Turek on men's health
U.S. News Top Doc

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.

The Recipe for Man Made Sperm



 

Tried and true recipes from The Joy of Cooking book
Will stem cell "recipes" become as tried and true as the ones in this book?

Stem cells rock. While the stock market tumbles, stem cell science is sizzling. I know, you’re thinking: what is he talking about? No diseases have been cured with new stem cell technologies. But, from what’s being discovered almost weekly now, I can tell you that male infertility is likely to be one of the earliest boxes ticked on the “Diseases to Cure” list for stem cells.

Sperm from Stem Cells

Honestly, stem cells appear to be great to use to create sperm. Just a few posts ago, I shared the exciting findings from a group in Japan who took stem cells from newborn mouse testicles, placed them in an “organ culture” system (basically Jell-O), and grew mature, fertile sperm in the laboratory. Over the past 2 years, my colleagues at Stanford have also shown that human embryonic stem cells can be pushed along the path toward sperm in a dish. They also showed that adult stem cells from places like skin can also be driven in the same direction. Not all the way to mature sperm, but certainly more than half the way.

Overcoming Sterility in Mice

Last week, researchers at Kyoto University in Japan brought man made sperm closer to reality…at least in mice. I know many of you aren’t really worried about infertility in mice, but we have to start somewhere.

In a study published this past week, they took embryonic stem cells from mice, the mother of all cells, and watched them closely as they began to develop into other cell types (i.e. differentiate) in a dish. After several days, they plucked out rare and transient downstream stem cells called the primordial germ cells and transplanted these cells back into sterile baby mouse testicles. And sperm were made. Good sperm. Genetically intact and fertile sperm. Sperm that led to offspring that were also naturally fertile. And they did the same experiments with adult stem cells and got the same result, eliminating the need to use embryos at the start.

Please realize that this success did not happen overnight, but was the result of good, wholesome science and lots of sweat equity. And not all the results were rosy: primordial germ cells are rare, short lived and inefficient. In addition, when slightly different cells were injected into testicles, benign tumors formed, the scourge of stem cell science. So now you understand why mice experiments come first.

Stem Cells and Human Male Infertility

Imagine this: A boy has cancer and gets cured by being pounded with chemotherapy. Easily enough treatment to sterilize him for life. After that, his testicles could make sperm, but the “seeds” (early germ cells) that develop into sperm have been wiped out. Solution? A skin biopsy. Turn it into an adult stem cell and inject it right back into his testicles. And ta da! Sperm. I can’t stop thinking about how possible all of this is, as stem cell recipes are perfected. As Ted Allen, The Iron Chef once said: “There are two words to improve any dish: Ba-Con.” 


167 Responses to “The Recipe for Man Made Sperm”

  1. jusman

    Hi,..

    I interested with your topic, like it so much,.. talking about sperm.
    I have a question for you…???

    How to make the SPERM more health and faster ?

    Reply
    • Paul Turek, MD turek

      Sperm want to be healthy and go fast. Just take better care of your body to help. Eat well, sleep well, all things in moderation and treat your body like a temple. Thats it.

      Reply
    • Nicole

      Hi Dr. Turek! My husband had a mTese back in March with Dr. Wayland Hsaio at Oakland Kaiser. He had given us a 70% change of finding sperm…got in there, and couldn’t find anything :-( It was devastating! His biopsy result was “It showed maturation arrest, meaning there were germ cells, but no sperm seen.That would explain the larger volume but still low count.” I asked him about FNA Mapping and he said it wouldn’t help, since he went through the biggest tubes in the testicle and couldn’t find anything. My DH has had a couple rare sperm in his ejaculate occasionally (twitching or dead sperm) so I know he used to produce a couple, which is why we were so shocked the doctor couldn’t retrieve any with his surgery. We’re proceeding with donor sperm now, but I’m wondering if there’s anything else you’d suggest we do…

      Reply
  2. Andrea J

    This is all fascinating stuff – yay to stem cells – I believe in you!

    Reply
  3. SarahKarlT

    Fingers, toes, and everything else crossed that one day this will become a reality!! Amazing stuff indeed. Thank you for sharing!

    Reply
  4. scf

    This is incredible research and a breakthrough has the potential to be the biggest breakthrough male infertility for those with azoospermia, when do you think that such treatment will actually be offered?

    Reply
  5. Foxy

    Incredible. and really brings tears to my eyes to think that we could be so close. While we were in the thick of dealing with azoospermia my mom always asked me what she could do to help. I always responded that I wished she could advance science by about 10 years. This gives me hope.

    Reply
  6. Jeff

    Dear Dr. Turek,

    I´m hypogonodal since a bilateral orchiectomy to treat cancer. I´m on TRT since then, but unsatisfied with current delivery systems .. will this treatment offers hope to androgen deficient male also?

    best regards

    Jeff

    Reply
    • Paul Turek, MD turek

      Jeff, Glad to hear that you are a survivor, but unfortunate that you have to take testosterone replacement. Just to let you know that this field is a rapidly evolving one. For example, there are 2 new testosterone gel formulations on the market in the last 4 mos (one underarm and one between the legs). Also pellet implants are becoming very popular as they require you to do something every 4-6 months and not daily. Creating stem cells from Leydig cells should be possible but I do not think it is being actively pursued by too many groups at this point. Maybe I can focus on it with my new NIH grant on testis stem cells…

      Reply
  7. Jeff

    Thank you Dr. Turek. I think it would be great not to deal with injections and gels .. unfortunatelly TRT isn´t so effective in all cases .. i´ve used Nebido and it doesn´t work for me .. now i´m in weekly cypionate shots, that work.. but i´d rather be in long-acting treatments .. pellets aren´t available in my country.

    In my opinion, a funcional artificial testicle, would help man to deal with psychological aspects of being hypogonodal also.

    Thanks again, and sorry my poor English.

    Reply
  8. Josh

    Hi Dr Turek
    My question is will this sort of technological improvement help those suffering sertoli only cell syndrome, and how would this be implemented? Eg, would sperm be made totally outside the body or would the stem cells be placed in the testis, and realistically how long until this process is in use for the general population?

    Reply
    • Paul Turek, MD turek

      Josh, This kind of treatment, derived from non-testicular cells such as embryonic or adult pluripotent stem cells, cold be a treatment for Sertoli cell Only syndrome. And, it might be possible to use cells by either transplanting them back into the testis and have them grow anew there, or to help them mature to sperm with tails in a dish. Realistically, I would say 5-7 years until clinical use.

      Reply
  9. SEZ?N KURBAN

    I’M HAVING MY BAD ENGLISH IN TURKEY CAN HELP U.S. stem cell maturation arrest AZOSPERM BIG THANK YOU OLAB?L?RM?

    Reply
  10. ANKA

    hello, Mr. Turek. 5-7 years, 2-4 years of clinical practice and we believe we are not. You can visit us here in the whole world will meet in the patients with azoospermia

    Reply
  11. Will

    Is it possible to try it from now. I have azoopspermia and willing to to try it in myself. And who I can approach?

    Reply
    • Paul Turek, MD Paul Turek, MD

      Will, no it is not possible right now in humans. And if it were, safety issues need to be sorted out. The good news is that the animal model sperm appear to be developmentally competent.

      Reply
  12. Pshtiwan

    Dear doctor,
    It is really hard to have no baby! could you tell us to which stage the techneque of artificial sperm has so far riched? and howlong is it remaining to be used clinically? this is a common question of all infertile men!
    best regards

    Reply
  13. ANKA

    Germany and israel dr’s. stem cell terapy and great. no:5-7 I think 2-3 years. yes dr thurek ?

    Reply
      • Bozo

        Dear Anka, Dear Paul,
        I’m SCOS and now we are 2-3 years after your post. I already done last year an unsuccessful multiTese so I decide to try a MicroTese begining 2015. Is this Mtese will compromise an eventually futur stem procedure? Shall I do this Mtese, shall I wait? Is Stanford (dr Renee Pera) are next to success stem cell human transplantation ? Thanks for advice.

        Reply
        • Paul Turek, MD Paul Turek, MD

          Dear Bozo, MTESE may compromise testosterone production more than stem cell sources. Ask your doctor about the chances that your testosterone level will fall to the point of requiring testosterone replacement after a two sided mTESE is done. I would make your decisions based on this information alone.

          Reply
  14. pshtiwan

    Some infertile men have Klinefilter Syndrome due to an extra X chromosome in their cells, by doing artificial sperm where will this extra X go? Will the baby have the same problem?

    Reply
    • Paul Turek, MD Paul Turek, MD

      Mr P, Great question! Not sure is the answer. However, currently we have KS patients with sperm and, believe it or not, the sperm tends NOT to carry the same extra X chromosome as the rest of the body. So, in fact, most children born to KS patients have a normal number of chromosomes. This is nature’s quality-control mechanism at work. Bottom line: I would expect a dish-made sperm to develop similar to what we see naturally.

      Reply
  15. Maverick

    Do the adult stem cells have to come from a male? I read an article that female stem cells actually have a better opportunity for growth.
    http://www.nbcnews.com/id/18022291/ns/health-livescience/t/sex-differences-found-stem-cells/

    And if this is true, then wouldn’t our next step be to allow for perhaps two women to genetically have a child? Could the DNA be tweaked to allow for different sex’s for Y and X?

    Thank you kindly for your information, I have been following this type of research since 1995.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Maverick,

      Not sure if the stems cells have to come from a male. We are just starting with what we think has the best chance of working. Certainly a fascinating and early research trajectory would be to take female stem cells and and create X sperm. And producing a sperm with a single X chromosome is not theoretically out of the question as: a) women go through a similar process (meiosis) to make an egg that men use to make sperm, and b) half the sperm that men make are X sperm anyway. Keep in touch!!

      Reply
  16. joe

    Hi Doctor,

    My friend has been tried to have a kid, but unfortunately, the doctor said that he has sertoli only syndrome and there’s impossible to produce sperm. I read about the stem cell treatment and just wondering if the stem cell treatment in sertoli cell only syndrome can be done?

    If it’s possible how long does it take to be able to produce sperm?

    Thanks Doctor

    Reply
    • Paul Turek, MD Paul Turek, MD

      Joe, You are a good man to look after your friend. Validated and authentic stem cell treatments for male infertility are currently not available. However, your friend may still have the possibility of having sperm at this time; it depends on how hard the doctors looked for sperm. Think of sperm production as apples on a tree branch. Depending on which branch you look at you may see apples or not. Be happy to talk with him; call 415-392-3200.

      Reply
  17. janine sayed

    The stem cell cultured from own body greatly interests me as under Islam any intervention from any external donor system is proscribed and liable to many future problems as Koranic inheritance laws would be breached.
    I have a cousin in Egypt who has no viable spermatozoa, only spermocytes present in his ejaculate. He is desperate for his wife to conceive his child. Is there any hope for his treatment in England or even USA for a viable foetus.
    Any thoughts please.

    Reply
  18. Sara

    Hi Dr. Turek,

    My husband has unobstructive azoospermia. He had a MicroTese in March 2011. The doctor gave us some tissue, but the embroyologist could not any viable sperm. The tissue is currently frozen. What would you suggest at this point? Do we have any hope? Is our only option those clinical trials that are going to be availalbe in 5-7 years, or is that even an option? Thank you,

    Reply
    • Paul Turek, MD Paul Turek, MD

      Sara, this is unfortunate. However, some options may still exist.
      1) Depending on the experience of the surgeon and the lab that looked for sperm, FNA mapping has found sperm in cases of failed MicroTESE
      2) Depending on the histology of the tissue at MicroTESE, medical therapy with FSH injections or varicocele repair can “convert” cases of early maturation arrest to mature sperm (generally found in the testis and not the ejaculate).
      3) Stem cell technology will probably be best for those men without sperm and whom have testis germline stem cells (early spermatogonia), but you are right, it will be 5-7 yrs.

      Reply
      • Sara

        Thanks for the quick response doctor. He already had the FNA mapping, and the results came back as inconclusive. His FSH and LH are 10 times what they should be, and he had two variococele surgeries as a teenager. Regarding option number 2, do you reexamine the tissue?

        Reply
        • Paul Turek, MD Paul Turek, MD

          Cases of maturation arrest may respond to FSH therapy and to varicocele repair. If ejaculated sperm do not return, then I often look at sperm production in the testicles with another (repeat) FNA mapping procedure after such treatment for 6-9 months.

          Reply
  19. ornela

    dr turek

    my husband have NOA. the biopsy showed 50% sertoly cells, mature arrest arrest of the spermatids and hypospermatogenes. the doctor prescribed choriomon profertil and vitamin e. after three months of this cure he added merional because he had a low level of FSH and LH and after three other months he will repeat the analysis. my question is: Are there any hope that this cure will make possible to find any mature sperm?

    kindly regards ornela

    Reply
  20. J

    Dr Turek, I have been diagnosed with sertoli only cell syndrome but in 3 of 4 SA tests I had small amounts of sperm in my samples. Since then I have had a testicle removed due to a leydig cell tumour (non cancerous) about 12 months ago. Histology reported that there were no germ cells in my removed testicle. 2 SA taken around 3 months after my surgery revealed no sperm. Therefore I have been on pregnyl injections for last 2 months In hope of getting sperm in my samples for icsi. My question is, is it likely that the sperm were produced from my “good” – non tumerous) testicle, and if my removed testicle showed no sign of germ cells and SOCS, that my good testicle is identicle?

    And is it likely that i will see any results from taking this medicine, or is it the likelihood that I will need to wait until the reproductive technology mentioned in this article to come into commercial use to father my own genetic children?

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear J, More twists and turns here than a winding road! Answer: Hard to know. We published that 19% of time, FNA mapping found sperm in the opposite testicle when its mate did not have any, pointing to a real variation or “patchiness” to sperm production between testicle sides. Clearly that sperm came from somewhere! Hopefully that “somewhere” is still there after your procedure. Hormonal stimulation may or may not help. If it doesn’t, there is still the possibility that you are making sperm in your remaining testicle at a level that is too low to get into the ejaculate, but could be obtained by sperm retrieval. Consider FNA mapping! http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/sperm-mapping-testicular/

      Reply
  21. J

    Dr Turek in my earlier post I mentiOned I had SOCS and was on pregnyl after having a tumour and testicle removed. I have since done a S.A and they found a few sperm, but they were poor quality and probably dead. My hormone levels did not change much also with the medication and my specialist said its not worth taking anymore. Is it likely that I may have some “good” sperm that may be retrieved through the use of sperm mapping? And at what stage is a sperm good or bad for use in ICSI?

    Reply
  22. Karl

    Dr. Turek, I’m a 28 year old male who was diagnosed with non-obstructive azoospermia, my FSH was 14 and I did a testicular biopsy (TESE) only to discover that I have sertoli-cell only syndrome and that no sperm were found or can ever be found. My doctor told me I was born this way and that I can never father a child. Please help. What are my chances, if any?

    Reply
  23. Kheira

    Dear Dr. Turek
    We had several discussions and try to keep me regularly informed of the latest developments. Unfortunately, this case is very difficult but still we always keep the hope that science will overcome.
    My husband is homozygous for the aurora kinase C gene which causes the formation of all abnormal sperm with chromosomal excess.
    The cause is due to consanguineous marriage of his parents who sent her two failed mutations.
    Do you think that treatment will be available for my husband in the years to follow?
    What treatment would be most appropriate in his case?
    Do you have a colleague to advise me?
    Thank you again for your answers.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Kheira, I remember vividly. I am still thinking of what can be done. Germline gene therapy with stem cell technology comes to mind…but not yet possible.

      Reply
  24. Stefan

    Dear doctor Turek,
    could you tell us to which stage the techneque of artificial sperm has so far riched? and howlong is it remaining to be used clinically?

    Reply
    • Paul Turek, MD Paul Turek, MD

      Stefan, to date no one has made a believable human artificial sperm in the world. Many groups are trying, as are we. I predict 3-5 years before a sperm is made and more time after that to ensure that safety studies confirm that they are genetically “healthy.”

      Reply
  25. Stefan

    So what are your predictions when it will be available in practice? Hurry up please we all wish to have our bioligical children :(

    Reply
  26. Jonny W

    Hi,

    Following this research, I am interested in the next steps available to men with Sertoli Cell Only syndrome. I have sarcoidosis which has affected the testes. In 2010 I was diagnosed with azoospermia, but shortly after produced a few sperm in the ejaculate. Every subsequent test showed no sperm, and the hospital did not freeze the few that they initially found. I had a normal testicular biopsy which showed Sertoli Cells only. I was put on Clomifene for 18 months and the doctors performed a micro TESE a month ago, which showed Sertoli Cells only. They did not perform FNA mapping. After the procedure, they mentioned that it might be possible to use a PET scan to look for sperm. Is this something that you know about? Are there any further treatment options for a man in my position?

    Any help would be gratefully appreciated!

    Reply
    • Paul Turek, MD Paul Turek, MD

      Jonny, your story is unfortunate. The term “PET scanning” that the doctors told you about is probably our work with magnetic resonance spectroscopy of the testis which is still awaiting clinical trials (but we are working hard on it). Consider reading what others have done in you situation at TheTurekClinicSupport.com.

      Reply
  27. JG

    Dr Turek
    How is the artificial testicle and the endeavours to make man made sperm progressing? Do you have any updates on the progress of this exciting project!
    Wishing you and your team all the best with your work!!

    Reply
  28. A josef

    Hello dr.Turk I have been following this issue eagrly hopibg for such advancemwnt to happen really soon I have some questions
    My husband is 31 he has NOA He had a TESE done no sperms were found and his histopathology reads: good number of seminiferous tubules all of which show much thickening and hyalinization of their wall. About 10% contain primary spermatogonia with no further maturation.leyfig cells are prominent.
    Now I read ur comments about FNA mapping do u think ww should give it a try? If we do do risk any further damage to what could be salvagable with stem cell treatment?
    About stem cells treatment what r the risks for cancer ?? And I read that some centers in germany are actually doing stem cell treatment on humans , I actually cobtacted some but felt funny about it , r u by any chance familliar with their work and what do u think of it…
    Thanks in advance..

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Josef, If you diagnosis of early maturation arrest was made based only on a simple TESE that sampled only a few sites of each testis, then yes you may benefit from FNA Mapping or a microdissection TESE. Importantly, a map is very noninvasive and will not “damage” the testis and prevent either a) further sperm retrievals from being successful or b) remove important stem cells for future use.

      You ask a great questions regarding stem cells and cancer. Yes, there is a risk of cancer. If stem cells are injected into the testicle and it is done in the wrong place (in the interstitial space and not in the tubules) then cancers could arise. This is because stem cells respond to their environment and putting them in the wrong environment for them could get them confused and they could become cancerous and lose their focus. I have heard of stem cell work in humans being done in Germany, and have known patients who have done it and it has not worked for any of them. It is quite expensive as well. Based on applying sound and safe scientific principles of medicine, these types of “experiments” are not allowed in the U.S.A.

      Reply
  29. arifa

    My husband suffer from klinefelter syndrome he recently underwent micr tese surgery… this was unfortunately unsuccessful. .. 7 sperm of maturity level 2 and 3 were found…. is there any other way we can have biological children

    Reply
    • Paul Turek, MD Paul Turek, MD

      Arifa, I am not sure of what you mean by maturity “level 2 and 3″ as I think of sperm as mature or not. However, if no mature sperm are present, then stem cell technology is your best hope in the future.

      Reply
  30. MVC

    Hello Dr.Turek
    My Fiancé and I have been trying to conceive for almost 4 yrs and finally went to the Docs to get our SA twice No Sperm found both times, our urologist ordered blood work for testosterone LH and FSH
    Both testosterone and LH were normal but FSH was high the Urologist said that my fiancé has sertoli cell only syndrome . Is it possible to give a diagnosis this on just one blood test ordered ? We are both so shocked and in disbelief our world has just been turned upside down. His family history has no one that has this problem and he has siblings as well and they have healthy children and so do I. We have thought of homeopathic remedies because we so desperately want to have our child naturally but if not we are not opposed to IVF . please help. thank you
    My fiancé is 31 and times running out for me I’m 32

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear MVC, There are many possible diagnoses besides “Sertoli cell only” syndrome for the finding of azoospermia and an elevated FSH. You have been given a testis biopsy diagnosis in the absence of a testis biopsy. Not only that, men with Sertoli cell only syndrome can have islands or patches of sperm admixed with other areas of Sertoli cell only seminiferous tubules. It might be worth looking a bit harder here as up to 60% of men in your situation will have sperm for IVF-ICSI, REGARDLESS of what you have been told. FNA mapping is a nice first choice to figure this out.

      Reply
  31. NJ

    Dear Dr Turek,
    My husband (age 29, height 1.82m, weight 110kg) was diagnosed with Sertoli cell only syndrome with no spermatogenesis via TESA.
    His results read:
    “Testosterone 6.0
    FSH 8.7
    Both testis are homogenous and measure rt:29mmx19x22
    Lt:32mmx16x22, left side varicocoeles
    3 biopsies on the testes showed majority of tubules have Sertoli cells only with a smaller population being totally sclerotic and acellular. The testicular interstitium is oedematous with small clusters of normal appearing leydig cells. No evidence of vasculitis. No evidence of intra-tubular germ cell neoplasia, unclassified (IGCNU) or malignancy. Johnson’s score is 1.9″

    Could you please doctor look into the results and see any available options i.e. FNA, mTESE (no harm on testicles), homeopathic treatments or stem cell therapy?

    Thank you so much in advance

    Reply
    • Paul Turek, MD Paul Turek, MD

      NJ, If I read you correctly, you had 3 biopsies per testis and all 6 showed Sertoli cell only pattern. This is reasonably good sampling for sperm. I would predict that either FNA mapping or microdissection TESE would have a 20-25% chance of finding pockets of sperm. Homeopathic treatments do not create stem cells in the testis which is what you need to get started. Stem cell therapy is still several years away.

      Reply
      • NJ

        Dear Dr Turek,
        I’m not sure if it means 3 biopsies in each testis, so you think there is no point of doing FNA?
        I mentioned that he is considered obese and has left side varicocoeles, do you think losing weight and removing varicocoeles might help?
        please doctor we are desperate to have a biological child and any help is much appreciated.
        any advances in stem cell therapy?
        Thank you kindly

        Reply
  32. ahmad

    Hello Dr Fidel

    What is your thoughts on stem cell bone marrow clinics. I have sertoli only cell and I was wondering what your thoughts are on this.

    Thanks

    Ahmad

    Reply
    • Paul Turek, MD Paul Turek, MD

      Ahmad, I have heard of these through the grapevine but not in academic circles where we present and publish amongst peers. Patients have told me that there is a 20% success rate in finding sperm after bone marrow transplant when microdissection TESE is used to look for sperm in testicles. That is about the same rate of success that I would expect without a bone marrow transplant. Go figure.

      Reply
      • Noor

        I have heard that a Jordanian doctor called Dr Adeeb Al Zoubi has started doing stem cell therapy using bone marrow. Have you heard any success from them?
        My husband has the same condition

        Reply
        • Paul Turek, MD Paul Turek, MD

          Noor, I mentioned this a week or so back. Here are my thoughts (again): “I have heard of these through the grapevine but not in academic circles where we present and publish amongst peers. Patients have told me that there is a 20% success rate in finding sperm after bone marrow transplant when microdissection TESE is used to look for sperm in testicles. That is about the same rate of success that I would expect without a bone marrow transplant. Go figure.”

          Reply
  33. Paige

    What about the treatment of seritoli only syndrome? What treatment do you have for that? We’re very interested even if just for research!

    Reply
    • Paul Turek, MD Paul Turek, MD

      Paige, The treatment of Sertoli Only Syndrome depends on how the diagnosis was made. If it was made based on a single testis biopsy, then there is a strong chance that pockets of sperm exist elsewhere, like apples on an apple tree. If it was made based on an extended FNA mapping procedure or a well-performed microdissection TESE, then the likelihood of finding pockets of sperm is much lower, maybe 1-10%. In this case, metabolomics technology (pending) or stem cell technology (pending) may help in the future. Updates on these will be posted on the blog.

      Reply
  34. thebos

    ı have certoly cell only and ı had mikrotese in 2011 nofind sperm what would you advise me can ı do again mikrotese how many times will we wait stem cell treament is herbel treatment useful whwt do you think about it thanks for reply

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear thebos: microTESE for Sertoli cell only pattern histology can be very complete and accurate, depending on surgeon and laboratory experience. Extended FNA mapping can find sperm in cases of failed microTESE but its ability to do so varies alot but is generally low at 0-10%. I believe that stem cell treatment for making sperm has great potential, although the timeline is still unclear.

      Reply
  35. A.ali

    Hello Dr.Turek,
    I have sertoli cell only syndrom and my urologist has prescribet me brevactid 1500iE. I shoukran inject it for 1 Year. Have you any experiences with this therapy on this diagnosis?
    FSh 13
    Testosteron 3,45

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear A.ali, Brevactid is another name for human chorionic gonadotropin (hCG) which is another name for the hormone LH. It is given to increase (generally low) testosterone levels and may or may not help in your situation by improving the hormone balance in the testicular itself. Generally it is recommended for 3-6 mos and then the semen is checked for sperm and a sperm retrieval can be attempted. A thorough examination of the testicles for sperm by either FNA Mapping or microdissection TESE is more important than a course of this therapy to find sperm in the future.

      Reply
  36. A.ali

    Hi Dr. Turek
    I have already made a biopsy an a Tese by a prof. here in Germany. Both diagnosed with sertoli cell only Syndrome. So I try it with this therapy. How often can I make a Tese? And how does the FNA Mapping work? My LH is about 5-7 is it normal? Thanks for your answer

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear A.Ali, Whether or not you have sperm depends on how hard they looked. Typically the most sites the better. However, testicles cannot endure repeat TESE procedures very much without paying the price of low testosterone. Mapping does not affect testosterone levels, for the most part, as it is much less invasive.

      Reply
  37. sertoli cells only

    my husband has sertoli cells only…and he made an operation to search in.hos tests about sperms and we dodbt find….what is your advice ?????. especially that we going to visit usa after 3 monthes …

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear sertoli cells only, If your diagnosis of Sertoli cells only is based on a testicular biopsy, then you should wait at least 6 months before taking another look with a potentially different technique (i.e. FNA mapping).

      Reply
  38. ayman

    Dr. hello., I married 3 years ago and I am suffering from a shortage of sperm 1 million and was described by a doctor are Tmaxvin 10 mg and Faatmit e400, but did not improve well only 2 million please help

    Reply
    • Paul Turek, MD Paul Turek, MD

      Ayman, You have severe oligospermia. Sounds like you are taking antioxidants, which may or may not help. Consider a formal male infertility evaluation that includes a history, physical exam and reproductive hormones. Possibly, lifestyle issues, medical (hormonal) or surgical therapy may be of benefit. This could also be genetic and due to Y chromosome or karyotype issues. Consider a Second Opinion with us to learn more.

      Reply
  39. Mike Zaim

    Dear Dr. Turek.
    I am married since one year and half and discovered recently that I have azospermia when i did semen analysis.

    My blood tests showed irregular prolactin , once high and once low .. but also the FSH level was high. I also found I have varicocele , 2 to 3rd level in the left and 1st level in the right.
    I did the varicocele surgery 8 days ago, Saturday 11.1.2014. Before the surgery I did blood test which showed the following results: Prolactin (15.2), the test result was 9.1 six months ago ( the prolactin test is up and down once some how near 17 and once some where near 9
    . FSH (27.15) , the test result was 25.6 six months ago LH (6.45) , the test result was 6.7 six months ago Total Testosterone (4.10) , the test result was 3.9 six months ago
    ->>>> Now I would like to come to you for the FNA mapping and the sperm extraction . To increase the chances of finding sperms while doing the FNA , I consulted a doctor who prescribed tamoxifen and proxeed plus to me to take for three months to 6 months before doing any surgery. He also adviced me to do the FNA with you.

    will that help ? should I start them or do you have any suggestions ? I want to do the surgery in the summer
    Also, will doing the FNA mapping make the next stage easier should sperms where found ? I mean will i still do MESE or what ?
    looking forward to hearing back from you ASAP.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Mike, Please see my response to your query in another post. Be happy to help!

      Reply
    • Adam

      Dear Mike Zaim,ihave exactly same situation with u ,and same fsh
      ,lh level,and also had the varicocele surgery in February. I m considering to consult DR Turek for FNA mapping . Have u did this FNA yet? And what’s ur situation now?looking forward ur reply ,or may u send email to me (matt_jxh@hotmail.com), then we can share info and help each other!

      Reply
  40. miranda

    Dear Dr. Have you got any news yet about stem cell treatment in case of sertoli cell only we are getting a little depressed seems like everyone gets to have children of their own but us i am from the netherlands.

    Reply
  41. Gemma

    Dear Dr Turek
    My husband has been diagnoised with Klinefelter disease and is currently on testogel treatment.
    However after recent fertility tthereit has been confirmed he has no sperm.
    We are desperate to have a child of our own and have granted fertility treatment with a donar but I know my husband really is deverstated.
    Is there anything we can do with all this modern medical miracles?
    Many thanks

    Reply
    • Paul Turek, MD Paul Turek, MD

      Gemma, there are several things that you can do. Waiting is one. Think about circling back after your first (donor) child if your husband feels the same way after his child is born as he does now. Think about freezing eggs, a gift of hope that you can give him understanding that someday sperm may be made from other types of stem cells.

      Reply
      • Gemma

        I dont think having a donar child will change how he feels and wouldn’t want to bring a child into the world for my husband not to love and care for it as his own.
        What are the several options?

        Reply
        • Paul Turek, MD Paul Turek, MD

          Gemma, Of course, donor children are not right for all people. Adoption after birth and adoption before birth (embryonic adoption) are also alternatives, as are foster parenting and child-free living. Hopefully time, faith and love will give you the guidance you need going forward.

          Reply
  42. Miranda

    Dear Dr. Have you got any news yet about stem cell treatment in case of sertoli cell only we are getting a little depressed seems like everyone gets to have children of their own but us i am from the netherlands.
    Greetings

    Reply
    • Paul Turek, MD Paul Turek, MD

      Miranda, This must be a trying time for you. Stem cell treatments are not yet available in the US, although many of us are working on it.

      Reply
  43. BostonCouple

    Hi Dr. Turek,
    My fiancé had neuroblastoma as an infant/child and underwent two rounds of chemotherapy. He doesn’t have any motile sperm. We haven’t yet done a dissection procedure to determine whether or not he produces any sperm like material (to be used for IVF), but it seems unlikely. We want to explore options now and potentially enter into any clinical trials for using adult stem cells. Do you know of any studies that would be interested in our participation. We are not in an absolute rush to have children (he is 33 and I am 28) but would be open to it now and are very excited to get the ball rolling so that it would be possible in the next few years. Any tips or information you could provide would be greatly appreciated (please email me back with your response). Thank you so much.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Boston Couple, Good that your fiance is alive and well. Given his story, there is still a reasonable chance that he may have sperm in the testicle despite having no ejaculated sperm and despite all of the treatment that he has had for his cancer in the past. We have published on the ability of a simple technique such as FNA Mapping to detect pockets of sperm that can be later retrieved through sperm retrieval. Often, after mapping, the large “dissection” (microdissection) procedure may NOT be necessary if you “know before you go.” This saves testicles! Consider a call with me to learn more and help you make your family building plans!

      Reply
      • BostonCouple

        Hi Dr. Turek! That is great news. The FNA Mapping technique is something we would definitely consider as a first step. We will definitely schedule a call in the near future to discuss options. Thank you so much!

        Reply
  44. Lubos Svoboda

    Dear Dr.Turek
    I’m male, 63, and suffer from diabetis about 20 years. I’m having problem with erection and I also have problem to ejeculate. Can you give some advice how to get rid of this problem? Thanks, Lubos Svoboda, Las Vegas

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Lubos, diabetes can have 3 sexual health issues due to the disease
      1. Erectile dysfunction. Generally helped with Viagra, Levitra or Cialis.
      2. Low ejaculate volume due to retrograde ejaculation, generally helped with cold medicine like Sudafed
      3. Low sex drive due to low testosterone from diabetes, generally helped by clomiphene citrate or tamoxifen.

      It’s a treatable hat trick of issues!

      Reply
  45. muhammad abid

    hi doc turek,
    i did my testicular biopsy in 2004 after diagnosing azoospermia, but still there were no sperm found result was as bellow plz advise that FNA mapping could work in my case.:

    Right and Left testicular biopsy

    testis with about 40 tubules in cross section: all show peritubular fibrosis. No germ cells are seen and the tubules are populated by sertoli cells only, The interstitiaum appears normal with no inflammation of fibrosis.
    Summary: Sertoli cells only, no spermatogenesis.
    Report by Dr. F R Griffiths. FRCP

    plz help and let me know if a person like me can go further for mapping.
    thanks a lot
    God Bless You.
    DOB: 2nd april 1978

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Muhammad, A single testis biopsy from each testicle showing no sperm is simply not enough of a look to say for sure that you have no usable sperm for a child. FNA mapping is an excellent opportunity to learn more about whether there might be small pockets of sperm that were missed by a single biopsy. The chances could be as high as 40%.

      Reply
      • muhammad abid

        Thanks A lot Doctor.
        your reply made my day!
        i found Dr.Fakih clinic in dubai where doc. rupin shah do the procedure plz wish me a luck. i ll keep in touch with you for your best advise. i am not sure whether he doest the same procedure or not. (FNA Mapping)
        thanks
        abid

        Reply
  46. Bob

    Hi Dr Turek,

    I am living in Indonesia, and would like to know if FNA is available in my country, or at least in Asia?

    thanks

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Bob, I have not trained anyone from these countries in FNA mapping.

      Reply
  47. Mandeep Sahi

    Hallo Dr. Turek,
    My husband is suffering from sertoli cell only Syndrome.We came to know that last yr after testicular biopsy.After searching so much on Internet we have found a Treatment for SCOS in homopathy in India.This Treatment is for 1 year.After reading your blog I get a ray of hope to have a biological Baby.We live in Austria.Can you recommend us any Dr. in India or Austria or in europe for FNA mapping.
    I really appreciate your work for childless couples. thanks.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Mandeep, consider FNA mapping before trying some experimental procedure that might generate scar tissue in the testicle. A colleague of mine. Dr Michael Haeberle does mapping in Berne, Switzerland and does a fine job.

      Reply
      • Sizzler

        Dear Doctor Turek. I have SCOS diagnosed from a single FNAC. I am from india and could you let me know if u have any contacts for FNA Mapping in india, since that is what you are suggesting for all SCOS patients. Waiting for reply

        Reply
        • Paul Turek, MD Paul Turek, MD

          Dear Sizzler, I have not formally trained anyone in FNA Mapping in India.

          Reply
      • Ali

        Hiya do you mind me asking which homeopathy treatment you have tried?

        Reply
  48. Carlo

    Dear Dr Turek, I have an unobstructive azospermia discovered in 2011. In 2012 I had my first single testis biopsy, with FSH 18,8 LH 2,9, Testosterone 4,93 and all genetic exams regular. Diagnosis was Sertoli Cells Syndrome but they found few sperms (used for an ICSI failled). Three months ago I had a Microtese made with the Schlegel method, no sperms was found, same diagnosis. Now few days ago the FSH was 16 so little less then before, this means something? Do you think that the FNA mapping can give us a chance? or the testosterone loss can be a risk? Do you know if in Italy or Europe we can do the Mapping? Can you help us? Thank you so much.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Carlo, not an uncommon story: pockets of sperm within a sea of Sertoli cells. The biopsy may have taken all the sperm pockets that you had or the microdissection missed them. FSH levels are not accurate to use to judge sperm presence or absence but you should check a testosterone level after this large procedure to make sure that it is still normal. After 6 mos following mTESE you can consider FNA Mapping as I have definitely found sperm in such cases.

      Reply
      • Carlo

        Dear Dr Turek, thank very much you for your reply. Testosterone for the moment is fine but we will repeat all exams in few months an will consider the FNA Mapping. Do you know any doctors in Italy or Europe that can do the FNA Mapping?

        Reply
  49. Mandeep Sahi

    Thanks a lot Dr ,
    Can u please send me his no. and address.
    Once again thanks for replying.

    Reply
    • Paul Turek, MD Paul Turek, MD

      You will have to search on the internet as I do not have his address.

      Reply
  50. Carlo

    Dear Dr Turek, thank you for your reply, do you have any information about FNA Mapping in Italy or Europe? Do you know any Doctors making this procedure? Hope you can help me.

    Reply
  51. Carlo

    Dera Dr Turek, do you think that a second Microtese can give same result? or something can change with time? can you suggest any Doctor in Italy or Europe that is able to do the Fna Mapping? Thank you

    Reply
    • Paul Turek, MD Paul Turek, MD

      Carlo, If sperm are found on the first procedure, then another procedure may be a reasonable idea. However, if sperm are not found, then one must hesitate to do the same thing all over again. Another strategy might be better. A new perspective, an alternative approach offering new information that sheds light on the situation. FNA mapping may be that perspective. I know of no one in Italy who maps like the best of us.

      Reply
  52. Mandeep Sahi

    hallo Dr Turek,
    I have searched alot on internet for Dr Michael in Switzerland but unfortunately I have not found it.Can u please send mr any link or website or email address from Dr Michael or any other Dr. for FNA mapping in europe.I will be heartly thankful to u. thanks

    Reply
  53. RAJ

    sir, whether any doctor in India is doing this Mapping procedure , Iam a NOA with normal FSH LH levels , Prolactin is lesser than the limit & steroli cell only syndrome, moderate germ cell hypoplasia with early maturation arrest in FNAC. whether there is a possibilty of finding sperm in it. As my Doc suggested me for karyotyping and Y chromosome deletion studies and for further TESE for ICSI IVF. Pls help

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Raj, Sounds like a complicated testis biopsy histology with 3 patterns (hypo, SCO and EMA). I agree with genetic testing. I would also wager that microdissection TESE would be difficult as the “fat” tubules visible under the microscope could be either EMA histology or have sperm, you can’t tell.

      Reply
  54. Noor

    Dear Dr Turek,
    Do you know anyone that does FNA mapping in the UK?

    Thank you

    Reply
    • Paul Turek, MD Paul Turek, MD

      No I do not know anyone in UK who was formally trained by me in FNA Mapping.

      Reply
  55. Nazir

    Dear sir ,how long do you believe there would be before there is real hope ,for men who have only sertoli cells , I have had two biopsy’s ,which only revealed sertoli cells ,we are so desperate to have our own biological child.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Nazir, Sertoli cell only pathology on two biopsies may not tell the whole story. Sperm Mapping can look in 36 sites and can “rescue” many men like you. For now, consider Sperm mapping. For the future, lets hope that sperm metabolomics and the artificial testicle research matures soon!

      Reply
  56. Ehssan

    Dear Dr.Turek
    Please let us know if there is any progress in stem cell research . It is our only hope and I wish it will be available soon

    Reply
  57. Alexis

    Dear Dr Turek,
    My husband has been diagnosed with nonobstuctive azoospermia after one SA. This is due to a long history of Hodgkin’s disease starting from a child. We have two children and ready for a third. Since his stem cell transplant 12 yrs ago we have been unsuccessful. A urologist wants him to undergo microTESE yet he nor the endocrinologist has ordered blood work. Should we be concerned. My husband is against TESE due to the risks and low probability. Where in the US is FNA mapping offered? We live in North Carolina. We just feel as if due to his poor medical history, these providers are skipping steps in treatment.
    Thanks!

    Reply
  58. Alex

    Hi Dr. Turek, a lot of my searches on infertility and testicular failure have led back to your site, and ultimately this page regarding stem cell research. This appears to be my only real hope based on a number of indicators including endocrine test results and testicular biopsy. Has there been any significant advances in stem cell research in reproductive realm of things? Most articles and videos with significant discoveries look to be dated back to 2010-2011 time frame.
    Thanks in advance.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Alex, I don’t know the details of your story, but I hope that someone has looked closely at your case to make sure that you really have exhausted all options. Have you been “mapped?” Regarding research, we have some very recent blogs from talks and papers published this year (Sperm from Skin? Almost) as we are still pursuing this with gusto.

      Reply
  59. Norai

    My husband diagnosed as Sertoli cell only syndrome after the 2nd microTESE . He had an undescended testicle that was removed at the age of 10. Testicle present is clinically 2/3 the normal size.Had a large varicocle on the single testicle present that was removed between the first and second micro TESE. Was on clomifene for 9 months between the first and second micro TESE due to presence of 10% spermatoginia in the first micro TESE.inhibin 0. No chromosomal micro deletions. Finally diagnosed as Sertoli cell only after the second micro TESE. Is there any stem cell Solution for this case to produce a mature sperm???

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Noral, There are no clinically accepted stem cell solutions to this problem, but believe me, I and others are working hard on this. Consider freezing your eggs while you are young to better take advantage of the day in the future when we can make sperm from skin or other organs.

      Reply
  60. Aliyyah

    Hi!Would u please help me. Because my husband i guess had a problem and maybe sterile. is there any cure or medicine for a sterile men to produce a baby? How many times we go to doctor but the doctor says that my husband balls too small.. please help..

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Aliyyah, I’m sorry to hear that your husband might be sterile. This could be due to a sperm production problem (small testes) or a blockage. Blockages can often be repaired with microsurgery leading to baby making at home. Sperm production problems are more complex but your husband may in fact have pockets of usable testicular sperm that could be used for children with IVF-ICSI. Read more about FNA mapping as this is a minimally invasive but comprehensive technique to learn whether he may have sperm.

      Reply
  61. aaa

    Hi, after reading this remarkable article i am too glad to share my experience here with colleagues.

    Reply
  62. Abdullah

    Hi Dr Turek. Hope you are well.

    Last weekend I had the MTESE procedure on both testis. 10 samples were taken from each testicle which revealed sertoli cells, primary spermatocytes and very rare spermatids. After processing no sperm found.

    Other related information:

    – Ultrasound results – mild (grade 1) left side refluxing vericocele.

    – No micro deletions found

    – FSH borderline high (12) ( LH and Testosterone are within range)

    The consultant has said nothing can be done at this point as the most sophisticated procedure relating to my situation is the MTESE.

    Could repairing the vericocele make a difference?

    Thank you for taking the time to read this.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Adbullah, Hope that you are healing well. One consideration here: micro dissection is not very good at distinguishing testis tubules containing late spermatids (stage 11 of 12) and sperm (stage 12 of 12) as both kinds of tubules are full and plump in general and cannot be visually distinguished. FNA mapping provides a much less invasive and very different “look” at things and, as we mappers always say: ‘where there are spermatids, there are usually sperm.’ If an FNA map showed even a single mature sperm, that allows a subsequent sperm retrieval to focus in that area and give a better chance of getting it than using blind techniques.

      Reply
  63. Mohd

    Hello Dr. Turek, i have non obstructive azoospermia, i did mtese but failed, no sperms were found unfortunatly and i have history of chemotherapy when I was a child, the surgeon said that i have global half normal size of seminiferous tubules , does it mean I don’t have sperm in all tubules ?? i am waiting for the final report, which hormone injections can i take till doing testicular mapping??

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Mohd, reports of sperm in men with azoospermia after chemotherapy are pretty common. We have even reported finding sperm in men with bone marrow transplants in which extensive chemo and radiation has been given. The small size of the seminiferous tubules has no real meaning except that they are unlikely to contain sperm. What most important is the extent and effort made to find sperm at the time of the procedure. Based on FNA Mapping, we have found some pretty small pockets of sperm in men such as yourself.

      Reply
  64. SINGH

    Dear Dr.Turek,
    Hi, I am Singh age of 34 yrs.Two yrs ago i was diagnosed with Sertoli cell syndrome only,
    Plz suggest me ray of hope.
    Regards
    Singh

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Singh, there are certainly “rays of hope here” both with current technologies (FNA mapping and microTESE) and potential future technologies (artificial sperm). Stay strong.

      Reply
      • SINGH

        Dear Dr.
        Hello & thanx for giving hope & advise, i really got lot of hope through your articles.
        Sir, plz find details of my various test which i done in last 4 years & plz guide me what next step i have to take:-
        my current age is 34yrs & i am from India.
        1st SA in Jan’2011
        2nd SA in jan’2013
        Sertoli cell syndrome only in feb’2013
        FSH & Testesteronre are normal in Oct’ 2015
        TRUS & SCROTAL(Normal & no blockage) in feb’2015
        3rd SA in feb’2015
        Dr.Turek, i request you to plz look into my reports & suggest me the next step.
        As my dr advise me us to go for IVF-ICSI but option for donar also.
        but my wife don’t want donor,so how can we know about my sperm retrieval before going for IVF-ICSI .
        Looking positively ahead
        Regards
        Singh

        Reply
        • Paul Turek, MD Paul Turek, MD

          Dear Singh, You clearly have azoospermia or no sperm in the ejaculate. There is a 60%-100% chance that you have sperm in your testicles, even with that many semen samples showing no sperm. This may be a blockage or testis failure. FNA mapping could certainly sort things out for you.

          Reply
          • SINGH

            Dear Dr.Turek,
            Hello, hope u r doing well,
            Sir,thanx 4 ur kind advise.
            Dr.Paul can u suggest any good dr who can do FNA mapping in India.

            Regards
            Singh

          • Paul Turek, MD Paul Turek, MD

            Dear Singh, there is no one formally trained by me (certified training) in FNA mapping in India.

  65. Hasan

    Hi Dr. Turek, i am 25 years old diagnosed recently with non obstructive azoospermia, testicular biopsy showed overall small seminiferous tubules, lack of tortuosity, mild thickening of basement membrane, single layer of sertoli cell syndrome and no evidence of spermatogenesis, leyding cells show dysplasia, then i had Mtese, multiple biopsies taken that showed no sperms unfortunately, then the urologist suggested that future stem cell therapy could help. Can i take hormone injection tell doing testicular mapping and which one is best? would it work in my case ?? Any hope to be a father one day….

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Hasan, Whether or not you have sperm depends in part on how expertly done the mTESE procedure was, and how expertly were the extracted testis tissue samples evaluated. FNA Mapping has found sperm after mTESE failures (pretty routinely) but tends not to be of help when the quality of the mTESE procedure and analyses of tissue is high. So, assuming a top-notch procedure was done, I would estimate that the chance of finding sperm by FNA mapping to be 0-10% at best. Hormone injections generally do not help in cases of missing germ line stem cells (spermatogonia) that is typical of Sertoli cell only syndrome.

      Reply
  66. Peter

    Dr Turek:

    This blog has been therapeutic for me. Thank you for taking the time. I was wondering if I could speak with you privately about a doctor in NY I am considering using for a mapping procedure. I was wondering if you’ve had any experience with him. So far, I have had two SAs (w/in 2 was of each other) with no sperm but I am trying to stay positive hoping they may be temporarily suspended due to illness. Had my first visit to the urologist today and he said no apparent blockage, small vein on left side not likely causing issue, and smaller than avg testes. Fsh on prior blood test slightly elevated and testosterone a bit low. Trying to stay positive that we can either start to generate sperm or find sperm on a mapping procedure. I could really use a recommendation how to proceed and your endorsement for the doctor Thank you again!

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Peter, I am starting a certified training program in FNA Mapping this year. So far, many have visited me and have observed mapping but very few have been formally trained (only my 2-year fellows). He may be great, he may be good or he may not be. Consider this: with azoospermia and a varicocele and a high FSH, the published chance of finding sperm with me is 63%. Ask your urologist what he estimates the odds are and from whence the number is derived. Evidence based medicine baby.

      Reply
  67. Angela

    Dear Dr. Turek,
    Pls.help me. My hubby has SCO. Doctor did FNAC in epididymal area & it appears small clusters & isolated sertoli cells admixed with fragments of fibrous tissue in a proteinaceous background. His hormones are normal except TSH is little high (5.41ulU/mL). Pls. Tell me what can we do now?? Is there any hope?? Thanks.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Angela, Sertoli cells line the testicle but not the epididymis. Fine needles (FNAC) can be placed either in the testicle or epididymis (PESA). Not sure what was sampled here but it sounds like the testicle. So, given that, the key question now becomes: How extensively was the testicle sampled? The more you look the more you find. Your hubby might be a great candidate for FNA mapping!

      Reply
  68. Marsa

    My husband had bone marrow transplantation when he was 13 years old because of Fanconi anemia and diagnosed recently with sertoli cell only syndrome after right testicular Tese and failed Mtese, when i read in internet about fanconi anemia, it says that it causes hypogonadism, impaired spermatogenesis with progressive testicular germ line depletion and premeiotic and meiotic defects and all this is caused by DNA damage, any hope that artificial testicles to overcome this DNA damage and meiotic defect if taken from skin “contains the same genetic error” to produce sperms.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Marsa, Me too! My hope is that we can create a stem cell using your husband’s skin and then add a cocktail of missing proteins to it to avoid the progressive germ line depletion, and then turn that stem cell into a sperm. This is not gene therapy which is not allowed in the germ cell lineage; it is simply protein modification to avoid a genetic disease.

      Reply
  69. Recent Patients

    Hi Doc – thanks for your time – we have been trying to digest our outcome of your fna mapping and although it’s the worst news we can hear it’s good to know the background information of what’s going on in there. I have decided to freeze my eggs so that once you have perfected this research we will be ready for it – please do keep us posted – we wont give up hope seeing children half me and half my husband knowing great minds such as yourself haven’t given up either. We look forward to hearing from you.

    Reply
  70. Hassan Kaled

    Dear Dr Turek,

    I have undergo a TESE boispy recently and only spermatids were found, does your clinic support the treatement with spermatids using ICSI and IVF..

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Hassan, No where in the US are spermatid injections being done. We are just not convinced that a spermatid (germ line cell just before it develops a sperm tail) is genetically and epigenetically “mature” enough to use safely. It is also very difficult to tell a spermatid from a myoid cell, another common cell type in the testis. My opinion is, using FNA mapping: “Where there are spermatids, there are usually sperm.”

      Reply
  71. haan

    I have a question . I had a tasticular biophsy my result was johnsen`s score 9 is this ok and recoverable or not plz tell me Im really vorid.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Haan, Johnsen scoring of testis biopsies is one of the most rigorous yet developed. A score of 10 is perfect, like in the Olympics, and implies normal sperm production. A score of 0 means no germ cells (sperm precursors) or sperm present. A nine is VERY high and suggests that mature sperm are present, at slightly lower levels than normal. This could be consistent with a blockage and blockage may in some instances be repaired. Repaired blockages may allow for natural conception. Alternatively, IVF-ICSI could be used with TESA/TESE procedures. A micro dissection should not be necessary for adequate sperm retrieval here.

      Reply
  72. Amy

    Dear Dr. Turek,
    My husband was recently diagnosed with ‘Sertli cell only syndrome (Germ Cell Aplasia)’ and we were told that the only option we have is to adopt or use a sperm donor, as germ cells are missing. His biopsy reported stated ‘The testicular biopsy reveals approximately 70 seminiferous tubules, few of them exhibiting thickened basemwent membranes. The tubules contain only Sertoli cells. Germ Cells are absent. The interstitium shows few Leydig cells’. We both are devastated. He has already undergone MTESE, but no sperms living or dead were found. His hormone study (FSH, LH & Testosterone) are in normal range, genetic study of Y chromosome micro-deletion and chromosome analysis reports are normal. We reach out to you for any hope that would help us get our own biological child. We both are 32. Would it be realistic to wait for man made sperm reasearch to pan out? Please advice.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Amy, You have been through a lot. You had a sufficient sized biopsy (70 tubules) and also and micro dissection TESE that have found no sperm. Whether or not FNA mapping might be able to locate a small pocket of sperm at this point is unclear, but I would say a low possibility, depending on the quality of the mTESE procedure. Man made sperm is not yet available. Consider alternatives to having your first child and circling back with us before you consider a second one!

      Reply
      • Leonard

        hello Dr. Turek im having the same issues that army husband having and plus i have varicocele on the left testicular. are any hope for me and my wife.

        Reply
  73. Deutschland

    Hello dr. Turek
    Is here in Germany a doctor that can make FNA Mapping ??
    Thanks for answere..

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Deutchland, There is no certified-trained FNA mapping specialist in Germany.

      Reply
  74. Akram Baloch

    Dear, dr I hope you will be fine and busy for helping needy people, im azoospermic due to maturation arrest, only left testis is normal rt testis atrophic, all hormon normal level, on biopsy , spermatogenesis abruptly ceases at spermatocyte level, last year I did testicular sperm extraction sperm found but 1 percent alive and among them 1 percent normal.icsi done 3 times no benifit, can I wait for artificial sperm or stem cell or have to do micri tese,
    thanks.
    akram

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Akram, Thats quite a lot of work for very few sperm and no baby. Usually, about 85-90% of testicular sperm is alive and usable when obtained fresh, regardless of motility. I wonder if you may have a chromosomal issue, or some other issue going on.

      Reply
  75. YThomas

    Dr. Turek it is very encouraging to hear what you have said over the years in your blog regarding advances in man made sperm. My husband has been diagnosed with Kleinfelter syndrome and just recently went through a micro-tese procedure. The procedure was unsuccessful in finding sperm. The doctor said that he had basically no tubules and germ cells are not present. This has been the most devastating year of our lives. My question is, as you mentioned in a post back in 2011 – it would be approx 5-7 years until routine clinical use for this development. Can you tell us if this is progressing and provide a time frame as to when you think this would be available? How many years do you think we are from being able to have this available to us?

    Once we have a detailed report from my husbands doctor, we will be setting up an appointment to speak with you to get a second opinion.

    Thank you very much for this blog and providing so many people hope!!!

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear YThomas, The field has progressed slowly, but is progressing. In fact, the French announced today that they have made man-made sperm from a testis biopsy. No data, no publications, no supporting documentation. Kind of like a “believe it or not” announcement. Not sure if its true and actually doubt that it is unless they submit their work for peer review and publication.

      Reply
  76. Maria

    Dear Dr. Turek,
    My husband received his results and all is normal however his FSH is 8. He did the tesa procedure and they found not many and not mature sperms. We are now thinking of micro tese, what are our chances since we know he has sperm (just not mature)?

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Maria, I am confused. The TESA procedure should have shown either sperm or no sperm. Not sure what is mean’t by “immature sperm.” Does this mean primary spermatocytes were observed? Spermatids? I think that the statement is that there are currently no sperm but immature germ cells. And if immature germ cells means maturation arrest, then mTESE may not have the benefit as, say, FNA mapping.

      Reply
  77. Nicole

    Hi Dr. Turek! My husband had a mTese back in March with Dr. Wayland Hsaio at Oakland Kaiser. He had given us a 70% change of finding sperm…got in there, and couldn’t find anything :-( It was devastating! His biopsy result was “It showed maturation arrest, meaning there were germ cells, but no sperm seen.That would explain the larger volume but still low count.” I asked him about FNA Mapping and he said it wouldn’t help, since he went through the biggest tubes in the testicle and couldn’t find anything. My DH has had a couple rare sperm in his ejaculate occasionally (twitching or dead sperm) so I know he used to produce a couple, which is why we were so shocked the doctor couldn’t retrieve any with his surgery. We’re proceeding with donor sperm now, but I’m wondering if there’s anything else you’d suggest we do…

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Nicole, In cases of maturation arrest, mTESE is notoriously unhelpful, precisely because it is simply a visual technique. Maturation arrest tubules all appear the same and look “normal,” just like tubules that have sperm. It’s like operating in the dark. FNA mapping is different, however. It is not a visual technique at all. It looks for all cell types within tubules and may be able to localize areas in the testis where tubules have sperm. If true, then these areas, and only these areas, are intensively biopsied (usually through a limited mTESE technique) until the lab calls out “sperm!” Maybe this is the reason that FNA mapping has found sperm on many cases of failed mTESE due to maturation arrest, cases even done by the masters themselves. You must wait 6 months after an mTESE before considering “looking” in this way however, and testosterone levels should be rechecked to ensure that the testicle is healthy.

      Reply
  78. somesh

    my sperm analysis result shows azoospermia condition with fructose positive,and FNAC test for both testis showed sertoli cells only and sonography result varicole I/II grade. FSH 10.5 (normal range 2-11.5).testosterone 9.66 (normal range 4.90-32.0).plz suggest me further treatment.

    Reply

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