no blockages in the vas deferens. Blockages can be corrected with surgery.

Usually, sperm doesn’t come into contact with the rest of your body and immune system. However, injury, surgery, or prostate gland infections can interfere with this protective system.

And when sperm comes into contact with your immune system, the body may produce anti-sperm antibodies.

Your doctor may ask for an anti-sperm antibody test if the cause for infertility is still missing.

You’ll be asked to provide a sample of semen. The test checks your semen for antibodies that fight against your sperm by using a substance that binds only to affected sperm.

The higher the level of sperm affected by antibodies, the lower the chance of a sperm fertilizing an egg. (These antibodies can also be found in women, so your doctor may ask for your partner to get tested too.)

Doctors are divided over whether this testing is advisable. Some say it doesn’t help set a treatment plan for infertility; others advise taking medication to lower the body’s immune response.

This test may come at the end of the line if the other tests you’ve done aren’t conclusive.

In this test, a sample is removed from the testicle, either with a needle or through a small cut. If the results of the testicular biopsy show that sperm production is normal, your infertility may be caused by a blockage or some other problem with sperm transport.

Following the development of in vitro fertilizing techniques, research on genetic causes for infertility has expanded. Genetic abnormalities are found in 10 percent to 20 percentTrusted Source of men who have severe disorders with sperm production.

Genetic testing carried out on DNA can help rule out chromosomal abnormalities, especially in men with either azoospermia (no sperm present in the semen) or oligozoospermia (low sperm count).

The test results can:

• relieve you of uncertainty
• help you avoid unnecessary surgical or medical treatments
• help you make informed decisions on what your next steps should be

If you’ve done all the tests and everything has come up as normal, you may hear your doctor saying “idiopathic infertility.” Basically, this means that at the moment, there’s no way of figuring out the cause for your infertility.

While it won’t ease your frustration and pain, know that your uncertainty is shared by many. Idiopathic infertility is an extremely common infertility diagnosis in both men and women.

Depending on your diagnosis, you may find that you need to draw on reserves that you never knew you had.

But there are many options for medically assisted pregnancy. And remember many male infertility diagnoses can be successfully treated.

Low sperm count, also called oligospermia, is a major cause of male infertility. Sperm count is considered low if it dips below 15 million sperm per milliliter (mL) of semen, although the average is around 75 million sperm per mL.

Risk factors include having obesity or overweight, having experienced trauma or surgery in or around the testicles, and taking certain medications. Other things that may put you at risk include exposing your testicles to too much heat or having other medical issues.

Beyond that, there are various causes of low sperm quality, which can be divided into three main categories: medical, environmental, and lifestyle.

Medical

A history of testicular symptoms, injury, or surgeries, as well as genetic conditions like Klinefelter syndrome, may increase your chances of having a low sperm count.

Cancer treatments, including chemotherapy, radiation, or surgery, may also affect hormone and sperm production. Radiation of the testicles directly damages the cells that produce sperm, while radiation or surgery of the brain can likewise cause low sperm count, as hormones produced in the brain stimulate sperm production.

Other possible causes include:

• swelling in the veins that drain the testicles, which is called varicocele and one of the most common causes of male infertility
• previous infections or sexually transmitted infections (STIs), which can cause blockages, scarring, or other damage to the reproductive system
• issues with erections or ejaculation (For example, diabetes and spinal injuries may cause erectile dysfunction or retrograde ejaculation.)
• issues with the immune system
• conditions like cystic fibrosis or being a genetic carrier of cystic fibrosis may block sperm from entering the semen
• medical procedures, treatments, or medications for a range of conditions, including some cancer, antifungal, antibiotic, and ulcer drugs
• previous surgery to the male reproductive system, such as testicular surgery, bladder surgery, surgery for undescended testicles, inguinal hernia repair, and of course, a vasectomy

Environmental

You may be surprised to learn that ideal sperm conditions are slightly less than body temperature, which is why the testicles are positioned outside of the abdominal cavity.

Overheating your testicles can lower sperm production. This means that anything from frequently enjoying hot tubs to sitting with your computer atop your lap may lower your counts.

Other possible environmental causes include occupational exposure to herbicides, pesticides, solvents, and other industrial chemicals or heavy metals. Exposure to radiation from X-rays or other sources may harm sperm production as well.

Lifestyle

Activities like heavy drug and alcohol use, as well as using tobacco or vaping, may likewise lower sperm count. Anabolic steroids, which are usually taken to increase muscle mass, will almost always shrink testicles and decrease sperm production.

Marijuana and opioids also reduce sperm production.

Other possible causes include:

• testosterone boosters, vitamins, and pre-workout supplements marketed toward a workout crowd all may contain small amounts of anabolic steroids, which can impair sperm production
• jobs that require long periods of sitting, such as truck driving
• emotional issues, like stress and depression, particularly if they’re long term and severe
• body weight, particularly if you have obesity or overweight, can also affect hormones

What about masturbation?

You may have heard that masturbating too frequently can lower sperm count. However, this studyTrusted Source indicates that you can ejaculate daily and still maintain normal sperm quality.

You may not experience any signs or symptoms of low sperm quality until you try to start a family. That’s right — the main symptom of oligospermia is infertility.

If your low sperm count is caused by an underlying condition — a hormone imbalance, chromosomal abnormality, testicular issue, or blockage — you may experience symptoms related to the condition, which isn’t the same as having symptoms of low sperm count. These symptoms may include:

• low sex drive
• erectile dysfunction
• swelling or pain in or around the testicles
• less facial or body hair

Related: Everything you need to know about infertility

If you’ve been having unprotected sex regularly for the last year and haven’t gotten your partner pregnant, you may want to see your doctor. If you don’t already have a primary care provider, you can browse doctors in your area through the Healthline FindCare tool. In fact, you may want to head in for an appointment sooner if you have symptoms like trouble ejaculating, pain in the testicles, or previous surgeries.

Diagnosis usually involves a physical exam, medical history, and semen analysis.

We know — ejaculating into a cup may be the last thing you want to do. However, for the medical professional requesting or receiving the analysis, it’s really no different than a urine or blood sample, so there’s no reason to feel awkward.

A semen analysis may be particularly helpful in receiving a diagnosis, as your sperm can be counted under a microscope and checked for motility (movement) and morphology (shape). Your doctor may even want to repeat the analysis to ensure consistent results because of high variability between samples.

You’ll likely be provided with a container at your doctor’s office. You’ll be asked to masturbate and ejaculate into the container either at the clinic or at home. If you opt to collect the sample at home, you’ll be instructed on how to care for the specimen until you can get it back to the lab within an hour.

Other tests your doctor may try include:

• blood tests to check hormones or chromosomes
• ultrasound to visualize the testicles or prostate
• biopsy to evaluate sperm production in the case of blockages

Related: Semen analysis and test results

The treatment you receive for low sperm count will depend on the cause. There are also some ways you can change up your trying to conceive (TTC) routine that may make pregnancy more possible.

Surgery

For cases involving large varicoceles, blockages, or issues with sperm leaving the body, surgery is an option. For example, a varicocele can be corrected with a minor outpatient surgery, and previous vasectomies can be reversed.

In other cases, sperm can be directly obtained for assisted reproduction procedures like in vitro fertilization (IVF) by surgically retrieving it from the testicle or epididymis.

Medications

Infections in the reproductive tract can be treated with medications. It’s important to treat infections promptly. Even if an infection is properly treated, sperm count may not always return to normal if permanent tissue scarring has occurred.

Counseling

Issues with sexual intercourse, including erectile dysfunction or premature ejaculation, may respond to a combination of medication and counseling.

Related: Best home remedies for premature ejaculation

Hormonal treatments

Since testosterone and other hormone levels that are either too high or too low can cause low sperm count, addressing the levels with medications and other treatments may help restore fertility.

Remember that the use of anabolic steroids, testosterone, or even most over-the-counter testosterone boosters can cause infertility, so avoid these.

Lifestyle modifications

Things you can do at home to increase the odds of pregnancy with low sperm count include having sexual intercourse more frequently and timing sex with ovulation.

For example, having sex every day or every other day within a few days before, during, and after ovulation will help ensure that the swimmers who make it all the way to the egg get there at the right time.

While you’re at it, skip all lubricants that may slow sperm travel. If you want to use lubrication, try something like Pre-Seed, but use it sparingly. Despite the common misconception, even Pre-Seed can introduce a physical barrier if used in excess.

And avoid activities that raise the temperature of the testicles, such as frequent hot tub dips, saunas, or steam rooms. Lastly, avoid excessive drug and alcohol use, as well as workout supplements that are known to lower sperm quality.

Alternative medicine

Although a variety of vitamin supplements have been studied, antioxidants or vitamins may have a minimal effect unless you have a true dietary deficiency.

Speak with your doctor before taking supplements, as some may interact with other medications you’re taking. And importantly, certain workout supplements may harm your fertility.

Give it time

It’s important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. As such, you may not see an increase for 3 months, on average.

The good news is that having fewer sperm swimming around doesn’t mean it’s impossible to achieve pregnancy — it may just make take a bit longer. Researchers share that unless your sperm count is zeroTrusted Source, you may still be able to get your partner pregnant with time.

Statistics are hard to come by here, as just how long it takes depends on a number of factors that are individual to you and your partner, including how low your sperm count is and how healthy your sperm are.

For example, motility refers to a sperm’s ability to get where it needs to go. If your motility is good, having few sperm may not be as big of a problem. However, if your sperm count is low and motility is affected, it could take longer.

Your partner’s fertility affects the equation as well, as does your ability to time sex with the ovulation window. Fortunately, you have options if pregnancy isn’t happening.

In some cases of abnormal semen quality, your doctor may suggest intrauterine insemination (IUI). This procedure may involve your female partner taking a drug called clomiphene to support egg development. At the time of ovulation, you supply sperm in a cup that’s then washed and concentrated. Next, the sperm is placed in the uterus using a long, flexible tube.

If your sperm count is very low, in vitro fertilization (IVF) may be a better option. In this procedure, doctors give the female partner certain drugs to develop healthy eggs and retrieve the mature eggs surgically.

Meanwhile, sperm can be collected ahead of time and frozen, or supplied fresh the day of fertilization. Your doctor fertilizes the eggs in a lab and then transfers healthy embryos into the uterus to implant. This whole process takes around 3 weeks to complete.

While this assisted reproductive technology is the most effective, it’s also the most invasive and expensive. According to Planned Parenthood, one cycle of IVF can cost $15,000 or more.

Couples can get pregnant with low sperm count. It may just take more time than you originally expected, and it may require seeing a doctor to see how you can improve your sperm quality.

Regardless, if you suspect you have an issue, make an appointment with your doctor. That way, you can get a better picture of just how low your count might be, what treatments are available, and whether you want to explore options like IUI or IVF to grow your family.

If your low sperm count is caused by an underlying health condition, your doctor can also help you get the treatment you need to relieve any other symptoms you’re experiencing.