Generally speaking, couples are considered infertile after about a year of trying to conceive with unprotected sex. Crossing the invisible line into the infertility world can be overwhelming and intimidating. Aside from feeling like pregnancy announcements are posted everywhere you look, you may worry about your overall health and not know what to do next.

You’re not alone. Some 12 to 13 in 100 couples experience infertility. Up to 50 percent of these cases can be attributed to what’s called male-factor infertility. Azoospermia is a possible cause, which is marked by a total lack of sperm in the semen. While rare, about 1 percent of men have azoospermia, and it’s the root of between 10 to 15 percent of infertility cases.

Related: Infertility: Male causes and female causes

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.

Related: What is sperm mobility and how does it affect fertility?

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.

Related: Vasectomy reversal: What you need to know

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

Related: What is normal sperm count?

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.

Related: 10 ways to boost sperm production

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.

Related: Why are my testicles cold and what’s the best way to warm them up?

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.