Case Report: Reappearance of spermatozoa following multicomponent lifestyle modification in men with previously diagnosed azoospermia: a case series

Azoospermia, defined as the absence of spermatozoa in the ejaculate, is a severe form of male infertility, and the potential effects of intensive lifestyle modification on sperm production remain uncertain. We describe three adult men whose available pre-intervention records reported azoospermia and who undertook a multicomponent lifestyle programme centred on a predominantly raw, whole-food, plant-based diet, prescribed hydration, progressive physical activity, sleep and stress-management guidance, reduced alcohol consumption, and avoidance of ultra-processed and animal-derived foods. Clinical records, serial semen analyses, and available hormonal assessments were retrospectively reviewed. Approximately 10 weeks after programme initiation, spermatozoa were detected in all three participants, with concentrations of 1.6, 2.0, and 2.2 × 10 6 /mL, respectively, at the first sperm-positive assessments; these values remained within a severe oligozoospermic range, and motility and subsequent trajectories varied. Two participants had previously received fertility-directed hormonal therapies, and one had undergone unsuccessful testicular sperm extraction. Participants also reported improvements in body weight, sleep, physical-activity tolerance, libido, perceived energy, and general well-being, with no major adverse events documented. Complete etiologic assessment, genetic testing, objective adherence measures, and uniform documentation of semen-analysis methods were not available for all participants. This uncontrolled case series documents a clinically notable temporal association between initiation of an intensive lifestyle programme and subsequent detection of spermatozoa in men with previously reported azoospermia. Causality cannot be established, and the individual contributions of diet and other programme components remain uncertain. Prospective controlled studies using standardized andrologic assessment, comprehensive etiologic investigation, objective adherence measures, and prespecified reproductive outcomes are warranted.