Do you think it is possible to have your own children with absolutely no sperm in the ejaculate?
Why yes. It happens on a daily basis in my practice.
Honestly, the word “sterility” has really lost much of its meaning nowadays with advances in reproductive technology.
The Affairs of Sperm
Azoospermia is the word used to describe the lack of any sperm in the ejaculate. It is a devastating thing for men to hear as they try to conceive. It comes in two forms: as a consequence of blockage in the sperm ducts outside the testis in the setting of normal sperm production in the testicle (i.e. vasectomy) or as a result of poorly functioning testicles and normal, open ducts beyond it. We routinely grab sperm from behind vasectomy sites to use with assisted reproduction to conceive. Finding sperm in men with poor sperm production, termed nonobstructive azoospermia, is a more complex matter.
One way to think about sperm production in men with poorly functioning testicles is to compare it to a mug with coffee in it. Say the mug is filled with ¼ cup of coffee. If you hold shake the mug, you may not see any coffee spill over the side. In this case, you might assume that the mug has no coffee inside. But, if you peer into the mug directly, you will see that there is actually coffee in the mug. Similarly, the testicle makes more sperm (coffee) than is found in the ejaculate (spilling over cup). There exists a threshold of sperm production, over which sperm shows up in the ejaculate and below which it will not. So, now you know the secret of making fathers out of “sterile” men with poorly functioning testicles.
Sperm from a Rock
Of course, it’s not quite that simple. There is one more layer of complexity here. Poorly functioning testicles may not make sperm evenly throughout their substance. In many cases, there are “pockets” or “islands” of sperm within a sea of otherwise empty tissue. Clinically, this makes sperm retrieval more difficult and has pushed this technology to a high art.
To find sperm, fertility specialists use several sophisticated approaches in men with nonobstructive azoospermia. The traditional testis biopsy works about 30% of the time to find sperm and, as a consequence, is no longer the de rigueur technique for this problem. Fine needle aspiration “mapping”, which I invented about 15 years ago, is easily twice as good as a biopsy in finding sperm and much less invasive. Lastly, “microdissection” of the testis another alternative and involves an all-out surgical assault on the testicle to find sperm making it the most invasive approach. The elegance and complication rates for these approaches vary widely, but their intent is the same: to find enough sperm to allow biological fatherhood. Importantly, when expertly performed, these techniques will find sperm in the majority of cases. For the remainder, there is hope as even newer “no touch” scanning technologies are on the horizon…
Clinic by the Bay is a locally funded, volunteer-powered primary care clinic in San Francisco that tries to meet the needs of our friends and neighbors who are medically underserved. We need your support to operate. 
How much does this non-invasive Spectroscopy cost for people paying out of pocket. how can one request this. Is this already available in large hospitals?
Amy, It is currently not available at all. We are working out the kinks. Then we will offer a clinical trial to set the bandwidth. Expect to see something out there in 2-3 years or so.
Good evening Dr. Turek,
I had a biopsy done and it determined azoospermia around six years ago. What is the next step? I thought all hope was lost.
Well Javier, lots of things have happened over the last 6 years! All may not be lost. Be happy to speak with you about this. Call 415-392-3200 and we can chat.
DEAR DR. TUREK,
MY SPERM TEST SHOWED A HIGHER FSH LEVEL,AND NO SPERM AT ALL.
I HAD A BIOPSY WHICH RESULT CONCLUDED THAT THERE IS A MATURATION ARREST AT THE PRIMARY LEVEL.
I AM 48 NOW. WHAT CAN I DO TO BECOME A BIOLOGICAL FATHER. REALLY DESPERATE.
ERNIE
Ernie, Sounds like you have nonobstructive azoospermia. Wondering whether your doctors identified any genetic (y chromosome or other chromosome) or non-genetic (variocele, exposures, medications, illness) causes. In our previous research, we have observed that about half of men with this condition and this biopsy pattern have a genetic cause, either definable or not, and the others might not. Interestingly, we have also found that men with early maturation arrest can have sperm if: (a) you look harder than a biopsy does at more places in the testis (see: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/spermatogenesis/, (b) remove insults such as recurrent fevers, illness, certain medication or varicoceles or (c) add FSH injections (expensive) for a period of several months to “push” sperm production past the point of the arrest. The point is that there is hope with this biopsy pattern.
HI DR TERUK I had a biopsy done in 2008 the result was no sperm found and I had FNA mapping at your clinic a 2010 also no sperm was found .DR TERUK is there any hope in my sitaution. thank you DR TERUK.
Gelle, good to hear from you. If you want, I can put you on the list of men who are interested in research protocols ( 2 being developed) that will use either metabolomics or stem cells to increase the odds of finding sperm http://theturekclinic.com/metobolomics-the-picture-of-fatherhood/ or creating it. Neither is prime time yet. Just let me know.
HI DR TUREK how are you I hope you are doing well DR TUREK I just iwant to thank you again trying to help me. if you asked me if i want to put me the list of men who are interesing in research the answer is YES Iam ready whatever you think will help me. it is depersing sitaution thank you offering me opportunity. goodbye gelle from johannesburg south africa.
Hello Dr Turek
Following on from your post. I have been diagnosed with Azoospermia almost 2 years ago, as well as bilateral varicolcel. I have done the varecocel operation almost a year and a half ago.
i have also done testis biopsy and only setolli cells were found with very few germ cells with complete maturation arrest.
I am not sure if your mapping technique can help in my case and wether the latest advancements in stem cell (Adult or Embrionic) can help.
please let me know if you think I have hope before I make the trip to visit you in SF.
Thanks a lot
Wal, Having a biopsy showing Sertoli cell only with rare maturation arrest and getting a varicocele repair may not commonly lead to ejaculated sperm afterwards, but could lead to some improved sperm production in the testis. This, in turn, could be detected by FNA mapping. Let’s set up a call! 415-392-3200.
Dear doktor,
I am Ozcan, I come from Turkey but I live in the Netherlands.
I am 33 years old and my partner is 29 years. We have a problem. I am
patient azospermia, NOA and i am twice operated (TESE and Micro-TESE)
and both operations without result. The pathology results is:
non-obstructive Azoospermia with Maturation Arrest, I have round spermatid, but no sperm.
I want to be father, can I ever be father?
Dear Dr. Turek,
I was diagnosed with Non-Hodgkin Lymphoma about 10+ years ago and I did not utilize a sperm bank at the time because I was so scared with the illness I had to deal with. I wish my Oncologist pushed the issue more about sperm banking… Moving on, I finally got the courage to do a semen analysis about a month ago because my wife and I have had no success with getting pregnant, the result showed no sperm found. I am going to do another semen analysis to find out definitively if that is the case. What do you think my options will be if the results are still the same and is there any hope after undergoing chemo treatment (R-CHOP) Rituximab,Cyclophosphamide, Doxorubicin, Vincristine, Prednisone?
Thank you
Myles, Of course there is hope! We and others have published on our ability to find usable sperm in men just like you. FNA mapping is an excellent technique to find small pockets of testicular sperm that just don’t make it out. See:http://www.theturekclinic.com/male-fertility-preservation.html. I can’t say that it is “routine” to find sperm after your heavy but curative chemotherapy regimen for cancer, but I certainly see men like you weekly. Give us a hoot!
Thank you, I think I will.
Hi Dr. I am 41 years old married 14 years ago, due to aesospermia unable to become biological father. I did biopsy in 2005 in Saudi Arabia but doctors didn’t find any sperms. Last year I shifted to Toronto, On, Canada. I am going to have have surgey again with Dr. Keith Jarvi working in Mount Sinai Hospital. Do you think it is good idea to spend more money, time and get emotional Trauma instead or should I try my luck?? Does there any treatment for Aesospermia has really discovered yet????
You have done alot and you still sound motivated to learn more. Certainly, there is a chance that you have sperm, despite the findings from a simple biopsy in 2005 that showed no sperm. Remember, sperm production can be “patchy” in men in whom it is low. It really becomes a sampling issue. The harder you look, the more likely you will find sperm. I must agree that there is also an element of luck. Dr. Jarvi is a good friend and excellent doctor. Based on the numbers and statistics that he gives you, you can decide whether it is worth it for you to keep pursuing this strategy.
Thank you very much D. Turek. I really pray and wish you long life and to all your colleagues doing research and treatment for human infertility. I already requested Dr. Jarvi to add myself in his research study. May be one day your team will reach to the permanant solution of Aesospermia.
Dear Dr,
Please help me. I have no child due to the fact that my husband is azoospermic. Initially he had ED,and also high FSH,and Low testerone,after much treatment and spending all we have all the hormones has normalised. We have done testicular biophys which says maturation arrest at an early stage.Please find below the details of his last three semen analysis since after the biophys:
1st 19/09/2011.
SEMEN: 1.O ML
VISCOSITY: THICK HYPERVISCID
LIQUEFACTION TIME PROLONGED
TOTAL SPERM COUNT:00
NO SPERM COULD BE SEEN AFTER CENTRIFUGATION BY H.P.F
W.B.CS/H.P.F NIL
R.B.CS/H.P.F NIL
SPERMATOGENIC CELLS NIL.
2ND SEMEN ANALYSIS 26/12/2011
SEMEN: 1.5 ML
VISCOSITY: NORMAL
LIQUEFACTION TIME:VISCID
TOTAL SPERM COUNT:00
NO SPERM COULD BE SEEN AFTER CENTRIFUGATION BY H.P.F
W.B.CS/H.P.F: 2-3
R.B.CS/H.P.F:1-2
SPERMATOGENIC CELLS:0-1
3RD SEMEN ANALYSIS 26/03/2012
SEMEN: 2.0 ML
VISCOSITY: NORMAL
LIQUEFACTION TIME:30 MIN
TOTAL SPERM COUNT:00
NO SPERM COULD BE SEEN AFTER CENTRIFUGATION BY H.P.F
W.B.CS/H.P.F: 2-4
R.B.CS/H.P.F:1-3
SPERMATOGENIC CELLS:3-5
please Dr, advice me do i have any hope of being a mother one day? how do i get in touch with you for am currently based in Gulf country.
Many Thanks.
Fortune
Dear Fortune, It appears that your husband has azoospermia and has had (correct me) a single testis biopsy? If so, think of sperm as apples on an apple tree. Not all branches have apples. One must look harder for apples and this is possible with FNA mapping. It is also possible that some forms of “maturation arrest” look on biopsy can be “pushed” to make sperm by treating correctable conditions such as diabetes, fevers, varicocele etc. Consider a call to talk more at 415-392-3200.
I am 28 yrs and married 2 yrs back but yet no issue. I got examine by Dr. and seman exam. and Azoosperima came. I fear that I never become Father. I request to kinly help me and advised me further treatment. As i live in India but i can not come to your place due to ecominally condition. pl. help me.
Ratan, I understand your situation. Although it is too big a deal to come see me in San Francisco, you can also consider asking for a “Second Opinion” on the website http://theturekclinic.com/services/get-a-second-opinion/. In this way, I can comment on the quality of the care that you are getting, suggest what you may need and help out where I can. Works for many who live far away. And, recently I helped a couple with their first pregnancy and I never actually met them!!
Hi doctor Turek,my husband is azoospermic after bone marrow transplatationn for non hodkgin deasese that he had 10 years ago .his hormone levels are normal so are the other tests but he has varicocele and doctors here in Croatia said it is not the reason for azoospermia and dont want to operate it.do you think that varicocele repair could start sperm production in patients with non obstructive azoospermia after chemotherapy?Can you advice me if there is a clinic in Europe that offers sperm mapping?thank you
Ante, given this story, the bigger issue appears to be the treatment for NH disease, not the varicocele. Varicocele repair is a distant second issue. If one were to fix the varicocele and ended up with ejaculated sperm, that would be rare to the point of being publishable! Certainly varicoceles can be fixed for scrotal pain and this may be an indication for surgery. Best bet is to look at the testis for sperm, though. We have published finding sperm in men like your husband (see: http://www.nature.com/index.html. Consider emailing us http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/male-infertility-evaluation-sperm-test-semen-analysis-san-francisco-los-angeles/ to set up a brief call!
Thank you for your answer ,my husband did fine needle aspiration(not mapping)they didnt find any sperm.we should do biopsy to be sure in diagnosis.what should we do next ?is there anything to use or do to make results better?
dear Doctor,
my husband recently was diagnosed with azoospermia, he have done 3 SA and all came zero, his hermones levels are normals. his ultrasound shows that he got moderate bilateral varicocele and both epididymi are slightly prominent . we are schedualed for biobsy next week. the options for us according to the doctor is either obstructive or maturation arrest.
we are davestated knowing that incase of maturation arrest the hope is very minial. kindly advise
thank you
Dear Hopeful, stay true to your name: hopeful. Sounds like good care. Consider talking with us if you have reached the end of the rope where you are. We may have some tricks up our sleeve for the maturation arrest…
Dr. Turek, I already discussed with you my problem via this wonderful blog communication on your website on April, 03, 2012. Your answer gave me hope and courage that I underwent Micro Tese by Dr. Jarvi. Luckily he found healthy sperms by his expert surgery procedure. I was really over the moon that a person like me who declared aesospermia for more than 16 years, suddenly got that unique news. I must appreciate you and Dr. Jarvi who also worked with you for your extra ordinary hard work and research on human infertility problem.
Dr. Turek, My trial doesn’t end up yet, I need your expert opinion once again, I hope you will guide me in this situation. Dr. Jarvi refer my case to Dr. Tom Hannam for IVF treatment and he did all the blood and hrmone work of mywife. He told us a shoking news that my wife’s AMH (Anti Mullerium Harmone level) is tremendouly low. It’s just 0.3%. Also the FSH level is too high. He told us clearly that your IVF success chancess are also less than 1%. He wrote a letter to Dr. Jarvi saying, “Wonderful news, as you know: From your procedure on the 9th of May, Javad had elongated spermatids from
the right-hand side, plus the occasional mature forms (one per high-powered field). This was frozen in four
vials. Perhaps we would have one opportunity at pregnancy, with IVF, from each vial.
As you are also aware, Nazia has an extraordinarily low ovarian reserve. This precludes the expectation that
there will be multiple eggs with fertility medications. Our intention, then, is to run a modified natural cycle
this summer, after starting the supplement treatments directly.
Please advise us what to do now in this stuation. I will be highly grateful to you.
Jadi, this is certainly good news and proves the point that you should not give up! However, my expertise ends with the male. A second opinion may be worthwhile however. In the final analysis, despite the numbers and odds, you will choose to do what you need to do. And that will be that.
congratulation Jadi on finding healthy sperms i wish you all the best for a sucessful ivf and healthy baby .your story gave me hope than you so much
please dont give up hope inshAllah everything will be a major sucess for both you and your wife
my prayers for you
Sir,My aged 39 years old.I am married.I have no child.But want to a child.Microscopy test:No spermatozoa seen. Doctor comment: Azoospermia.how to increase the spermatozoa.pl treatment to drug me. Thank you sir.
Milon, Sounds like you are azoospermic. Medical treatment for azoospermia may not work, unless you are lacking hormones that can be replaced. Having no sperm is either a blockage or a sperm production problem. Blockage is treated with microsurgical reconstruction. Often, production problems are treated with sperm extraction and IVF-ICSI. Let’s set up a call to talk: http://theturekclinic.com/urologist-california-contact/
Hello Dr Turek,
thank you for this useful website.. my husband is azoospermic with FHS level of 38 and had biobsy 6 years ago with no success. we are considering mapping but with the level of that FSH, do you think sperms are likely to find? and if you think they are, what are your recommended clinics closed to the UK (e.g Turkey, Germany).
your help is highly appreciated.
Amina
Amina,
The ability to find sperm with mapping depends more on the extent or number of previous biopsies taken than it does the FSH level. I have men with ejaculated sperm and similar FSH levels. FSH simply doesn’t predict the presence of sperm well. The chance of finding sperm could range from 25-40%!
Hello Dr Turek,
Thank you for your time.
My husband (age 34) has a non obstructive azoospermia discovered since 3years. The result of the biopsy done in 2009 was negative, nothing found. All the hormone are normal (FSH, LH and Testosterone). The analysis was described as below:
Arrest maturation at the spermatocyte stage with hypospermatogenisis.
Is there any cure or treatment for this kind of azoospermic? Do you think that we should ask for a second biopsy? We try with honey, black seed, chickpea…
Thank you
Hello Dr Turek,
Thank you for your time.
My husband (age 34) has a non obstructive azoospermia discovered since 3years. The result of the biopsy done in 2009 was negative, nothing found. All the hormone are normal (FSH, LH and Testosterone), no chromosome prb… The analysis was described as below:
Arrest maturation at the spermatocyte stage with hypospermatogenisis.
Is there any cure or treatment for this kind of azoospermia? Do we should ask for a second biopsy? We trying natural cure as honey with black seed, chickpea… Do you think that it’s efficient?
Thank you in advance.
Regards
Youni, Your husband has an interesting “mixed” testis biopsy pattern that may be a hopeful sign. Having “maturation arrest” on a biopsy has been discussed many times on this blog. If not due to a genetically defined problem (as you have pointed out), then I advise looking harder to see whether pockets of sperm can be found elsewhere, in areas distant from the biopsy, say with FNA mapping (http://theturekclinic.com/services/male-fertility/sperm-mapping/). Before that, however, I would suggest “medical optimization” of your husband through lifestyle changes (stop hot tubbing, smoking, lose weight, control diabetes better) and fixing varicoceles if present and/or taking FSH injections. This might increase the odds of finding sperm on a “second look.”
More interesting, however, is the finding of “hypospermatogenesis” on the testis biopsy reading. In our published series using FNA mapping, 100% of men with a biopsy pattern like this were found to have usable sperm in the testicle for IVF-ICSI. So, one thing you could do is to consider sending the actual biopsy slides to me for re-review to confirm that this pattern is actually truly present (see: http://theturekclinic.com/services/get-a-second-opinion/).
Thank you Dr for your Replay.
I checked the medical record, and there are only the results of the hormone, chromosome and the biopsie. Two EchoDoppler was done before and after the biopsie. I don’t find any slides… Do you think that I should ask the laboratory? I don’t think that they keep the slides. All the results are in French, do you need a translation for get second opinion?
Regards,
Inès
Youni, get whatever you can. I can read French.
Hello Dr Turek, you may remember me, i had the FNA mapping done with you in 2011 and no sperm were found. Sertoli only cell was my condition. Has there been any advances in treatment for men with my condition? Are we still 3-5 years away from artifical sperm procedures?
Im keem to catch up with you and if you can offer any treatment alternatives now or in the near future please let me know.
Thank you,
Nas
Nas, Of course I remember and thanks for circling back. Please see where we are the with artificial human testicle at FertilityPlanit.com. Also, you have inspired me to write a blog about where we are at the moment, to be posted Monday Feb 11, 2013 at http://www.TurekonMensHealth.com.
Thanks Dr Turek. I look forward to the blog and hopefully working with you again in the near future.
nas
Hi Dr Turek
Just a quick question, i have read that lowering testosterone for a period and taking various supplements will hopfully restore sperm production in men. I have sertoli only cell syndrome.
The website is spermhope.com which offers this treatment? By reducibg testosterone can it help restart the male reproduction system?
Thanks,
Mark
Mark, the technique of testosterone withdrawal and replacement is an old and abandoned one that was employed to improve sperm counts in men with ejaculated sperm. I know of no study ever published that shows this technique used successfully in azoospermic men. The key question for you is whether you might have “pockets” of sperm in a testis characterized (based on what technique?) to have only Sertoli cells but no germ cells. The harder you look, the more you find: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/spermatogenesis/
Thanks Dr Turek.
Sorry to pester you again but I wanted to ask if i had the variocele procedure would this improve my condition? Also is there any meds i can take that will give me a glimer of hope. It would be great if we could set up a call to discuss any options if possible even though they may be a long shot.
Thanks,
Nas
Nas, whether or not surgery or medicine can help is a complex discussion. Considering contacting by phone to set up a call: http://theturekclinic.com/urologist-california-contact/
Dr. Turek, I just watched your video on fertilityplanit.com. Amazing stuff. I did have a question. As I understand it, the man made testicle can be fueled with one of three things: (1) embroynic stem cells; (2) testicular stem cells; or (3) adult stem cells.
My take away from the video, was that there was no way to get embroynic stem cells, and you were skeptical if sperm could be made with adult stem cells. You did say you could probably generate sperm with testicular stem cells, and that you determine if you have testicular stem cells through mapping. I thought mapping tells you if you have sperm in the first place, so then there would be no need to generate sperm that you already have.
If this is true, the only hope for people with no sperm is to generate sperm through adult stem cells. So, is that the ultimate objective?
I’m very confused and would like to understand this a little better.
Sara, good read on this! My (and others) beliefs are changing about which of the three human stem cells can be made into sperm in a dish. The biggest issue are adult stem cells, as they are not quite exactly like embryonic cells and they have not been made into human sperm yet by anybody. The jury is still out on this one. Maybe its possible to make human sperm with adult stem cells, but maybe not. This answer will come with time.
Sorry about the confusion about sperm mapping, I need to explain further. In addition to letting men know if they have mature sperm or not (which can be used now), FNA mapping also creates an “archive” of all the cell types in the testicle, including the earlier cell stages in the process of spermatogenesis (the 13-stage process that a testicular stem cell makes to become a mature sperm). So, in fact, mapping can routinely identify earlier stages testicular germ cells before sperm are made, and many of these cells may be valuable in the future to make sperm in a dish.
Aren’t the recent studies last summer of skin cells turning into sperm precursor cells/spermatids enough to give a good prognosis that a viable, mature sperm can be made in a number of years time,especially sine the new technology has been moving forward quickly in the past few years?
Dr. Turek,
My husband has been diagnosed with azoospermia (non-obstructive) with an elevated FSH and normal testosterone and LH. A TESE was performed to locate sperm for IVF-ICSI, but no sperm was found. We are wondering what our next course of action should be. We aren’t opposed to donor sperm, but we would like to exhaust the possibility of biological children first. We are Canadians living in South Korea, so communicating our issues is difficult. The clinic we’re going to is great, but like most, they are much better at dealing with women’s fertility issues. I don’t know if he has Sertoli-only syndrome or otherwise because they only looked for sperm (non found). Suggestions? What does it cost for an FNA mapping? Thanks.
Sarah, Depending on the complexity and extent of the prior TESE procedure, there may still be a chance that your husband has pockets of sperm in the testicles. A center that specializes in looking harder for pockets of sperm in testicles is the best way to go. FNA mapping and microdissection TESE are two possible ways to look harder. I do both, but prefer sperm mapping as it is far less invasive and highly informative. I suggest starting with a phone call with us. To arrange, contact us at: http://theturekclinic.com/urologist-california-contact/
Hi Dr Turek, my question is how many times can someone have a microtese procedure? I had been diagnosed with Cryptozoospermia and had a handfull of sperm in every other sample. I had Microtese in December last year with successful sperm retrieval but non-successful ivf with icsi. Medically, could I have another Microtese and if so, how long would I need to wait?
JG, I have safely done mTESE procedures several times in a single patient, but I get more concerned about lowering testosterone levels with each attempt. I have not done many mTESEs in men with small numbers of ejaculated sperm as I prefer using the ejaculated sperm to doing the large surgical procedure. I debated this point with Dr. Schlegel in public last fall at our annual meeting (ASRM). We are presenting our research next month on using smaller numbers of banked and freshly ejaculated sperm for IVF-ICSI and AVOIDING surgical sperm retrieval. This sperm works great! However, it does take some time and energy to 1) get it to be reliably ejaculated and 2) to get enough to bank before going forward with IVF-ICSI. Stay tuned to next week’s blog post!