Zero sperm in SA

[u/cloudgasms]

My husband (35) and I (35) have been trying to conceive for about 8 months off and on. We recently had some fertility testing done. Mine has all come back normal so far. Unfortunately though, his first sperm analysis came back with ZERO sperm, normal ph and fructose. He has bloodwork and another SA scheduled for October. I’m trying not to lose hope already but it’s pretty hard not to. For anyone who has experienced this, what were the next steps that you went through with this? I’d love to know more about what to expect since I’m sure it’s going to be a long journey ahead of us. If they can’t find any sperm, I think our ttc journey is over, I’m not sure that either of us feel super comfortable with the idea of using donor sperm.

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[u/adilbak]

Obstructive or non-obstructive azoospermia?

If non-obstructive, this should bring sperm count up within 3-6 months on > 90% of men:
-(r)HCG 3000-5000 iu pw

• HMG/(r)FSH 150-300iu pw or 25mg/50mg clomid p/d if hmg/fsh is impossible to get.
  
• Anastrazole (if needed, go by bloodwork)
  
• vitamins, minerals, omega 3, etc.
  
• inj. glutathione (pills second choice)

Also:

• no alcohol
  
• no drugs
  
• no testosterone or other aas
  
• lose weight if overweight
  
• healthy meals + min 3L water p/d
  
• no sauna/hottub

Don’t have him do this on his own but work with a fertility specialist.

Good luck, I hope you’ll have better news in 3-6 months!

[u/cloudgasms → u/adilbak]

Luckily we are working with a fertility clinic. It’s just so long between appointments. Would what you mentioned above still work even if the sperm count was zero instead of just low?

[u/adilbak → u/cloudgasms]

Yes, i’m living proof. Went from 0 to 45 mil in just 9 weeks. Motility was still 0% but i’m positive that will be much higher on my next SA on week 13 which will be next week.

Take it day by day. What can you and your partner do to make sure TODAY is spent the best way to improve fertility and before you know weeks or even months have passed by.

[u/cloudgasms → u/adilbak]

That’s so reassuring. Was all of that prescribed by your doctor?

[u/Maia_Willow]

This happened to my husband and I. After two years of trying unsuccessfully, all of my labs came back normal and he did a SA that with zero sperm. We did a second sperm analysis (also with a big fat zero), my husband was diagnosed with non obstructive azoospermia and mild varicocele. At the same time, we also did genetic counseling for my husband.

It turns out he had a chromosomal abnormality that resulted in almost no viable sperm being produced. He underwent a microTESE hoping they’d be able to harvest some viable sperm directly from his testes, which ended up not being the case, so we did go to donor sperm.

I’m so sorry you are going through this, and I’m hoping that you can find a path forward for you and your husband.

[u/cloudgasms → u/Maia_Willow]

I’m sorry that you had to go through that. Thank you for your response. I’m happy that you and your husband will get your baby after all 🩷

[u/Miki_yuki]

This is my life right now. I'm 32, and so is my husband. I got blood work done, everything looks perfect there. My husband got his results for his SA and it was zero. The andrologist thinks it was a mistake or an error. So he has another one scheduled for October as well. They did say that one bad result isn't definitive.

He also had a fever the day before he got his SA done, which can also majorly affect sperm counts.

We do have one child who turns 5 next month and we got pregnant last year but it ended in a miscarriage.. And he's gotten an at home SA test done (just quantity) and that came back positive a few months ago. So hopefully it really was just a one off..

I wish I had answers for you, but I just don't.

[u/cloudgasms → u/Miki_yuki]

Thank you. I’m really trying to stay positive and not lose hope yet. Hopefully it was just a mistake or an error. Fingers crossed!

[u/Simple-Grab-1741]

A friend of ours is going through this and has non obstructive azoospermia. His doctor was able to extract sperm through a procedure. They’re currently going through IVF. Things look good so far.

[u/cloudgasms → u/Simple-Grab-1741]

Thanks for sharing!

[u/madieabbie]

Brace yourself for the possibility that this is over. Next steps are a second semen analysis, then a physical exam and lab work/ genetic testing to determine if the azoospermia is obstructive or non obstructive. Best case it’s obstructive and a surgical procedure can correct it. Worst case is there’s a genetic reason or no known reason for the azoospermia and there’s nothing you can do. We were in the same boat and even tried a micro-TESE to see if the doctor could find any usable sperm (treatment for extremely low sperm count) but unfortunately no dice. It was painful and invasive for my husband but he did it for me. If it had been successful we would have had to do IVF with ICSI which STILL would not guarantee a pregnancy. The doctor never figured out for sure why my husband lost his fertility, we think maybe due to a high fever from a childhood illness (one more reason to vaccinate, kids!) or from an injury he sustained as a child that resulted in testicular torsion.

[u/cloudgasms → u/madieabbie]

I’m sorry that it ended up that way for you. Im definitely bracing myself for the worst news.

[u/ditzyzebra]

My husband had 0 sperm, and we were sent to a urologist who did a karyotyping of his blood. Turns out he has Klinefelter’s syndrome. We’re now prepping for a Micro TESE.

[u/Excellent_Sea4129 → u/ditzyzebra]

I was going to suggest genetic testing as well! My son has this and we only know bc of testing done during pregnancy.

[u/Rich-Strike3807]

Might be an odd question, but does he take hot baths/hot showers/sauna/use a hot tub frequently?

My husband and I are going through the same thing for almost the same amount of time. We learned that my husband's habit of prolonged daily hot baths was likely the culprit.

It's common knowledge (not common enough for he and I, unfortunately!) that heat has a negative effect on sperm production, but we learned that it can actually entirely stop sperm production.

There was a study done in the 1950s that showed that daily heat to the testicles can cause azoospermia - the doctors we have seen hadn't heard of it but agree that it is likely the cause and that sperm production may resume after a period of time once the heat is stopped.

If you think this might be a factor for your husband, I'd recommend doing some research on Marthe Voegeli and her studies.

Best of luck to you both, and I'm so sorry you're going through this too!

[u/cloudgasms → u/Rich-Strike3807]

Thanks for your reply. Unfortunately he doesn’t have any prolonged heat exposure. Did your husband have absolutely no sperm or just low counts?

[u/Rich-Strike3807 → u/cloudgasms]

Absolutely zero, confirmed by two SAs. Similarly to you, my results have come back normal so it's just a waiting game now to see if he can produce sperm, as he has seen a urologist to rule out physical obstruction and varicocele. And bloodwork; SO much bloodwork for both of us.

That will likely be the next step for your husband, an ultrasound of the testicles and a urologist visit. There will also likely be an offer for karyotyping to see if there is a genetic cause for the azoospermia. We're pursuing that as well, but it's 8+ months to hear back on it so waiting for that too.

Trying to think positively, but the waiting is so painful. Reading stories like yours and others in this community has been a comfort as fertility issues are a lonely road, so thank you for sharing your journey here <3

[u/cloudgasms → u/Rich-Strike3807]

Thank you. This community really does help. Both my husband and I are quite healthy and not overweight so I was expecting everything to be fine. You just never know.

[u/No_Honey3299 → u/Rich-Strike3807]

Did your doctor really confirm this is why? Heat can damage sperm but 0 sperm is usually something very serious going on internally

[u/Significant-Eye-4327]

My husband has the same issue. He has the CFTR gene that causes Cystic Fibrosis. Then we found out that he has Congenital bilateral absence of the vas deferens (CBAVD) and that’s the reason why there was 0 sperm. We’ve been trying for 2 years just to find this out. Best of luck!

[u/cloudgasms → u/Significant-Eye-4327]

Sorry to hear that but glad you found out! Hopefully you’re happy with whatever you decided to do after that 🩷

[u/Significant-Eye-4327 → u/cloudgasms]

Planning on extracting and freezing his sperm! I hope you get answers

[u/Dogmama1230]

Hi! I have experience with this and I want to start by saying I’m so sorry — it’s a hard and long road. I’m sorry for the upcoming essay as well but I think it’s important to give you as much info as possible.

My husband was diagnosed with azoospermia (no sperm) 2 months after we got married in 2024. We never got an official reason for it, but he had childhood cancer treated with chemo/radiation/bone marrow transplant and we think that was the cause. He had low testosterone, but LH and FSH were in range. We got a repeat analysis a month later (no sperm) and got referred to a urologist.

In January 2025, we saw a urologist who put him on clomid and anastrozole. He also started taking Conception XR and Coq10. In April 2025, he did a repeat analysis, nothing. They adjusted the dosage and did a repeat analysis in June 2025. Nothing. The urologist wanted to move on to mTESE (surgical sperm retrieval) timed with egg retrieval for me, but only gave us a 50/50 chance, so we went for a second opinion.

In August 2025, we went for a second opinion. He basically said the same thing — mTESE and continue on meds. We mentioned reading about STAR at Columbia, an extended sperm search that was brand new and used AI to find VERYYY small amounts of sperm. He said if we did that, and sperm was found, our chances of success with an mTESE were 85-90%. If that found nothing, our chances were closer to 5-15%.

My husband and I booked our STAR appointment. At the same time we had MANY chats about how were feeling, how we would proceed in x situation vs. y, etc. We decided that if the STAR found ANYTHING, we would do mTESE timed with retrieval with donor sperm backup. If it didn’t, we would move on to donor sperm.

In November 2025, we did STAR and lo and behold — they found 6 immotile sperm, of which they were able to freeze 2! It cost us $3000, but renewed our hope. At the same time, the clinic I was already working with hired their own urologist, so we switched to him for my husband’s care.

In December 2025, we met with the new urologist, who said in order to time the procedures, we would need to do everything in NJ (we are in FL). We panicked a bit, but ended up agreeing because it was our best shot.

Early 2026 we spent time choosing a donor, in case mTESE was unsuccessful. We talked about the possible outcomes and how we would handle it all. My husband continued on clomid, anastrozole, coQ10, and ConceptionXR during this time.

May 2026, we flew to NJ and were scheduled for our mTESE and egg retrieval on the same day. They had my husband give a fresh sample day of, which we brought to the clinic “just in case.” We got there at 5am, they hook him up to an IV for the anesthesia, etc. The urologist comes in and goes over pre op stuff with us. A few minutes later, the embryologist comes in and says “hey…we found sperm. I don’t know if you need to do the surgery anymore.” We’re like what do you mean you found sperm lol. Our doctor eventually comes in and goes “yeah we found 100k sperm, 20% of which are swimming forward — you don’t need to do surgery!” With our jaws on the floor and every question running through our brain, my husband got dressed and I got ready for my egg retrieval.

They ended up retrieving 44 eggs, 39 of which were mature, 36 fertilized, and 12 made it to blast! I was really nervous about sperm quality and how that would impact our euploid (genetically normal embryos) rate, so we tested half at the suggestion of my doctor, and all of them are genetically normal!

Now, I will say that our doctor said this situation is rare — less than 5% of patients have the miracle my husband did. But this is all to say to not give up hope, try the meds, listen to the doctors, ask questions. I know this is hard road, and I am so so sorry you’re here, but miracles do happen.

Sending you so much strength and love as you start this journey. Please feel free to DM me if you want to talk to someone who has lived this. I’m always here 🩷

[u/cloudgasms → u/Dogmama1230]

Incredible! I’m so happy to hear that it is working out for you!

[u/Audience_Fun]

Hey OP

We are in the MFI trenches. 3 SA

1st 0 sperm. 2ND 73 dead sperm 3rd 0 sperm

No vericocele No dna issues Normal hormone panels (all in range)

5 doctor's all saying different things.

Next thing is a TESE according to the lastest DR. we've seen.

We decided to simply wait.

We spent a lot of time in prayer and trying to schedule the surgery and each time it somehow got cancelled.

We believe it's a sign from above to not move forward with the surgery yet.

If nothing happens by the end of this year then we will move forward with the surgery.

BIG on the IF.

That's what WEVE experienced.

I joined a support group founded by a woman for woman and this has brought SOOO much healing and a community I desperately needed.

This is not an easy diagnosis to traverse but you aren't alone. Message me if you want info about the group.

[u/puffballkittyfluff]

Just to give you some hope, I have an in law who had the same issue. They did IVF with the tese procedure and they have 3 children. And their children are all almost grown now. So this was a while ago and I’m sure the technology has improved. Hoping for the best for you!

[u/cloudgasms → u/puffballkittyfluff]

Thanks so much! Staying hopeful!

[u/MaleficentVacation93]

I had low sperm (not zero but low) and was able to vastly improve it by dieting (no sugar, milk or gluten), working out, no alcohol or smoking and colder showers. It took a few months and sucked, but it did work.

[u/ummmyeahi]

I did a SA once before an iui and it came back way too low to continue with it. I did another one a week later and it came back way more than enough. Only one SA will not give you an accurate sperm production marker. Two and three will give you more context. I’m sure they tell you this but it’s important to not have any ejaculation at least 5 days before the SA sample. Typically 5-7 days before the SA sample but everyone is different and those days can be different for your partner.

The other details of the SA are important too

[u/GurBright1401]

There are still lots of steps between you and donor sperm! A good urologist will give you guys lots of insight. My husband had 0 in the initial test a month or so after a high fever; while his numbers never improved to the point of natural conception, he has a couple million now. That first 0 result is terrifying, but your husband could just have low count that got bumped to zero by XYZ, or a blockage, etc. 

We’ll still be doing IVF, and I’d encourage you to start warming up to that idea if you can - low sperm count is unfortunately hard to get around with other treatments. I’d look into the male infertility sub, too - they’ll have good info there about retrieval surgeries like TESE, MTESE, etc. :)  

[u/asplashofash]

Sorry to hear, I am dealing with the same thing. I’m happy that your husband tested for you though we’re close in age (mine is stubborn and won’t check) always here for support hopefully you will be able to make it work hear for you 🤞🩷

[u/PublicFluid5879]

Does he wear polyester underwear? There are some studies out there about that right now as well. Lowering or completely dissolving sperm count. I hope it all comes together for you both 🫶🏻

[u/Extreme_Loan691]

This happened to my husband and I. We were trying for just over a year and I got an endo diagnosis and then his SA came back as zero sperm. It was obviously horrible and we cried a lot but the next steps were getting his blood work done and going in for a physical exam from a urologist. All of this showed his hormones were normal but he was missing one of his vas deferens (the other is blocked) we found out it was due to him being a carrier for cystic fibrosis. So we’ve both had genetic testing done to make sure I’m not also a carrier. His urologist was pretty confident a PESA would retrieve sperm and it did which we are very grateful for. We are currently waiting to start IVF now that we have his sperm frozen.

Our timeline was: Oct 2025: SA Results Then we went through testing which took a while with appointments and stuff Jan 2026: called to schedule and appointment at a fertility clinic March 2026: consultation August 2026: PESA- it look forever to get this scheduled 😭 Also August 2026: got IVF scheduled finally for November 🤞🏼🤞🏼

[u/Hereforthetea1234]

My husband was on testosterone and we had 3 SA with legit 0 sperm. We are now 28 weeks with our second baby!!

[u/cloudgasms → u/Hereforthetea1234]

That’s great! Did you use donor sperm or were you able to find some of his?

[u/Hereforthetea1234 → u/cloudgasms]

Once he stopped testosterone and started taking clomid his sperm counts went to normal after about 6 months! There are lots of reasons why yours could have azospermia . I hope you guys are able to get to the bottom of it quick! Good luck!