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…


133 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
  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

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