Turek on men's health
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Award-winning urologist - and pioneer in Men's Health - Dr. Paul Turek blogs weekly about issues such as infertility, vasectomy and vasectomy reversal, sexual and hormonal dysfunction and more. Keep up with the latest on this fascinating field of medicine.

Fertility from Sterility



Looking inside a coffee cup is like looking inside a testicle
What’s inside of a coffee mug depends on how you look at it.

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…

Get Help Today
Schedule a private consultation or second opinion with Dr. Turek to learn more about your treatment options and get all your questions answered.

230 Responses to “Fertility from Sterility”

  1. amy

    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?

    Reply
    • Paul Turek, MD

      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.

      Reply
      • Todd cool

        Now that it is 2015, how this procedure resulted in an actual procedure/ test? If so, what would the cost be to someone that needs to pay out of pocket?

        Reply
        • Paul Turek, MD

          Dear Todd, Noninvasive metabolomic scanning technology is not available for routine clinical use at this time, but is still in experimental stages. No costs have been assigned as yet.

          Reply
          • Leonard

            hello Dr.Turek i had a biopsy done and the urologist diagnosed me with.Sertoli-cell-only (SCO) syndrome are there any other way.

          • Paul Turek, MD

            Dear Leonard, Yes, there is hope. Keep doing research. Finding sperm depends on how hard you look!

      • Leonard

        hello Dr.Turek i had a biopsy done and the urologist diagnosed me with.Sertoli-cell-only (SCO) syndrome are there any other way.

        Reply
  2. Javier

    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.

    Reply
    • Paul Turek, MD

      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.

      Reply
  3. ERNIE

    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

    Reply
    • Paul Turek, MD

      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-male-doctors/sperm-mapping-testicular/, (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.

      Reply
  4. gelle

    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.

    Reply
  5. gelle

    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.

    Reply
  6. Wal

    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

    Reply
    • Paul Turek, MD

      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.

      Reply
  7. Ozcan

    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?

    Reply
    • Izel

      Ozcan…

      Hoe is het nu verder afgelopen met je? Heb je al een kindje ondertussen?

      Reply
  8. Myles

    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

    Reply
  9. Jadi

    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????

    Reply
    • Paul Turek, MD

      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.

      Reply
      • Javed Tariq

        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.

        Reply
  10. Fortune

    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

    Reply
    • Paul Turek, MD

      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.

      Reply
  11. Ratan

    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.

    Reply
    • Paul Turek, MD

      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!!

      Reply
  12. Ante

    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

    Reply
  13. Ante

    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?

    Reply
  14. hopeful

    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

    Reply
    • Paul Turek, MD

      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…

      Reply
  15. Jadi

    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.

    Reply
    • Paul Turek, MD

      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.

      Reply
    • hopful

      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 :)

      Reply
  16. Milon Hossain

    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.

    Reply
  17. Amina

    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

    Reply
    • Paul Turek, MD

      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%!

      Reply
  18. Youni

    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

    Reply
  19. Youni

    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

    Reply
    • Paul Turek, MD

      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/).

      Reply
  20. Youni

    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

    Reply
  21. Nas shah

    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

    Reply
    • Paul Turek, MD

      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.

      Reply
  22. nas shah

    Thanks Dr Turek. I look forward to the blog and hopefully working with you again in the near future.

    nas

    Reply
  23. nas shah

    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

    Reply
  24. Nas shah

    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

    Reply
  25. Sara

    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.

    Reply
    • Paul Turek, MD

      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.

      Reply
  26. JR

    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?

    Reply
  27. Sarah

    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.

    Reply
    • Paul Turek, MD

      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/

      Reply
  28. JG

    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?

    Reply
    • Paul Turek, MD

      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!

      Reply
      • JG

        Dr Turek
        In regards to my earlier post, I performed Icsi with sperm extracted with mtese and my wife is now almost 14 weeks pregnant and all is going well. It is great that it worked, and fingers crossed for the rest of pregnancy…unfortunately though I didn’t have any further sperm for further attempts and will most likely require a further mtese. As ejaculation has not produced any viable sperm the last half a dozen times I am resigned to having mtese again. My question is… Is it likely that more pockets of sperm will be found around the same area? As i had 1 succesful mtese is that a precursor for another? Do the pockets regenerate or once the tubules with sperm have been retrieved then that is it?

        Reply
        • Paul Turek, MD

          JG. Congratulations! and great questions. In over 90% of my first time sperm retrievals, I have been able to find sperm again on subsequent procedures, but it depends. Sperm producing tubules typically do not regenerate. Once they are pulled out, they are gone. In addition, scar tissue may be present, making subsequent procedures more difficult. This, in fact, is one of the reasons that I like FNA Mapping, as it allows you to do the smallest, least invasive procedure the first time (cause you know before you go) which keeps things nice and clean for subsequent procedures. You could consider doing an FNA Map after 6 mos to see if there are pockets of sperm left and “tailor” the next sperm retrieval procedure to the map.

          Reply
  29. Shilpa

    Hi Doctor,
    I have filled up your contact form and also posted a conversation message directly to you. Hoping to hear from you.

    My husband was diagonised with Azoospermia. A little elevated FSH and normal LH and Testosterone. Also the Inhibin B levels were low. Our Andro suggested a Micro TESE. No Sperms were retrieved. Also the Centrifuge method was tried with no use. The Tese reports have been sent to the patho lab for further analysis.

    Please suggest us if there is still hope. Would sperm mapping help in this case. We are ready to try ANYTHING and EVERYTHING possible.
    We are from India, so we also would like to know any of the trusted Centers or doctors you consider the best to undergo this procedure.

    Please suggest. Eagerly waiting for your response.

    Shilpa

    Reply
    • Paul Turek, MD

      Shilpa, Sounds like your husband has nonobstructive azoospermia. You didn’t mention whether genetic testing was done but it also sounds like it might be genetic in origin. Microdissection TESE failures may or may not have pockets of sperm on extended FNA Mapping; it depends on the quality of the procedure, the histopathology (“look”) of the testis and the quality of the lab processing the tissue. The results from the pathology lab can give us some clues here. If maturation arrest pathology is found, then repair of varicoceles and injectable medical treatments such as FSH MAY be of benefit.

      Reply
      • Shilpa

        Thanks for the reply Doctor. Will get back to you once we have the pathology report.
        I was searching for FNA mapping and found a doctor ‘Karthik Gunasekaran’ who works in Metro Male Clinic. The site claims
        He was trained in Mens Reproductive health and Reproductive microsurgery by none other than world renowned Andrologist and Reproductive microsurgeon, Dr.Paul Turek (www.theturekclinic.com) at San Francisco, California.

        Could you please let us know if this is the right information. We just want to know any options we can look out for in India. Please let us know if Doctor Karthik can be approached.

        Thanks,
        Shilpa

        Reply
        • Shilpa

          Hi Doctor,
          Please find below the pathological report of my husband. Please suggest our next step after this. PLEASE let us know of any small or big thing we can do for this. We are ready to try all options available.

          Microscopic Description:

          Received multiple tiny bits altogether measuring 0.5*0.5 cm. Entire Tissue Processed

          Sections show seminiferous tubules with only sertoli cells. Few of the tubules are hyalinized. Interstitium shows leydig cells. There is no spermatogenesis seen.

          Diagnosis/Comments:
          Right testicular biopsy
          —Shows sertoli cell only syndrome

          Thanks,
          Shilpa

          Reply
  30. Hari

    Hello Doctor, Hope you are doing good. My testicular biobsy shows that it’s a maturation arrest at secondary spermotocyte stage. Also during one of the semen analysis, found only one sperm with good motality. Im at the age of 32 now. Please advise next step and also share if there is any hope.

    Reply
    • Paul Turek, MD

      Hari, this is good news! Although I have never seen maturation arrest at the “secondary stage” I have seen it at the late spermatid stage, also termed “late maturation arrest.” And, even better, you are ejaculating motile sperm!

      So, I would encourage maximal medical therapy (fix any varicoceles, normalize FSH, Testosterone and E2, and correct all lifestyle issues [stop hot baths, smoking, alcohol] and see if you can start banking ejaculated sperm (cryptozoospermia). IF not, FNA mapping has a great chance of finding mature sperm in the testis and can guide a testis sperm retrieval if necessary. BEWARE: Microdissection TESE is a much larger procedure that MAY FAIL in this scenario as the seminiferous tubules are big and normal appearing all over the place.

      Reply
      • Hari

        Thanks Doctor. I have checked all the mentioned hormone levels and also underwent ultrasound to check for the vericose veins. According to my Doctor, All the hormone levels are perfectly within the range and no vericose. Does this maturation arrest at secondary spermatocyte have any chance to become biological father if i undergo FNA mapping. I quit smoking and drinking 5 years back. Have noticed only one motile and that too only once. Please advise.

        Reply
  31. Hari

    Hello Doctor, would like to know one thing about you said start banking on ejaculated sperm. Can you please shed more lights on this procedure. Thanks once again for your time.

    Reply
  32. worried

    Dear Dr. Turek,
    I’m interested in MicroTESE because of Sertoli cells only syndrome. I’ve done standard testicular biopsy once and got this diagnosis. I’ve read that this situation doesn’t have to be present in 100% of testes, there may be area(s) with spermatogenesis. My testosterone level is normal (close to higher limit), FSH 2xnormal and LH 50% higher. Had mumps at age of 13 with no visible complications.
    I live in Serbia, southeast Europe and would like to know what clinics, if any, perform real microTESE in Europe and West Asia or closer than USA. I understood only you and dr. Schloegel at Cornell mention complicated and long operation WITH possible risks, which is understandable.
    Thank you

    Reply
    • Paul Turek, MD

      Dear Worried, Sounds like your azoospermia may be due to mumps orchitis (if your testicles hurt during the mumps infection at 13 yrs) or genetic reasons (Y chromosome, cytogenetics). In the former case, we have published that at least 40-50% of men will have sperm somewhere in the testicle using FNA mapping in areas distinct from the prior biopsy. In cases of unexplained azoospermia, this number falls to about 30-40%. Microdissection is a much larger procedure that has real and measurable risks that has about the same sperm yield rates. I prefer mapping to microdissection because of the much lower complication rates and the ability to minimize the extent of a sperm retrieval later on because you “know where to go” in advance.

      Reply
  33. Britt

    Hi Dr.Turek- Your Youtube interview gave me new hope. My husband is 29, has NOA. Normal Genetic tests, very LOW testosterone, small testes, no blockages or varicoceles, healthy weight and diet. Never had cancer, doesnt drink or smoke, and has only had me as a partner. No one here in Grand Rapids says we can conceive ever naturally. I had to pull teeth and beg my RE to put my husband on 25mg daily 3 mo of Chlomid. We are in month two now, is this something you’ve ever seen work before? My RE has never even put an azoospermic man on it, I just read about it and thought, *maybe*. We are not open to IVF/TESE at all. :9( Thank you for your read!

    Reply
    • Paul Turek, MD

      Britt, Absolutely it is worth medical treatment to “optimize” sperm production in many cases of azoospermia. It is not uncommon to see small numbers of ejaculated sperm result from such treatment. However, it is still very unusual for natural pregnancies to occur with such treatment as generally only small numbers (<1 million sperm/mL) of sperm are generated. The main benefit of such therapy is to eliminate the need for testicular sperm retrieval and create the opportunity to use small numbers of ejaculated sperm with IVF.

      Reply
      • Britt

        I just finally read your reply, thank you for that. Is it possible that Febrile seizures at a young age could have something to do with his infertility? Doctors I’ve asked have always been unsure. He had a few very high fevers as a child following different vaccinations that sent him to seizure; his mother says he had one grand mal and two petite by the age of 7 and then they stopped vaccinating him. He never had any other after that or any types of illnesses or injuries.

        Since that post my husband did become open to a biopsy and there was no sperm found, he took the clomid up until the procedure (for about 3 mo). The urologist called the method a TESE and took tissue from each testicle. We were disappointed to find out later that this procedure also bore no diagnostic benefit. The office said that they cannot comment on the cause of the NOA because they do not create permanent slides of the tissue to look at afterward. The doc. commented that he is truly perplexed because my husband’s tissues etc. all looked “healthy” whatever that means. We don’t know where to go from here, I think he would have been open to IVF if it had it been an option. We feel like our situation is hopeless and no one out here seems to know much about Azoospermia because we have had to come up with a lot of research and suggestions. Do you think there is anything that we should be asking to be done besides what our doc has done so far? Do couples ever come to see you that live in another state? Here is a little bit of more detailed info : hormone levels a year ago were:T:340,FSH:28.6,LH:6.7,P:6.8
        Thank you so much!

        Reply
        • Paul Turek, MD

          Britt, You have officially become my average patient! I see men from all over the world and most have had what you just went through and were told. Consider a Second Opinion or a visit. If you visit FNA Mapping can be done on the same day and you can go home within 24 hours. HOWEVER, you should now wait at least 6 months after just having a testis sperm extraction before you look for sperm any other way to let the testicles recover from the procedure.

          Reply
          • Britt

            Thank you for your quick response! It is encouraging to know that we are not alone, I will talk to my husband about getting a second opinion with you a little down the road. Thank you for your help :-)

          • Britt

            I do have a question, Phil had a chromosome analysis and the final report said normal male karyotype these metaphase cells had a modal number of 46 chromosomes including the x and y chromosomes. no consistent structural or numerical abnormalities were detected. Are these types of tests usually sufficient in ruling out micro-y deletions, or is this too basic of an analysis? I was always curious if this really meant anything or not.

  34. Allie

    Dr. Turek, hoping that you are still keeping an eye on this article. My husband was diagnosed with azoospermia after 3 SA that came back with zero count (one only had 3 non-molitile sperm). After a few test found out he had low testosterone but all other levels were normal. Is taking clomid and just had a testi-biopsy that diagnosed him with late maturation arrest. Urologist recommends IVF with backup doner sperm. Do we have any hope for a biological child? What are our options? Thank you in advance for your guidance.

    Reply
    • Paul Turek, MD

      Allie, you bet that I still have an eye on things! A biopsy diagnosis of “late maturation arrest” is unusual. It may reflect lifestyle issues (hot baths, tobacco use, medications) or acquired issues (obesity, varicocele, illnesses like diabetes). It may also be genetic (Y chromosome deletion, karyotype abnormality). Not sure what the plan is for retrieving sperm for IVF, but microdissection TESE in these cases can be very difficult, as all tubules look the same and the ones with sperm are hard to distinguish from those without. FNA mapping can be very informative here as a “know before you go” approach and is much less invasive.

      Reply
  35. Samantha

    My husband shows 0.2 m sluggish linear progressive 5% total forward 5% biopsy shows arrest maturation shows presence of some primary and secondary spermatocytes, sonography shows right mild varicocele

    Reply
    • Paul Turek, MD

      Dear Samantha, So there appears to be a count of <1 mill/ml sperm with low motility. Not sure why a testis biopsy was done but it showed maturation arrest. There is also mention of a right varicocele. I would begin to think about genetic causes (Y chromosome deletions, karyotype issues), varicoceles on BOTH sides (isolated right varicocele occurs in <1% of men) and lifestyle issues going forward. Maturation arrest is a natural response to environmental and reproductive “toxins” such as smoking, obesity, varicocele, hot tubs, illness, flus. All this must be corrected.

      Reply
  36. JD

    Dear Dr Turek
    Ref: NOA
    I have had a tesa and just recently a mTESE after being on clomid for 6 months performed by Mr Minhas in UK – I have always had nothing in all my SA however in the mTESE we found lots of spermatids at late stage development and in contrast to this the Histology report came back as Sertoli Cell Only which makes no sense as the andorologist has confirmed that in each slide there were ample spermatids?

    Any suggestions as to what can be done at this stage in regarding to medication to help and perhaps a third mTESE?

    Reply
    • Paul Turek, MD

      JD, Yes, these conflicting results are strange. Biopsy histology is generally more accurate than a live, unstained assessment of testis tissue during TESE for germ cell patterns. In addition, in my experience, where there are spermatids, there are USUALLY sperm nearby on TESE. If the andrologist (TESE) is correct, then aggressive treatment of varicoceles, improving lifestyle issues (stop smoking, lose weight, consider changing medications, stop hot baths) may help convert spermatids to sperm in the testis. This may not result in ejaculated sperm but may result in enough testis sperm to be detected by FNA mapping. If you really have Sertoli cell only histology and no spermatids, then these changes may be of no benefit, as testis germ line stem cells are not present.

      Reply
      • jd

        Thank you for your advice. I have emailed you for a telephone consultation and really look forward to speaking with you soon. Thanks!

        Reply
  37. Traci

    Dr. Turek,
    My husband was diagnosed with spermoticytic arrest about 6 yrs ago. ( before I met him, so I’m not sure of all the details) . Is this the same thing as azoospermia? If not, does his condition have a treatment? He was told by the doctor that he will never have children.

    Reply
    • Paul Turek, MD

      Traci, Great questions! Spermatocytic arrest is a well-described pattern of spermatogenesis found on a testicular biopsy which means that the process of making sperm has started (germ line stem cells are present) but is not going to completion (mature sperm) in the testicle. The “arrest” of this process can occur “early” (primary spermatocyte) or “late” (spermatid stage). Also termed “maturation arrest,” some such cases are genetic in origin and unmodifiable and others may be modifiable to the point of sperm production. In latter cases, however, sperm retrieval is generally needed along with IVF-ICSI. Consider a Second Opinion with us and send along the actual testis biopsy slides if you want more information.

      Reply
  38. Stence

    Dear Dr. Turek,

    My husband was diagnosed with Sertoli Cell Only Syndrome and we have been told that he is infertil and our only option is to find a donor. Do you agree in this or do you think there is a possibility that we could both get a biological child?

    Thank you in advance.

    Reply
    • Paul Turek, MD

      Dear Stence, It may be possible to have a child. It really depends less on the pattern found (e.g Sertoli cell only) and more on HOW HARD they looked to find sperm. If a simple testis biopsy was done to find sperm, then the chance is 30% that it would. If an FNA map was done (which samples 18 sites/testicle for sperm much less invasively) then there is a 60-65% chance of finding sperm.

      Reply
  39. Megan

    Hi Dr. Turek,
    My husband was recently diagnosed with Sertoli-cell only syndrome after a testicular biopsy. We were told microdissection with IVF is our only chance for him to have biological children. He is still healing from the biopsy and is extremely apprehensive about the additional surgery where the odds do not seem in our favor. I read about the MR Spectroscopy you wrote about in 2011. Is this an option today? If so, can we call to speak to you about it? We live near San Francisco. Any advice you may be able to give would be greatly appreciated. -Megan

    Reply
    • Paul Turek, MD

      Dear Megan, SCO on a single biopsy may still mean that there is sperm elsewhere. FNA mapping is a (safer) alternative to microdissection to locate sperm and determine candidacy for IVF. In fact, FNA mapping patients take an average of 1-2 pain pills after their procedure, far fewer than men having a biopsy (4-6 pain pills, ask your husband). Metabolomics is still undergoing patents etc and clinical trials have not started yet.

      Reply
  40. Emma

    Hi Dr. Turek,

    My husband has azoospermia due to history of bilateral undescended testicles. Which were operated on at age 4. He had normal hormone levels. Was on pregnyl injections for 6 months after which he had microdissection. Results were zero sperd and a few grade b spermatids. After a while he was prescribed some pills (forgot the name) along with vitamin c and another sperm count enhancing supplement. Went through the microdissection process again with same result.

    Any hope for us?

    Thank you in advance.

    Reply
    • Paul Turek, MD

      Emma, it would seem that another microdissection is NOT the way to find sperm in your husband. Remember, when the testicular tissue looks the same under the microdissection microscope, sperm could be missed, as the technique relies on visual differences among tubules to succeed. With FNA mapping, the tissue is looked at completely differently and far less invasively. As a result you may find a pocket of sperm and then go back to it and focus the sperm retrieval on that specific area, increasing the likelihood of finding sperm. As an example, I am lecturing next month at the AUA on my latest data from the last 100 cases like this: When I do a microdissection without a prior FNA map, I find sperm in 52% of cases. However, when I do a microdissection guided by a prior map showing sperm are present, I find sperm in 92% of cases.

      Reply
  41. amin

    hello doctor :
    im 25 y old azoospermia and fsh 2.57 and free testosterone 17.2 at lower limt
    im doing FNA mapping and the dignosis maturation arrest at round spermatid level and no sperm
    now im in rFSH and HCG and capergoline
    can you give me doctor the percent to be biological father
    and what other option medical mangment

    Reply
    • Paul Turek, MD

      Amin, the diagnosis of late maturation arrest (round spermatids present but no sperm) is very unusual. However, the treatment approach of “pushing” production past round spermatids to sperm with FSH and LH injections is very reasonable. I would consider a “re-map” after 6 mos of such therapy if a semen analysis shows no sperm then. I would estimate that the chance of finding sperm after this therapy and a good (36 site) map is 20%.

      Reply
  42. Ayman

    Hi Dr. Turek,

    I am 37 years old and been married for 7 years. In 2009 i found out that I had no sperms. After ruling out blockage I was diagnosed with Azoospermia. I underwent FNA and the diagnosis was “Spermatogenesis arrest at spermatocytes stage”. My chromosome test came back normal and I don’t have varicocele. My FSH and LH levels are normal. My Testosterone levels are low. I was told by the doctors who treated me initially that my only hope would be to wait for stem research to advance. Can you please advice me on what you think my chances currently are and if there is anything that I can do.

    Reply
    • Paul Turek, MD

      Dear Ayman, Your ability to have sperm with maturation arrest on mapping depends in part on 1)how many sites were examined (we use 18/tesis) and 2) the quality of the mapped samples (all samples should be “readable” if done right). I would be happy to re-review your mapping slides and lend an expert opinion on what has been done and what your chances of currently having sperm are. Consider a Second Opinion

      Reply
  43. amin

    Hi Dr. Turek,
    i wanna ask you about multivitamin and coq10 and thers role in maturation arrest ??

    Reply
    • Paul Turek, MD

      Amin, I am not aware of any relationship between MVI and antioxidants and maturation arrest. Our supplement with these ingredients was mainly designed to improve low motility and lower sperm DNA fragmentation.

      Reply
  44. amin

    hello doctor turek
    what do u prefer in medical treatment of maturation arrest clomid or HMG and HCG
    MY FSH 2.75 AND IN OTHER TIME 3.5
    inhibin b 150
    and dignosis maturation arres at round spermatid
    in this case
    is there any probability to be y chromosome micro deletion

    Reply
    • Paul Turek, MD

      Dear Amin, It is somewhat unusual to be arrested at the round spermatid stage. Arrest at this stage can be genetic, but can also be due to lifestyle issues (obesity, fevers, smoking, varicocele). Consider fixing as many of these issues as possible. FSH is preferred to HCG unless T levels are low. Consider FNA mapping as “where there are spermatids, there are usually sperm.”

      Reply
  45. mak

    Hello doctor,
    I m 33 years old..;suffering from non obstructive azoospermia..my biopsy report says that I have sertoli cell only syndrome.
    We went for tesa twice…once they found three immature sperms from which only one embryo was formed that too..C grade embryo which resulted in failed ivf.
    Second time nothing was was found.
    An expert from germany went through our case and said us that there is no hope …and we should wait for further technical treatments.
    Please suggest…
    All the reports of my wife are normal except her LH is elevated.

    Reply
    • Paul Turek, MD

      Dear MAK, The fact that a relatively noninvasive procedure (TESA) was used to find sperm and did at least once is a VERY encouraging sign that more islands of sperm may be present. Sperm mapping is an excellent and precise way to locate these and determine whether you are a candidate for further procedures.

      Reply
  46. Adam

    Dear Doctor Turek,
    I m 32 years old, live in Beijing China. I have non obstructive azoospermia which was diagnosed in May 2013. And at that time,my fsh was 32, T was 5.3, my testis size were 10ml left and 9ml right, the doctor told me there were almost no hope to have children. Then I began my trip searching for solution. In January 2014, I had varicocele surgery and biopsy, the biopsy report told sertoli cell only syndrome. About three months later, I went to china peking union medical college hospital(the biggest general hospital in China), they found spermatogenic cells in my semen twice, and my FSH turned down to 18.7, T was 4.7. However ,there is still no sperm in the semen till now.
    I has been following ur blog three months, which gave me hope and power to keep going. Could u pl tell me the possibility to find sperm in testis with FNA mapping. I m considering to schedule consultation with u, but a little worry about my oral English which may have problem with talking with u.
    I really need ur suggestions and help! Looking forward ur reply!

    Reply
    • Paul Turek, MD

      Dear Adam, First off, your English (at least written) is fantastic! Secondly, the chance that extended FNA mapping would find sperm in the setting of a prior biopsy showing Sertoli cell only is roughly 40%. Consider setting up a Second Opinion or a free call to pursue further.

      Reply
      • Adam

        Dear DOC. Turek,
        According to ur suggestion, I consider to have a second option from u. But first of all, I have a plan to US in september, should I meet u and have a face to face communiction with u ,and show u all my medical records, and by the way to have THE FNA mapping?? Or just get second option and keep taking medcines? and if we have this mapping, how long will it take till available to travelling back ? Cause I only have 7 days.And if any sperm catching, what should we do next and how long will take?

        Really need ur suggestion. Thank u very much.

        Reply
      • Adam

        According to ur suggestion, I consider to have a second option from u. But first of all, I have a plan to US in september, should I meet u and have a face to face communiction with u ,and show u all my medical records, and by the way to have THE FNA mapping?? Or just get ur second option and keep taking medcines? And should I schedule consultation before we go? If we do this mapping, how long will it take till available to travel back? if any sperm catching ,what should we do next and how long will take? We only have 9 days holiday.

        Really need ur suggestion. Thank u very much.

        Reply
        • Paul Turek, MD

          Adam, great questions! I would start with a complimentary phone call to discuss these issues. Contact us to schedule.

          Reply
  47. TYRON

    DEAR DR. TUREK,
    I AM 31 FROM. MY SPERM TEST SHOWED NO SPERM AT ALL (AZOOSPERMIA)
    I HAD A BIOPSY WHICH RESULT WAS MATURATION ARREST AT SPERMATID LEVEL MEAN TUBULAR SCORE 50%
    WHAT CAN I DO TO BECOME A BIOLOGICAL FATHER?
    KINDLY PLEASE ADVICE
    THANK YOU
    TYRON

    Reply
    • Paul Turek, MD

      Dear Tyron, Nonobstructive azoospermia due to later (spermatid) maturation arrest is very unusual. Typically, when I do FNA Mapping on such cases, which allows me to look much harder and in more places than does a simple biopsy, sperm can be found. Late maturation arrest can also be caused by lifestyle and medical issues (smoking, hot baths, fevers, illness, medications, varicocele) and may be partially reversed to the point of ejaculated sperm counts if these issues are attended to.

      Reply
      • TYRON

        Dear Doctor…
        Thank you very much for your reply…..
        According to my Urologists the reason for this issue, was due to virus, that had occurred during my early childhood (I got mumps virus & Malaria Virus) other than that doctor I am a tea tootler.
        Also the scan reports say that there is varicocele
        Doctor advised me & said that there is nothing they can do about this matter, and wanted me to go for adoption or find a sperm donor.
        Doctor if sperm can be found like you said by doing FNA Mapping , I would not mind doing it.
        Please send me you email address, or any other means of contact information, I could scan all my reports for your reference.
        So that you could advise me on what should be done.
        Thank you,
        Tyron.
        .

        Reply
  48. Sarah F

    Dear Dr. Turek,

    I’ve been following your blog. My husband is diagnosed of NOA. He underwent mTESE and only few sperms were found. The diagnosis is maturation arrest. Can cryptorchidism cause maturation arrest? I don’t know at what level of maturation arrest. We were told that they found motile and non-motile sperms. Is this classified as early or late maturation arrest? While sperms can be found with mTESE or FNA mapping, I don’t seem to find information regarding their quality and how it is correlated with live birth. Unfortunately, our only two embryo ended in chemical pregnancy. Devastated. Now, we are directed to donor sperms. I wish the stem cell option is available at this time when we both want to have a family. Thanks for doing this for the future generation.

    Reply
  49. Gopi Krishna

    Dr Turek … I am from India , diaognised with Azoospermia 2 years ago , with below observation in biopsy report: Microscopic description of testicular biopsy :

    The biopsy is adequate & incules 25-30 seminiferous tubules.Germinal cells are reduced in number.There is a striking arrest of spermatogenisis at the primary spermatocyte stage with lack of spermatids and sperms across the tubules.Mild sloughing of germ cells is present in the lumen.Thickening of the basement membranes or tubular sclerosis is not seen.The interstiti show few leydig cells.There is no evidence of koch’s seen.

    Harmonal and ultrasound reports are normal. Please suggest.

    Reply
  50. Kumar

    Hello Dr. Turek,

    I have been diagnosed with azoospermia. I am 30 years old and married for 5 years. I have undergone frequent semen analysis, all shows nil sperms. I have undergone testis biopsy the findings of which says ” extensive maturation arrest, marked peritubal fibrosis and marked leydig cell hyperplasia – there is only a very rare focus of even partial spermatogenesis without evidence of complete development in any area of the biopsies. “. My hormone levels are FSH 25.9, LH 14.90 testosterone 191. the ultrasound scan of testes shows right testes measures 2.23*1.52*0.92 cm, left testes measures 2.21*1.59*0.84 cm with left grade 1 varicocele, epidydimis normal in both testes. I am on clomid from the past four months. Kindly suggest if FNA mapping would be helpful in my case since I am considering visiting you if its worthwhile. It would also be very helpful if you could guide me on further course of action. I am non alcoholic and non smoker.
    Awaiting your reply,
    Kumar

    Reply
  51. Jones Opoku-Mensah

    Dear Dr,
    i was diagnosed as azoospermia by several semen analyses. hormonal analysis showed normal levels of testosterone but very high FSH. scrotal scan showed no blockage of any tube and normal epididymis. testicular biopsy showed few germ cells with varying degrees of fibrosis with foci of leydig cells. i have been put of ZEMAN, a fertility drug which is more of a multivitamin rich in L-carnitine.

    Another doctor told me that, nothing can ve done about my situation therefore he did not give me any medication and asked me to just pray.

    Am in Ghana west Africa.
    thank you

    Reply
    • Paul Turek, MD

      Dear Jones, Although your single testis biopsy may not show any sperm, it does not mean that your situation is hopeless. FNA mapping, a less invasive procedure than your biopsy, has at least a 40% chance of showing sperm in areas of the testis that were not biopsied. Please don’t give up hope.

      Reply
  52. lizcolly

    Hi Dr. My DH was diagnosed with azoospermia 4 months ago. We have been trying for 18 months. Initially was diagnosed with infections staphylococcus. It was treated byt kept reoccurring. He had several SAs with no normal sperm present befire we were given the heavy blow that there was no other option except donor sperm. Which I am not game with. I adore and live my DH so much the thought of not carrying his biological child is killing.

    At the moment we do not know if it is NOA or OA as the hospitals available here did not seem to offer such advanced technical know how. However we were told a cyst was in one of the testis so physically one of the testis appears and feels smaller than the other.

    We want our own biological children what chances do we have?

    Reply
    • Paul Turek, MD

      Dear Lizcolly, You really must read my blog entitled a Users Guide to Azoospermia. It is perfect for you! If he is indeed blockage, there is the possibility of reconstructive surgery and babies naturally! If he is not blocked, there is still a 60% chance or so of sperm that might be used with IVF-ICSI.

      Reply
  53. Anna

    Dear Dr Turek,

    Thank you for your blog and all the articles and information. My husband is diagnosed with non-obstructive azoospermia and no sperm were found with biopsy…
    Could you please recommend some clinic in southern Europe (or elsewhere) that performs FNA mapping or MR Spectroscopy, since coming to US is not an option for us because of the finances?
    Thank you!!!

    Reply
    • Paul Turek, MD

      Dear Sam, Great question! If it is from the testicle and was painstakingly obtained and rare in numbers then YES, as 40-50% of this sperm is viable or alive and usable with IVF-ICSI after thaw. If it is from the ejaculate, then probably not, as much nonmotile ejaculated sperm is dead after thawing.

      Reply
  54. Ashley

    I am writing on behalf of my partner. He was recently diagnosed with non obstructive azoospermia. His fsh level is 24.7 and T level is 364. I don’t know the LH as the dr. didn’t mention it, so I am assuming it is within normal range. He has prescribed him letrozole along with various vitamins, and just last week hcg injections. I don’t think the shots will work and we are looking foreward to biopsy in a couple of months but me being the researcher I am have found this supposedly new treatment for azoospermia called SpermHope.. It is supposed to work by blocking testosterone for a period of time to allow the early stages of spermatogenesis to happen. Have you heard of such methods, and will it have an effect on having optimal setting in the testis for biopsy. We have never done a biopsy before so we don’t know what’s going on inside or what the problem could be. We will see his doc again on Nov. 25th during which I will ask for a chromosomal testing to be done. Will that tell me if there is any deletions or is that another test? What would be your professional advice as a male specialist? I just feel like his current specialist is more focused on female infertility, and maybe just doesn’t know enough about male infertility particularly.

    Reply
  55. Ashley

    Hi Dr. Turek,
    I am writing on behalf of my partner. He was recently diagnosed with non obstructive azoospermia. His fsh level is 24.7 and T level is 364. I don’t know the LH as the dr. didn’t mention it, so I am assuming it is within normal range. He has prescribed him letrozole along with various vitamins, and just last week hcg injections. I don’t think the shots will work and we are looking foreward to biopsy in a couple of months, but me being the researcher I am have found this supposedly new treatment for azoospermia called SpermHope.. It is supposed to work by blocking testosterone for a period of time to allow the early stages of spermatogenesis to happen. Have you heard of such methods, and will it have an effect on having optimal setting in the testis for biopsy. We have never done a biopsy before so we don’t know what’s going on inside or what the problem could be. We will see his doc again on Nov. 25th during which I will ask for a chromosomal testing to be done. Will that tell me if there is any deletions or is that another test? What would be your professional advice as a male specialist? I just feel like his current specialist is more focused on female infertility, and maybe just doesn’t know enough about male infertility particularly.
    Please and Thanks in advance.

    Reply
    • Paul Turek, MD

      Dear Ashley, it sounds like the doctor is “medically optimizing” your partner before looking for sperm, which is reasonable. I hope that the “look” that is taken is comprehensive and informative, as a simple testis biopsy is relatively uninformative for finding sperm relative to FNA Mapping or micro dissection. Sperm Hope is a new twist on a 50 year old idea that has fallen by the wayside. Funny how it seems to return every generation or so. Expensive and unproven, and potentially harmful.

      Reply
  56. Devon

    Hello Dr Turek
    I have been diagnosed with azoospermia a little over a year ago. I have been told that I will have no chance of having kids by my blood tests and hormone levels, as well as genetic tests also done indicating a slight mutation of chromosome 7. After my blood work and genetic tests, the Dr I saw informed me that there was no need to explore any further. She did not explain to me why she felt there was no hope, and I am wondering if I should seek a second opinion, and if mapping is worth looking into?

    Devon
    Canada

    Reply
    • Paul Turek, MD

      Dear Devon, Putting my thinking hat on here. Having azoospermia and a mutation in chromosome 7 likely means that you have obstructive azoospermia (i.e. a blockage) due to congenital absence of the vas deferens (which may be associated with genetic mutations [CFTR] on chromosome 7). That means that you may have NORMAL sperm production but no way to deliver it to the ejaculate. Fertility is certainly possible with IVF-ICSI and sperm retrieval. You may not even need a mapping procedure!!

      Reply
  57. Traci Smith

    Hi Dr. Turek. My husband was diagnosed with spermatocytic arrest about 10 yrs ago. Is there anyway possible for him to have a biological child??

    Reply
    • Paul Turek, MD

      Dear Traci, the short answer is Yes. Depends mainly on how hard they looked for sperm. A single biopsy is simply inadequate to find sperm in cases like this. A micro dissection can also be difficult as, with this pattern, all tubules look the same and picking the specific tubule that might have sperm is very, very difficult. FNA mapping can be very informative here.

      Reply
  58. Kellie

    Dr Turek!
    Hi! I have a question and found you while googling urologists in my area. My husband and I have two children. No problems conceiving them. I want to have one more before I turn 40(I’m currently 37), and have been trying for a year with no luck. I went to a reproductive endocrinologist and had every test imaginable. They could find nothing wrong. So, finally, I had my husband’s sperm analyzed and the lab results came back that he has no sperm! How on earth did that happen? He had sperm before, so where could it be now? He has not had any injury or anything that could’ve caused this. Our youngest is 5. Is this something that can be fixed? :(

    Reply
    • Paul Turek, MD

      Dear Kellie, Certainly the finding of no sperm after having children unremarkably needs an explanation. A formal male fertility evaluation is necessary to figure this out. It could be a blockage or a sperm production problem. A history, physical exam and reproductive hormones all give great clues as to what might have happened. From there, we can decide whether it can be fixed or not (possible fixes: Varicocele, blockage).

      Reply
  59. Jason K

    Hi Dr. Turek. I have just had my third biopsy (13 punches) and came back with 0, even though previous biopsies have yielded one or two. We meet with our RE on Tuesday to discuss further options. I am interested in FNA and other options. What would you suggest i do?

    Reply
    • Paul Turek, MD

      Dear Jason,

      Ugh, This is what happens when blind sperm retrievals are repeated again and again. Either you are “out” of sperm, or the remaining sperm pockets are not being found. An excellent case for extended FNA Mapping.

      Reply
  60. sudo

    Doctor, i had uti 4months before due to ecoli i was put on antibiotics i had left testis swell which my urologist said due to infection and swell is off in 2 days. Then after a month i felt varicocele bilateral usg doppler says normal testis with 5mm dilation. My sperm analysis is azoospermia for the first time and again azoospermia in the second time did after 4 days.my karyotyping is 46xy. My testosterone is 150, fsh 22, lh 9.8, prolactin normal.now after all this tests urologist says to go for tst n no to varicocele surgery.now my other urologist says my testis is atrophied and i cant father a child at all.my libido is lost experiencing rare erection from last week. This all happend in 5months. Will varicocele surgery help me. Im 21 yrs old not married from india.plz help me with any treatment options

    Reply
  61. sudo

    Doctor, i had uti 4months before due to ecoli i was put on antibiotics i had left testis swell which my urologist said due to infection and swell is off in 2 days. Then after a month i felt varicocele bilateral usg doppler says normal testis with 5mm dilation in palpax vien. My sperm analysis is azoospermia for the first time and again azoospermia in the second time did after 4 days.my karyotyping is 46xy. My testosterone is 150, fsh 22, lh 9.8, prolactin normal.now after all this tests urologist says to go for trt n no to varicocele surgery.now my other urologist says my testis is atrophied and i cant father a child at all.my libido is lost experiencing rare erection from last week. This all happend in 5months. Will varicocele surgery help me. Im 21 yrs old not married from india.plz help me with any treatment options

    Reply
    • Paul Turek, MD

      Dear Sudo, sounds like you had a bad case of epididymorchitis infection which may have contributed to the small left testis that you have. Varicoceles are common and do not generally cause azoospermia. Your genetics are normal but you do have non obstructive azoospermia (high FSH) and poor hormone production (T 150, high LH). If you goal is to have children, I would consider FNA Mapping to see if there is sperm. A biopsy is less informative but another option. After just varicocele surgery, there is a 20-35% chance of developing ejaculated sperm in low numbers. If your goal is a better sex life, it is likely that you will need formal testosterone replacement. However, do not take formal testosterone replacement while you are trying to conceive as it will “turn off” sperm production in the testicle.

      Reply
  62. Nicole

    Dear Dr. Turek,

    My husband (31 yrs old) has one undescended testicle (still in his abdomen) and one descended normal testicle. He has had 2 sperm tests. First yielded only 5 sperm total, 2 twitching and 3 non-motile. 2nd analysis only yielded 2 non-motile sperm. His FSH is elevated but all other hormones normal. Genetic testing all came back normal as well. Urologist from kaiser said we could do a biopsy but he doesnt think ita necessary as he thinks it’s non-obstructive cryptospermia and ivf with icsi is our only option. He had multiple surgeries as a child that I seriously think could have caused scar tissue obstructing sperm from leaving his “good testicle”. He just had a emergency ingunial hernia repair and hydrocele repair too, which left him with a hematocele. So now theres blood surrounding his good testicle. Urologist said we can still do TESE just makes it more difficult. In the meantime he has put him on anastrozole to try to increase levels of sperm in his ejaculate to avoid TESE. Just wanted your thoughts on all of this? We have 100% infertility coverage but of course in CA that doesnt include IVF or any services related to IVF. Were looking at 20k+. Big pill to swollow. Thanks for your advice!

    Reply
    • Paul Turek, MD

      Dear Nicole, Wow. Thats somewhat complicated. Here’s what I think is true.
      1) Since nobody has found sperm in an intraabdominal testicle (including myself) yet, I would agree that all ejaculated sperm is coming from the normally descended testicle.
      2) Since sperm is found in the ejaculate, then by definition the system is “open.” Partial obstruction in which lower than normal counts are found are very rare and are associated with NORMAL FSH (not elevated). Agree that this is non obstructive azoospermia
      3) Too bad about the recent hematocele. I would let this heal before pursuing any sperm retrievals.
      4) We have had excellent success using fresh and frozen thawed ejaculated sperm (cryptozoospermia) in low numbers. Why not start banking ejaculated sperm samples to use with IVF-ICSI?
      5) Finding testicular sperm in NOA with cryptozoospermia can be VERY DIFFICULT. Often large procedures are needed to find sperm, such as micro dissection TESE. These procedures can also lower testosterone levels and make him testosterone dependent for life. It would be VERY VALUABLE to know his baseline T and LH levels to understand his risk for testicular failure after such procedures. If he is at high risk, then you might consider FNA Mapping to pre-locate sperm in what is essentially a solitary testicle.

      Reply
  63. Jaspreet Singh

    Hello Doctor,

    I am having Non-obstructive Azoospermia
    I have undergone these test serial wise as doctor prescribed :
    1. Semen analysis:
    4ml, Azoospermia
    2. Hormonal Profile:
    Testosterone Basal 9.46 (nmol/L) slightly less.
    LH 4.35
    FSH 2.22
    3.TRUS
    Prostate Normal
    Left seminal vesicle and vas deferens is not visible
    On Right : No output ejaculatory duct is seen
    4. Left kidney absent.
    =====================================================================
    I am on this stage going to visit doctor with these reports 5 and 6
    =====================================================================
    5. FNAC
    Material Aspired : Thread like
    Report: FNA smears from bilateral testes show various stages of sperm maturation from spermatognia,
    spermatocytes, spermatidies and many mature spermatozoa
    Diagnosis : Both,Testes : Maturation normal pattern.
    6.Blood test
    PT : 11.1 (sec)
    INR : 1.07 (therapeutic) which is below then normal 2-35
    (Just to let you know i have lot of lipomas)
    PTTK/APTT : 32.6 (sec)

    As you have gone through lot of research What do you think what would be next step should be ?

    Awaiting your reply eagerly.

    Thank you,
    JS

    Reply
    • Paul Turek, MD

      Dear Jaspreet, This sounds ALOT like congenital absence of the vas deferens. IVF-ICSI with sperm retrieval will work in most cases. If the vas deferens is only missing on one of two sides, the surgical reconstruction may be possible (i.e. there may be fixable ejaculatory duct obstruction present). Ask your doctor whether the transrectal ultrasound shows this.

      Reply
  64. david

    Hi Dr Turek,

    I recently had FNA mapping done and the doctor found Sertoli cell only syndrome in all samples taken. I had light radiation therapy to my tailbone area when I was younger for a skin disease, and have used anabolic steroids for about 14 years on and off before trying to have a child. I’ve been off the steroids for 1.5 years. My question is, if they found no germ cells in my Sertoli cells, is it possible that I will ever make germ cells again, or once they are gone, there is nothing to produce new germ cells? The doctor also said he could do a micro dissection to look for sperm but the odds are very slim after the negative results of the FNA mapping.

    Reply
    • Paul Turek, MD

      Dear David, that story is complex. Was the radiation to the tailbone area combined with a scrotal lead shield? If not, that could well be the problem. I have seen the inability to get ejaculated sperm back after many years of anabolic steroid use, but feel that Sertoli cell only pattern is an extreme response to this issue. My first (and only) question is “how many good quality sites were sampled from each testicle on the map?” I ask this since, the more samples taken, the higher chance of sperm (to some degree).

      Reply
      • david

        Hi Dr. I can’t recall if a lead shield was used for the radiation treatments, I can probably get a copy of the report though. The dr mapped 11 and 14 sites in each testicle so it was pretty thorough. I am considering doing mTESE, as my dr said there is a very small chance something could still be there.

        Reply
  65. haleem

    im 49 yrs old with sperm maturation arrest at spermatocyte level,
    no sperm in semen,
    I did TESE sperm found but 1 % normal. can you help me,

    Reply
    • Paul Turek, MD

      Dear Haleem, Not exactly sure what “1% normal” means, but if this means they found sperm at TESE, then it should be possible to find it again. However, you may want to “know before you go” with FNA Mapping to reduce the extent of biopsies taken in a solitary testicle.

      Reply
  66. haleem

    dear dr turek.
    im 49 yrs old with single testis , and sperm maturation arrest at spermatocyte level , all hormon normal.
    can you help me.

    Reply
    • Paul Turek, MD

      Dear Haleem, the answer to your question is a firm “maybe.” Consider a call or a Second Opinion to provide the details of your situation to make an informed decision.

      Reply
  67. sara

    Dear Dr. Turek
    My husband has noa.
    Fsh level a little high
    Lh very high
    Testostron normal in the low range
    Normal karyotype but with a microdeletion in azf-b sub region.
    We didnt do biopsy or micro tese because our dr said there is no chance. Please help us. What can we do to have our biologic baby?thanks

    Reply
    • Paul Turek, MD

      Dear Sara, the presence of sperm in men with defined genetic infertility depends alot on the precision of the genetic testing. A complete or full AZFb deletion is unlikely to have mature sperm but a PARTIAL or incomplete deletion may in fact have sperm. The blood can be retested if the original test does not distinguish between these two.

      Reply
  68. AMITABH

    I am 41 years old, I am azoospermia patient, my recent Testicular Biopsy report showing

    “Section shows seminiferous tubules with sartoli cells only. No germ cells seen” on right testicular biopsy.

    is this report is final that I never become a FATHER…
    or there is some hope ..

    Reply
    • Paul Turek, MD

      Dear Amitabh, A single testis biopsy from one side showing Sertoli cell only may not be final, as sperm production can occur in pockets and those pockets could easily be missed if only a single biopsy is done. The relatively non-invasive technique of FNA mapping with 18 sites/side has about a 30-40% chance of finding sperm in this case. Consider a call to learn more!

      Reply
  69. Andrew

    Dr. Turek,

    I have been diagnosed with azoospermia. My T was low, everything else normal, FSH on high end, but in normal range. Urologist put me on 25 mg chlomid which got my T back up into low end of normal. Still no sperm in SA. He sent me to an infertility specialist, had biopsy done with no sperm found, pathology came back as hypo spermatogenesis. My doc now wants to do mTESE. Looking into HCG injections and anything else we can do to possibly boost production before procedure. Do you have any other suggestions? Is there anyone in the Indiana area that does the FNA mapping?

    Thanks so much for your time! You are such a great resource!

    Reply
    • Paul Turek, MD

      Dear Andrew, We published over a decade ago that a biopsy pattern of hypospermatogenesis (full, but thinned sequence of spermatogenesis) results in a 90-100% chance of finding sperm on FNA mapping. I like the idea of stimulating sperm production to higher levels with hCG if your T is low. Give it 3-4 months. Not sure that mTESE is necessary though. As far as I know, I have trained no one in FNA mapping in Indiana.

      Reply
  70. Hope

    Hi Dr Turek
    Since October last year I have been reading up on the Internet about azoospermia, low sperm & achieving pregnancy with these set backs. I came across your blog and am intrigued. My husband had 2 SA’s done prior to seeing an ivf specialist. 1st azoospermia, 2nd oligaspermia with under 1 million. Since then an ultrasound found white dots and a sample to be used to freeze unfortunately was azoospermia after attempts at spinning sample and so on. Urologist not concerned abt white markings on scan need to monitor. However we found the reason is Klinefelter syndrome. Fsh is high I believe and borderline to low testosterone. They are suggesting try another sample to see if can produce any sperm if not there is procedure needle in testis or the open testis procedure which we do not want to do. At age 33 do you think there is a chance to find sperm with this condition by repeating samples monthly or by the injection in testis? Very keen to hear your thoughts.
    Thank you

    Reply
    • Paul Turek, MD

      Dear Hope, It is a rare event that men with Klinefelter syndrome (non mosaic) have ejaculated sperm. Consider taking anastrazole daily and trying to freeze low numbers of ejaculated sperm after 3-4 months. In our reported series of 40 men with cryptozoospermia, it took about 4-5 samples to bank any with sperm. Certainly beats a testicular sperm retrieval that will almost certainly lower testosterone levels further.

      Reply
      • Hope

        Thanks for your feedback and time Dr Turek.
        What is the non mosaic and is that what all Klinefelter syndrome people are? So from your last message are you saying you would recommend leaving both surgeries and instead persist with multiple attempts at ejaculated sperm? If so how often weekly or monthly? Do you think there is a chance he could get enough over a few attempts or does it depend on his hormone levels? And you suggested anastrazole. Does that help produce more sperm? Are there any risks taking it and can we do it without taking anastrazole. Much appreciated for your help and advice.

        Reply
  71. Brian

    Hi Dr Turek

    My Sister husband is diagnosed with maturation arrest due to genetic reasons. The clinic asked to go for a donor.Is there any cure for Non obstructive maturation arrest due to genetic. Please help us. Please throw us some hope

    Reply
    • Paul Turek, MD

      Dear Brian, currently there is not “cure” for genetic infertility. However men with genetic infertility can have sperm. Men with maturation arrest due to genetic infertility are more likely to have a global pattern without islands of sperm than men with maturation arrest not caused by genetic reasons.

      Reply
  72. Brian

    Hi Dr Terek
    My Sister husband is diagnosed with azoospermia due to genetic reason, The clinic we tested , suggested to go for a donor. could you please let us know is there any treatment for azoospermia due to genetic reason. we are so devastated and pls help

    Reply
    • Paul Turek, MD

      Dear Brian, Having “genetic reasons” for azoospermia does not necessarily mean that you cannot be a biological father. For example, many men with chromosomal issues actually have ejaculated sperm. And, among men who are missing parts of the Y chromosome (i.e. have micro deletions), sperm can usually be found in men with the c region deleted, but are less likely to with the a and b regions missing.

      Reply
    • Paul Turek, MD

      Dear Md. Badiuzzaman, Of course there’s hope. Depends on how many TESE samples were taken. Must be mindful of lots of biopsies and micro dissection with a high LH as your testosterone could suffer. Consider FNA mapping.

      Reply
  73. Hope

    Thanks for your feedback and time Dr Turek.
    What is the non mosaic and is that what all Klinefelter syndrome people are? So from your last message are you saying you would recommend leaving both surgeries and instead persist with multiple attempts at ejaculated sperm? If so how often weekly or monthly? Do you think there is a chance he could get enough over a few attempts or does it depend on his hormone levels? And you suggested anastrazole. Does that help produce more sperm? Are there any risks taking it and can be do it without taking anastrazole. Much appreciated for your help and advice.

    Reply
  74. simo

    Dear Dr Turek, could you please help. I face nonobstructive azoospermia, I saw two doctors, one found varicocele, and my left testicular moves up and down , I am now 30 years. The other doctor advised to go for tests biopsy, we only found only 1 sperm. My FSH is high 18 UI/L. The doctor
    advised to go for IFV, but he said they may find the found sperm as they may not. But my question is, do I need to fix the problem of varicocele, and in this case, will it be any chance to produce sperms, or shall I go for IVF. Please I need your help. Thank you very much for what you are doing for humanity . My regards.

    Reply
    • Paul Turek, MD

      Dear Simo, Good questions. The fact that a biopsy showed 1 sperm is good news. And it is also true that further biopsies or more extensive procedures may or may not find sperm. FNA mapping is an excellent alternative here as you can learn where pockets of sperm may exist and potentially avoid large procedures to get them. Fixing a clinical varicocele can also optimize ejaculated sperm and potentially avoid testis sperm retrieval procedures, but this may take 6 mos to learn. If the varicocele is large (grade II-III) I would consider fixing it as the first step. If you were in California, I would offer a simultaneous FNA Map and varicocele repair.

      Reply
  75. Hope

    Thanks for your feedback and time Dr Turek.
    What is the non mosaic and is that what all Klinefelter syndrome people are? So from your last message are you saying you would recommend leaving both surgeries and instead persist with multiple attempts at ejaculated sperm? If so how often weekly or monthly? Do you think there is a chance he could get enough over a few attempts or does it depend on his hormone levels? And you suggested anastrazole. Does that help produce more sperm? Are there any risks taking it and can we do it without taking anastrazole. Much appreciated for your help and advice.

    Reply
  76. Hana

    Dear Dr. Turek,
    My husband has maturation arrest azoospermia. He did an ordinary biopsy to both testicles but the result was negative. However,there was germinal cells reached the phase of spermatid 1. He has a high FSH and the other tests were just fine. The previous semen analysis showed everything was zero even round cells. The last semen analysis showed the same result but 1.5 million round cells. He did also semen culture but no bacteria detected just WC only. We are planning to give it another attempt and do micro tese. Do you think from my husband’s medical history that there is hope to find hidden islands of swimmers somewhere in his testicles? Reagards

    Reply
    • Paul Turek, MD

      Dear Hana, Yes, there is hope. The finding of spermatids with a maturation arrest pathology suggests a pattern called “Late maturation arrest.” This is unusual as far as biopsies go, occurring in <5% of them. When approached with microdissection, finding sperm in this situation can be difficult as all tubules appear the same to the surgeon, as they are all normal-sized under the operating microscope. When approached by FNA Mapping, which is non-histological but cytological and can identify individual sperm, one can focus the sperm retrieval on areas of similar looking tubules that are known to have sperm and increase the likelihood of finding sperm.

      Reply
  77. Carl B

    Dr. Turek, 32 yr old male, I had NOA diagnosed (FSH 29 – all other hormones normal) in 4/2014 with morning T levels at 459. Evaluation and T levels of mid afternoon were 199 in August. I moved forward with MicroTese Surgery with Dr. Larry Lipschultz in the Houston Med Center in November 2014. He found sperm in 2 of 6 sample sites. At least 15 sperm were found in a very small amount of the total tissue sampled. The tissue was frozen for later IVF use in Austin, TX. Upon thaw, sadly no sperm made it through the freeze/thaw process. Sadly, our 2 donor sperm IVF attempts were unsuccesful as well. 4 months later, my testosterone is now hovering at 309 in the AM test, and I’m feeling the negative effects of lower T, i am almost certain. My testes are about 60% of a normal mans size. I’m unsure about my next steps and am looking for your thoughts. I would love a child of my genetic makeup, but I’m worried about my hormones, and know that if I get on TRT then my chances are gone. I would assume FNA mapping is an option. Any ideas on my total outlook based on my info above? Any natural herbal options to help support reproductive function in addition to any other thoughts?

    Reply
    • Paul Turek, MD

      Dear Carl, you should certainly let Dr. Lipshultz know how you are feeling after the mTESE procedure. You can also consider a second opinion with us to learn more about mapping. It is a reasonable idea to “know before you go” with FNA mapping when it comes to finding sperm when testosterone levels are on the fence.

      Reply
  78. Carl B

    Also, Dr. Turek, I took all genetic tests and they have found no reason for my NOA.

    Reply
  79. Carl B

    Dr. Turek, I also see above that you suggest freezing immotile sperm taken via “painstaking attempts”. I assume you are referring to surgical methods. So, I had this done. I was told that about 2% of my tissue sample was analyzed immediately after microtese, and they found about 15 sperm – nonmotile of course because found in the testicle…so at that point, they froze the remainder, and shipped it off to the IVF lab. The IVF lab found nothing. The lab tech at the microtese surgeons office predicted they wouldn’t find any in the thaw. I don’t understand why. If this is a best practice (option) to freeze and thaw, what could have been a signal? Also, my surgeon after the fact noted that fresh transfer microtese sperm to IVF eggs is always the best idea because non motile sperm don’t survive the thaw like normal ejaculate sperm would in the 50% range. I’m completely confused and obviously saddened by the news of my harvested sperm not surviving the thaw. Thank you for your opinion!

    Reply
    • Paul Turek, MD

      Dear Carl, that is unfortunate. I like to use testicle sperm fresh for this reason and mapping lets us know that its there and where it might be found. You also experienced what happens with differing levels of laboratory expertise: not everyone is the same when it comes to finding sperm. In fact, I believe that the laboratory experience is JUST AS IMPORTANT as the surgeon in finding testicular sperm in the toughest cases.

      Reply
    • Paul Turek, MD

      Dear Carl, In cases of extremely low sperm numbers in the testis, antioxidants probably improve sperm health (better motility and less sperm DNA fragmentation) than result in greater numbers. Just a hunch.

      Reply
  80. DR M.Akram

    dear sir,
    im 50 yrs old medical graduate, I got a trama to my rt testis at age of 14 yrs , and testis became atrophic, left testis is looks normal, I got married on 23 yrs of age ,and when I enter in medical colleague , I did semen analysis , which shows azoospermia, then I did serial of investigations ,all are normal, once I went to a androurologist who did testicular biopsy, result shows : spermatogenesis abruptly ceased at spermatocyte level. after that I took time by time diferent treatmenr , lie gonado trophn inj, testosterone , clomid tab, vit E tablets, homeopathic medicine, and many more , after some time my FSH raised uo to 22 miu.l,
    then a ivf specialist give me prednisolone and some DXN product, after that FSH normalized,
    last year I went for ICSI IVF , TESE done mature sperm found, embyo form grade B but no pregnancy occure, testicular tissue was preserved and I dis 4 time icsi embryo formed ,6 to 8 cell, but no pregnancy, then the doctor did test for testicular tissue and told me that sperm are not normal only 1% is normal .so no option for you, please wait for stem cell. then I went to Dubai to dr fakih ,he advised me for micro TESE and adv, to take, L arginine , DHEA, Co enzyme Q10 , tab clomid for 2 months , and come for micro tese.
    sir , can you guide me what I have to do, either wait for stem cell or do micro TESE,
    thanks,

    Reply
    • Paul Turek, MD

      Dear Dr AKram, Sounds like you have been through a lot. Maybe sperm was found later and not at first because it is present in islands, or maybe the treatments you took helped to make a little sperm. Embryos formed from TESE sperm can fail due to female reasons, laboratory reasons or male factor reasons. The only issue I have with many repeat procedures is that your testosterone levels can fall for good, requiring testosterone replacement. Stem cell treatments are several years away.

      Reply
  81. john

    Hi Sir,
    I am diagnosed with Azoospermia 6 months back. Got FNAC done which shows maturation arrest at secondary stage of spematasis. FNAC also shows 80% sertoli cells and 20% germ cells. I have been give testosterone injections each month since last 2 months. Please guide me whether this is treatable or not.

    Reply
    • Paul Turek, MD

      Dear John, your testis procedure shows a possible late maturation arrest pattern but I have never seen an arrest at the “secondary spermatocyte” stage, as this phase of sperm production is rapidly passed through on the way to making spermatids and sperm. If it is indeed late maturation arrest at the spermatid stage, then, as I always say, look harder with FNA mapping as “where there are spermatids, there are usually sperm.” Of course, testosterone injections will CAUSE maturation arrest and infertility, so this will need to be discontinued for 6 mos before looking again. In the meantime, more creative ways of maintaining your native testosterone levels should be considered (hCG, climid, anastrazole). Consider a call with us to get started: http://theturekclinic.com/male-fertility-consultation/

      Reply
      • John

        Dear Paul Turek,

        FIrst of all thanks for the reply which could guide me to a solution to my problem. I want to add that in my FNAC, this was found:

        Both Left and Right testes are circular and shows Sertoli cells(80%) amixed with Spermogenic cells(20%) comprising of spermatogenis and primary spermatocyte. No spermatids or sperms found.

        Respected sir, Did you mean that I should not be given Testosterone injections at all?. And will this lead to more maturation arrest and infertility?.

        I am quite shocked that I have been given wrong injections for treatment.

        Highly thankful to you.

        John

        Reply
  82. akshara

    Hi Doctor,

    My husband has azoospermia and as per the reports there are immature forms seen . All hormonal levels are normal. In the first analysis he has more wbc count , In semen culture there is no bacteria detected just WC only but after using the antibiotics it is nill ,. In the second analysis there are no wbc count but immature germs seen . It will cure using any medicines or to go for biopsy. could you please suggest

    Reply
    • Paul Turek, MD

      Dear Akshara, Not sure how the lab looking at the semen determined that “immature forms” were present and whether these are early germ cells (sperm precursors) or not. Good to hear that there is no infection present. With normal hormones, this is either a blockage of sperm in the ducts outside of the testis (obstruction) that may be amendable to surgical correction, or early maturation arrest pattern of impaired spermatogenesis that may be genetic (and therefore not treatable) and possible amendable to having babies with IVF-ICSI if testis sperm are present. A nice way to figure all of this out is with extended FNA mapping. Call!http://theturekclinic.com/male-fertility-consultation/

      Reply
  83. aarthi

    Hi Doctor,

    My husband has maturation arrest azoospermia and the results are 3 – 4 immature forms seen in each field. In the first analysis doctor said there is an infection where wbc count is more than 5 million he gave medication and now it is showing nill but the result still showing nill sperm count with immature form . could you please suggest how to proceed further.

    Reply
    • Paul Turek, MD

      Dear Aarthi, I am confused. Maturation arrest is a testis biopsy diagnosis; did you have a biopsy? Second, specifically what “immature forms: were found? Primary spermatocytes? Spermatids? If you are referring to the ejaculate when you say “immature forms” than the meaning of this is much less precise. Glad to hear that the white blood cells in the ejaculation have been treated and are now down to normal levels, although this may or may not be related to the original problem. Consider FNA mapping to learn more about exactly which immature forms are present and whether testicular sperm are present. Call!

      Reply
    • john

      Hi aarthi.
      Your husband’s case is same as mine. Won’t u mind if you could Mention about Wht treatment doctor is giving to your husband. I m also very tensed about solution to maturation arrest. I have mentioned mine treatment in my above posts

      Reply
  84. john

    Hi Sir,

    I am diagonsed with azoospermia. Gone through FNA which shows no sperms found, Only primary and secondary spermatocytes were found. 80% sertoli cells and 20% germ cells found. Doctor is giving me testosterone injections. Want to know whether my problem treatable.

    Reply
  85. RIFAT

    sir ,
    I am azoospermic from 7 years we have tried 4 biopsies each shows only few sperms but lots of spermatids (elongated).
    we have attempted ICSI but no sperm found at the time of egg pick up.I just saw that you are working on spermatid with ICSI kindly suggest us .
    i have taking clomophen 50mg one and half(75mg daily) from last three weeks and my hormones levels are now
    serum testerone 690.4ng/dl
    serum FSH 52.02mlU/ml
    and LH 26.90mIU/ML
    Please recommend us .
    Best Regards

    Reply
    • Paul Turek, MD

      Dear Rifat, Sounds like there are infrequent sperm found after taking many biopsies. This is typical for non obstructive azoospermia. I am not sure why “no sperm found at the time of egg pickup” though. Was it frozen and thawed sperm that was not found on thawing? I would consider a diagnostic FNA map to figure out exactly where the sperm might be located in the testicle before looking again. Medical treatment might help (clomid) and fixing varicoceles, stopping smoking, losing weight (if overweight) may also help with sperm production here. Consider a Second Opinion with me to guide you: http://theturekclinic.com/male-fertility-consultation/

      Reply
  86. Todd Cool

    Hi Dr. Turek, I was diagnosed with Klinefelter Syndrome in 2012. I was browsing research on men infertility and had come across your page and was very hopeful. Thus I wanted to see, if at all possible, for me to have offspring of my own. My testicles are very small, each the the size of a nickel in diameter or smaller! I had read so e years back about Dr. Testing sterile mice with testicle replacement and achieving success. I believe this would be my only option, but I would certain consider any other procedures that you may recommend. I have absolutely no sperm in my ejaculation and have been tested rigorously normal and on Anastrozole. I recently had my testosterone levels checked, and my at level was a dismal 50. If I start HRT, does that kill any chance to obtain sperm from me, if there were any lucky ones? Thank you for your time,

    Reply
    • Paul Turek, MD

      Dear Todd, There is hope. The fact that you were diagnosed with KS as an adult and presenting with a fertility issue (rather than failed puberty) is good. The fact that your testicles are the size of a “nickel” is good (most are smaller). Given that you have a low T to the point of being told to take hormone replacement (HRT), you should consider micro dissection TESE to find and freeze or use testicular sperm rather than FNA Mapping. There might be a 50-60% chance of sperm in there at this time…Consider a call: http://theturekclinic.com/male-fertility-consultation/

      Reply
  87. fred

    Dr. i run three semen analysis and my last result came with azospermia but microscopy showed spermadis am i going to be fertile

    Reply
    • Paul Turek, MD

      Dear Fred, where were the “spermatids” found? In the testis? In the ejaculate? How was this determined? This all matters because if it is in the testicle, then, as I always say, “where there are spermatids, there are usually sperm.” Consider FNA mapping after a hormonal profile. Call and lets talk! http://theturekclinic.com/male-fertility-consultation/

      Reply
  88. KB

    Dr. Turek,

    After 2 years of trying to conceive, my husband (33yo) was diagnosed with oligospermia in 2011. He had a count of 0.8mil, 75% motile, 50% progressive (2+ rate of forward progression) and the lab comments were “only 2-4 normal motile sperm observed in entire field”. My husband’s blood work showed Testosterone of 436, FSHof 24 and LH of 8. He tested negative for chromosomal issues and microdeletions. We went to Duke Fertility and did ivf with icsi, which produced 8 embryos and a live birth the first cycle. We recently used the remaining 6 embryos, the last of which resulted in a miscarriage at 9 weeks. The genetics on the POC showed a normal male fetus. We are beginning the process again for a fresh ivf cycle, but cannot get my husbands SA done at Duke for several months. My 2 questions for you are 1) is there anything we can do to improve his count? 2) should we be prepared for the situation to have deteriorated to azoospermia now? Last year his testosterone remained in the 400s but FSH went up to 34 and LH to 9.

    Thank you for answering questions on this forum. It truly helps people like myself who have a lot of waiting and worrying.

    Reply
    • Paul Turek, MD

      Dear KB, Your concerns about whether your husbands sperm count may have fallen are noted. I usually advise freezing sperm early on in the process in case this happens. Clearly his sperm “works,” which is good. If the low count is due to hormonal issues, lifestyle issues or a varicocele, then it could decrease further. But, in general, it doesn’t. I would DEFINITELY be seen by a male fertility specialist to learn more about whether it is possible to preserve or improve semen quality!

      Reply
      • KB

        Thank you. Yes, I agree we should have banked extra in 2011 but we didn’t think of it and weren’t advised to either. We also were optimistic about the 6 frozen embryos. My husband did see a RE specializing in male infertility in 2011 and was told based on his labs that he has primary hypogonadism. He had no blockage/variocle. His only health issue is adult onset type 1 diabetes. He took clomid before our ivf cycle but was only on it for 50 days before we cycled, so probably not long enough for the sperm production cycle. Are supplements and antioxidants beneficial in your opinion? Can they improve the motility issues with the few sperm that are produced?

        Thank you for your help.

        Reply
  89. sudo

    Doc,
    can NOA be temporary due to uti infection. SA is done within a month after uti.. Could this be the reason to see no sperm. You say sperm take 3 months right. Is there a possibility to have sperm after a year in either semen or in testis. Pls help

    Reply
    • Paul Turek, MD

      Dear Sudo, NOA is not usually temporary. A UTI could cause low motility due to infection cells (WBCs) in the ejaculate but rarely will it drop sperm counts to the level of 0 and raise FSH levels. UNLESS, there is actual orchitis or infection within the testicle, which is usually painful and visible on scrotal ultrasound.

      Reply
  90. john

    Dear Paul Turek,

    FIrst of all thanks for the reply which could guide me to a solution to my problem. I want to add that in my FNAC, this was found:

    Both Left and Right testes are circular and shows Sertoli cells(80%) amixed with Spermogenic cells(20%) comprising of spermatogenis and primary spermatocyte. No spermatids or sperms found.

    Respected sir, Did you mean that I should not be given Testosterone injections at all?. And will this lead to more maturation arrest and infertility?.

    I am quite shocked that I have been given wrong injections for treatment.

    Highly thankful to you.

    John

    Reply
    • Paul Turek, MD

      Dear John, Testosterone replacement is kind of like a contraceptive, and induces maturation arrest in most men. So, its not a great idea to take it if one is planning to pursue biological sperm retrieval.

      Reply
  91. BES

    Dear Paul Turek,
    My husband just turned 34. He was diagnosed with non obstructive azospermia. His FSH was 14.5, LH 4.99, PRL 22.5, RTH 1.64, testosterone 613. His y-chromosome was normal with no microdeltions. His Karotype is XY. He is all boy. He had a testicular biopsy with bilateral testicular microdisection. The doctor said it was unknown cause of maturation arrest. The path report stated there was interstial edema and thickened basement membrane. We do not know what stage of maturation arrest. They took 22 samples with no sperm detected. We are wondering if this is the end of the road. Can he ever have a biological child? I recently discovered my husband has been drinking a lot every day to help with back pain from a herniated disc. This has been going on awhile. Could the increased alcohol intake be causing the maturation arrest? All his other test are normal. We are at a loss. We don’t understand.

    Reply
    • Paul Turek, MD

      Dear BES, this is unfortunate. We do know that “maturation arrest” patterns on testis biopsy can be due to environmental or genetic causes, as this is a natural stopping point for sperm production if things aren’t right. To know for sure, I would suggest no more than 1-2 drinks/day and then reassess in 6 mos. Consider FNA mapping if there is no ejaculated sperm at that point as sperm production may be improved enough to the point that sperm could be detected within the testicle but not in the ejaculate. Consider improving all lifestyle issues (obesity, antioxidant diet, fix varioceles) as well.

      Reply
      • BES

        Dr. Turek,
        Thank you for your advice. We have an appointment with a fertility urologist at the Cleveland Clinic in July. Do you know if they do FNA mapping? We wanted to exhaust all efforts before looking into adoption or a donor. We live in Alabama. There are no fertility specialist in the area. We feel like we are not getting the proper attention and clinical evaluation information.

        Reply
  92. kiki

    Dear Dr. Turek,
    My husband is an Asian and age 34 and was diagnosed azoospermia. His first semen test shows no sperm seen on centrifuged sample, the second shows “ Rare nonmotile sperm present in low concentration.” Fructose shows positive. The urologist then ordered the hormone test and chromosome test for him, that all comes normal.FSH was 8.8, LH 3.5, PROLACTIN 7.1, testosterone 259 (close to lower range though). Since he has no injury or surgery done before, the doctor said it is unlikely to be obstructive azospermia, and it is very possible to be maturation arrest. He didn’t order ultrasound for him since he said the infertility specialist will do that any way.

    Now we’re in the stage of wanting to know the reason for his azoospermia and want to be sure there would be sperm in him before I start my IVF cycle.

    We are still hoping he could be obstructive azospermia (etc.,absence of duct), so that it would be easier to retrieve fresh sperm to be used in IVF+ICSI.
    Dear doctor, based on the info (and I know it is limited), do you think it is possible to be obstructive azospermia?
    And if there is nothing wrong with the later ultrasound result, is testicle biopsy the main option to diagnose if it’s obstructive or non-obs?
    If yes and it turns out to be non-obstructive, then usually how long does people needed to be recovered from the first biopsy to do the FNA mapping and/or eTESE ?

    Thank you very much for your time, your kind advice will be highly appreciated.

    Reply
    • Paul Turek, MD

      Dear Kiki, This story sounds like non obstructive azoospermia because: 1) FSH is actually elevated (<8 is normal) and 2) there are small numbers of ejaculated sperm indicating some degree of tubal patency. Ultrasounds aren't all that crucial but genetic testing for Y chromosome deletions and a karyotype (chromosome) blood test has a 30% chance of showing something. Sperm retrieval in cases of cryptozoospermia (small numbers of ejaculated sperm on a spun pellet) can be VERY challenging indeed. If a biopsy is chosen, then I recommend waiting 6 mos before pursuing Mapping or mTESE.

      Reply
      • kiki

        Dear Dr. Turek,
        Thank you very much for your reply. You don’t know how much we appreciated your time and advice!! Thank you!
        You mentioned cryptozoospermia, Is cryptozoospermia different from azoospermia? And is the chance of retrieving sperm for cryptozoospermia a bit better than azoospermia ?
        All the best!
        Kiki

        Reply
        • Paul Turek, MD

          Dear Kiki, YES, cryptozoospermia is very different than azoospermia. It means that there are small numbers of ejaculated sperm present. We have found these small numbers of sperm work QUITE WELL with IVF in n=40 men studied.

          Reply
  93. Esther

    Hi doc my husband has had two incidents which resulted in a seed like substance to exist on his genitals (not sure exactly where, but its nit exterior). He saw doctors who told him if he removed the seeds he wilk not be abke to have chikdren but if he doesn’t remove it he has a 50% chance of having Kids. We been having unprotected sex since we started and he has never pulled out to discharge. What can we do to have children,,,,,,, we are desperate. Thank you,

    Reply
    • Paul Turek, MD

      Dear Esther, Gees, I hope that they are not talking about cancer!! Please see a urologist and consider a consultation call with us…

      Reply
  94. Esther

    I think the wrong email was submitted though auto input did that sorry my email that works is the one you see with this note

    Reply
  95. George

    DEAR DR TUREK MY HUSBAND IS THIRTY ONE YEARS OLD AND WE LIVE IN GREECE. HE WAS DIAGNOSED NINE MONTHS AGO WITH NOA. HIS TESTICLES ARE NORMAL SIZE AND HE HAS NORMAL HORMONE LEVELS. HE HAD A BIOPSY THAT SHOWED MATURATION ARREST AT SPERMOCYTE LEVEL IN SOME TUBULES AND IN THE REST TUBULES SERTOLI CELLS AND HYALINE SCLEROSIS. AT THE SAME TIME OF THE BIOPSY THE UROLOGIST FOUND SOME SPERM AND FROSE IT FOR ICSI. WE HAD THREE EBRYOS TRANSFERED BUT AFTER TWO WEEKS NEGATIVE PREGNANCY RESULT. WE WERE TOLD THAT THE SPERM WAS IN VERY BAD CONDITION TO GIVE HEALTHY EBRYOS. SHOULD WE TRY AGAIN? WHAT IS CAUSING THE NOA IN OUR CASE AND IS IT POSSIBLE TO IMPROVE SPERM PRODUCTION

    Reply
    • Paul Turek, MD

      Dear George, Good to hear that there were pockets of mature sperm found in the testis with maturation arrest histology. The contribution of mature sperm to poor embryo development is hotly debated worldwide. Some think that if you have the ability to make a mature sperm then many quality control hoops have been jumped through and the sperm should be fine. However, we are now learning that sperm can have epigenetic and fragmentation issues that can contribute to poor embryo development. I suggest taking a good antioxidant and lead a healthy lifestyle (no smoking, hot baths, reduce alcohol) and keep trying if you can.

      Reply
  96. sudo

    Hi doctor,
    i do have noa, low t, high fsh, small testes. I had my left varicoelectomy last December. Doctor says check for sperm count after 6 months. My fsh was 22.93 before now its 20.46. Is my testis functioning? .. Can i have hcg to boost my t level. I’m unmarried so dont want to have trt. Cant go for fna now. I’m taking antioxidants after varicocelectomy. i do have a small pimple like cyst in my right testis near ephidymis. Doc said its just a cyst… Shd i worry about it. Pls help

    Reply
  97. Saj

    Dear Doctor, I underwent a testicular Biopsy in February 2015 and the results showed the following: Majority of the seminiferous tubules contain spermocytes with some lined by Sertoli Cells only. Mature Spermatids are not found. Leydig Cells are present. Diagnosis: Maturation Arrest. I desperately need your help in understanding what my options are. I was a heavy smoker and have quit for the last 3 months, I am also taking COQ10 and Vitamins. I dont know if it will help. I am so lost and desperate. My wife and I are still hopeful despite the doctor saying that I have no chance of fathering a child. Can you offer any advice? Thnx

    Reply
    • Paul Turek, MD

      Dear Saj, there is a lot written on this blog about maturation arrest, so please keep reading. Some of it appears to be environmental (smoking, tubs, fevers, varicocele, medications) and some of it genetic (Y chromosome deletion, other chromosomal issue). There is also the hope that a more extensive search for sperm (FNA mapping or mTESE) could locate pockets of sperm.

      Reply
  98. Syed

    Hi Doc
    i did testicular biopsy and below is the result

    infertility with azoospermia
    no spematozoa could be detected
    complete late spermatogenic arrest at spermatid level
    no evidence of neoplasia

    Please let me know if there is any chances

    Reply
    • Paul Turek, MD

      Dear Syed, As I always say with FNA mapping: “where there are spermatids, there are usually sperm.” I think that the chance of finding sperm if one looks harder is excellent here. But, before that, consider stopping smoking, eat well, sleep well and even fix any varicocele that may be present as the finding of late maturation arrest on testis biopsy can have environmental in addition to genetic causes.

      Reply
  99. Kyle

    Doctor,
    I am 30 yrs old and was diagnosed azoospermia in march of this year. I also have a grade 3 varicocele on the left side. My urologist wants to do a biopsy on my right side because he fears the left is “gone”. My hormones all came back normal except for fsh level of 34. My issue is thus…. I wanted to repair the vericocele but my doctor told me he wants to do a biopsy on the right testicle and if it yields sperm, he wants to repair the vericocele but he told me if none is found, it’s “case closed” and there would be no point in repairing the vericocele. I’m still not anywhere near ready to throw in the towel and have read online posts pointing towards the idea that repairing the vericocele before the biopsy is much better of an idea. That way, even if they don’t find sperm, at least the vericocele is fixed.

    Please give me some thoughts or advise! My urologist is very unapproachable so all my worries and questions go unanswered! Thank you!

    Reply
    • Paul Turek, MD

      Dear Kyle, a nice meta-analysis that was published addressed this issue recently. Basically, there is a 30-40% chance that simply by fixing a clinical varicocele that sperm will return to the ejaculate. Typically, it returns in low numbers, not enough to conceive naturally, but possibly enough to use ejaculated sperm for IVF-ICSI instead of a sperm retrieval. A testis biopsy as planned has a 30% chance of showing the presence of testicular sperm. FNA Mapping in this situation has a 60-70% chance of showing testis sperm. These are the numbers with which you should work.

      Reply
  100. Annie

    Hallo Doctor,

    I have been doing enough googling since my husband was told he has Azoospermia as a result of Cancer Treatment. We live in Kenya and his 37yrs he was diagnosed with 3rd stage Non Hodgkin Cancer at the age of 14yrs and he went through chemo and radiation. My question is
    1. Have you dealt with such a case/ similar one
    2. Through FNA mapping have you ever had luck with tracing sperms in Cancer survivors.
    3. Is stem cell our only hope of having our biological kids
    4. Is it possible to have our own biological kids.
    Your response will be highly appreciated my country is not soo advanced with this type of treatment. You can suggest closer options but we can still consult with you as he will be coming to the US in 2months

    Reply
    • Paul Turek, MD

      Dear Annie, Yes we have seen many patients with NHL and yes several have had sperm and have kids. FNA mapping is an excellent tool for cancer survivors and especially in men with testis cancer who have only one testicle. Stem cells are a hope but they are still in the future; you definitely have a present hope with FNA mapping. Please contact us to organize a visit while u are in the U.S. I only need a half a day of your time.

      Reply
  101. Mary

    Dear dr. Turek, is there any updates about metabolic mapping of testes, when could it be used in practice and if it is helpful to use for cases like sertoli cell only syndrome caused by genetic reasons ??

    Reply
    • Paul Turek, MD

      Mary, Metabolic mapping is still on my mind but requires more funding to proceed scientifically and clinically. I am working on collaborations with other institutions as well to help things along. I am committed to it.

      Reply
  102. Kristy

    Dr Turek,

    Two years ago my husband had 2 million Sperm. Last year when we went to do ivf he had zero, but occasionally would produce 10-20 on a icsi prep sample, so we froze the eggs. after a couple months of giving samples, he produced only 20 sperm, and we fertilized the eggs but didn’t have any success. Our doctor said it was because of the sperm quality. He has been tested for every possible cause and everything is normal. He has been taking HCG for the past 6 months, and the amount of ejaculated sperm has not changed. His urologist, Dr. W, said the only other option is Microtese. So our questions are; 1) should he continue on taking the HCG and 2) do you think Microtese is a viable option. Any other input you could give would be greatly appreciated. Thank you.

    Reply
    • Paul Turek, MD

      Dear Kristy, I am a big fan of using cryptozoospermic sperm (low numbers of ejaculated sperm) for IVF-ICSI as we have had good experience with this and it avoids complex and invasive testicular sperm retrieval procedures. However, using cryptozoospermic sperm samples demands a lot of IVF laboratory expertise and this can limit its effectiveness.

      Reply
  103. Rachael Aper

    Dr. Turk
    My husband had vericecele surgery in September and still was producing no sperm in the ejaculate. A tese was performed and the Dr found nothing. His testosterone levels are low and he has been on chlomid since September. I believe his fsh levels were high. Do we have any hope of finding sperm another way? Thanks for your time:) Rachael

    Reply
    • Paul Turek, MD

      Dear Rachel, the ability to find sperm in the testicle in men with testis failure depends on how hard one looks. If the “TESE” procedure was a well performed MTESE procedure and found no sperm, then the chances are low. If it was a simple biopsy procedure, then the chances could be 30-40% with FNA mapping.

      Reply
  104. MrsP

    Dr Turek, My husband ad the micro tese procedure a few months ago. We apparently have 10 vials of frozen material… though I understand they don’t know how many sperm might be in there…? but that they took a dropley under the microscope before it was all thrown into te ‘deep freeze’ and saw two abnormal sperm. My husand has been diagnosed with predominantly sertoli cell only, though the specialist said it can’t be entirely because those two abnormal sperm show something… in your professional opinion – what do you think the outlook might be for us for ICSI? my sde of things are all completely normal and I am 30 years old and have good ovarian reserve etc. so if everything goes well with my eggs- d we stand a chance that there might be more of these sperm ( even if abnormal) when things are thawed, and can abnormal sperm fertilise and egg? thank you…

    Reply
    • Paul Turek, MD

      Dear Mrs P. Tough one. This calls for a Second Opinion where you send me everything that has been written about what has happened. I can review the reports with my laboratory colleagues and assess the likelihood that viable sperm will be found on thaw. Certainly the banked sperm can be thawed just prior to egg retrieval and searched intensively for usable sperm. But sounds like a backup plan of sperm from another source (repeat TESE, donor sperm) should be considered, as should egg freezing or cycle cancellation.

      Reply

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