Azoospermia and ICSI

by Beena

Dear Amelia

I have been married for the past 2 years and haven't conceived. On testing, my husband was diagonised to have azoospermia and we were asked to go for ICSI. His FSH level also seems to be higher than normal.

But we aren't really prepared for ICSI and would like to have a baby in a natural way. Is there some treatment that you would like to suggest?


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by: Amelia Hirota

Hi Beena,
I'm so sorry to hear about your husband's possibly azoospermia. I'm curious as to whether your husband has a very low sperm count or no sperm at all? Azoospermia means that there is no sperm whatsoever in the ejaculate.

I ask because you mentioned that your doctor has recommended ICSI. Are they planning on harvesting your husband's sperm for the ICSI procedure?

Let's talk a bit about the big picture of azoospermia. The reason for zero sperm is either a problem in the production of sperm or in the presence of sperm in the ejaculate.

It appears from the high FSH that you mentioned that the problem may be in the production. A high FSH means that the pituitary gland is ramping up the production of FSH to stimulate the production of sperm. So, this may be a hormonal problem. I recommend making sure that your husband has his LH, prolactin, testosterone, and thyroid (I recommend testing TSH, T4, T3, anti-TPO and anti-TG) tested to see if there are any other hormonal imbalances.

Also, there may be a functional problem that is preventing the manufactured sperm from being ejaculated. In order to check for blockages, it's important to have a thorough physical examination of the scrotum. It's especially important to rule out a varicocele or blockages in the seminal vesicle with an ultrasound.

Lastly, your husband should ejaculate and then have the urine following ejaculation tested for the presence of sperm. If there is sperm in his urine, this could indicate that the entry to the bladder isn't closing properly, and is therefore allowing the semen to flow into the bladder.

So, in answer to your question about a treatment for azoospermia, I would recommend thoroughly examining your husband and figuring out the cause for his azoospermia first. Then once you know the cause, you'll be in a better position to choose a treatment strategy.

If the problem is entirely hormonal, then I think that acupuncture and herbal therapy could be very helpful for your husband. I'm wondering if your husband took steroid medication at some point? Prednisone can have an affect on the sperm and it is often prescribed for asthma, eczema and psoriasis.

I hope this is helpful for you. If you do decide to harvest your husband's sperm and undergo ICSI, please be sure to prepare your bodies for at least 3 months beforehand with a healthy diet and no caffeine, decaf, alcohol, artificial sweeteners, hydrogenated oils, high fructose corn syrup or processed foods. Best of luck to the two of you.

Sending Baby Dust Your Way,
Amelia Hirota, Licensed and Board Certified Acupuncturist and Herbalist

by: Anonymous

Hello Amelia,

I was diagnosed with azoospermia because of blockage in ejaculatory duct. My Urologist did a surgery after which the blockage was temporarily removed. After this we did find 9 million sperms during ejaculation. But soon after the blockage resurfaced and I now have 0 sperm count. Do you think acupuncture can help here?


Possible Infection
by: Amelia Hirota

I'm not sure if acupuncture on it's own is going to clear the blockage, but appropriate herbs might be helpful. If a blockage formed so soon after surgery, it sounds like there might be an infection of some kind. Common infections could include various STDs or just a low grade infection. I encourage you to see an acupuncturist that is board certified in Chinese herbs and she can check to see if you have an infection.

I recommend herbs in conjunction with acupuncture first. Hopefully, this will address whatever is going on constitutionally. If you need to have surgery again, this preparatory treatment will hopefully prevent the blockage from recurring again. Best of luck!

Warm regards,
Amelia Hirota

Azoospermia Following Normal Semen Analysis
by: GUS

Hi Amelia,
I have been married for 10 years now and couldn't conceive. Long story short , we had 3 ICSI without a positive pregnancy test. I had few problems with my thyroid and later found out that I have Hashimoto's.

Once I started working on it, I lowered my thyroid antibodies to 200 (was 900.)

Now my husband suddenly has azoospermia. There is nothing in the urine. What is causing that? It just suddenly happened. He is a truck driver. Please any answer would help.

Thank you,

Sudden Azoospermia
by: Amelia Hirota

Hi Gus,
Because you've done 3 IVF cycles with ICSI already, it sounds like there was already a male factor issue. I'm curious what your husband's sperm count, motility and morphology were when you were doing ICSI.

I understand that now the count is zero with the azoospermia diagnosis. Did you husband sustain any kind of groin injury or have an infection in his genital area recently? It seems that his count was probably already low if you were doing ICSI, so possibly some sort of health issue or injury could have caused the count to diminish to zero.

As I mentioned above, it's important to check out hormone levels and structural function to determine what is causing the azoospermia. I'm sorry that I can't give you a definitive answer as to why your husband has azoospermia now. However, the fact that you needed ICSI before tells me that possibly his sperm counts were already in the process of declining. I have seen patients that had low sperm counts and then had Azoospermia one day.

If your husband had very high sperm counts with good motility and morphology before and then all of a sudden had Azoospermia, it would be a different issue. I suspect that this has been a steady progression if he hasn't had a recent genital infection or sustained an injury.

Definitely have him see a urologist that's familiar with Azoospermia and get him thoroughly tested.

Take care,
Amelia Hirota, D.Ac.

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