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.

That Azoospermic Feeling



Painting of Depressed Man by Van Gogh. Was he azoospermic?
Was Van Gogh Azoospermic?

At the beginning of the office visit, I like to ask men with no sperm in the ejaculate who are unable to conceive a simple question: “What crossed your mind when you first heard that you were azoospermic?” The answers varying greatly but are very telling:

  • “It must be a mistake.”
  • “I shouldn’t have joined that fraternity in college…”
  • “It wasn’t the best sample I’ve ever done.”
  • “I was simply and utterly devastated.”
  • “I was in shock and then got really depressed.”
  • “It changed my life…I always thought that I would be a father.”

The Meaning of Azoospermia

Azoospermia is the lack of sperm in the ejaculate. It can be due to a blockage in the system (obstruction) or failure of the testicles to make sperm (nonobstructive). The most common reason for blockage is a vasectomy. Other causes include infections, prior surgery, injury or congenital absence of certain reproductive tract organs. Failure to make sperm can be due to exposures (hot tubs), medications, varicocele, a history of undescended testicles, cancer and cancer treatment. However the largest chunk of men with poor sperm production have none of these issues. Instead, they have a subtle genetic cause: either they are missing genes on the Y chromosome or have other chromosomes harboring subtle alterations that do not otherwise affect their health or lives.

So, like Captain Renault in the movie Casablanca, most men with azoospermia are “shocked, shocked!” because they feel so normal in every other way. And the vast majority are normal (as normal as men can get) in every other way. Most of the things they worry about, like college indiscretions, are exposures that are entirely reversible with time. My response is usually to allay fear and guilt by saying: “This is not something that you have done to yourself; let’s see if we can do something about it at this point.”

Treating Azoospermia

In fact there is a whole lot that we can do with azoospermia. Men with blockages can often be unblocked with microsurgery, one of my favorite things to do. This gives them the chance to conceive naturally again. And most men with poor production as a cause of azoospermia will have pockets of sperm in the testicles that can be identified by techniques like sperm mapping and that can be used for high-technology pregnancies.

What I have learned after caring for hundreds of azoospermic men over two decades is that they really don’t care what their sperm counts are as long as they can be fathers. And once they are fathers, it is clear that that “azoospermic feeling” goes away, as it should.


359 Responses to “That Azoospermic Feeling”

  1. Andrea Joy

    I enjoyed this article – well not “enjoyed” but you know – interesting. And well written. Those guys who can make babies again must feel sheer ‘joy’. You the man PJT.

    xaj

    Reply
  2. Dr Turek

    Yes, it happend again today. A successful sperm retrieval procedure at The Turek Clinic for a young man from Cleveland, who had had several procedures there and who was told that “there is really no chance for getting his sperm.” He was teary eyed in the recovery room (sitting there, pain-free) when I told him the news. My Nobel Prize is when patients name their kids “Paul.” PJT

    Reply
    • Mohammad

      Please help me , I have azoosperm doctor said I cn’t have baby.. Please give me solution..

      Reply
      • Mohammed

        Hello Doctor
        I heard about your interview Regading (one step closer to make sperm from skin) it can be a treatment or solution for Azoosperm while FSH is high

        Reply
        • Paul Turek, MD

          Mohammed, using stem cell based technology along with our artificial testis bioreactor is potentially one great solution for azoospermic men to have biological children, regardless of FSH. We just need some time…

          Reply
          • Mohammed

            Thanks doctor
            sertoli cells only syndrome is the result of my testis microscope
            this treatment will work for it

            regards

  3. Brady

    I had a right inguinal hernia repair a few years ago and just found out that I have azoospermia as well as low testosterone. I can relate to the feelings of the other men you talked about, but mostly I am angry. I feel that my azoospermia may have been caused by my surgery. Is it possible that this could have resulted in a tube obstruction?

    Reply
    • turek

      Yes, azoospermia has been reported with inguinal hernia repair. Typically it would occur with: a) mesh hernia repair b) hernia repairs on both sides. If the hernia repair is only on one side, then there needs to be another explanation for why the second side (assuming that you have both testicles!) is not contributing sperm. Maybe you should call me… (415-3092-3200) PJT

      Reply
  4. David

    oligoasthenoteratospermia, normal testosterone, normal FSH, literally everything else normal. Had child five yrs ago on first try, naturally, giving me dx of secondary male infertility.

    I’ve convinced myself that there must be an obstruction somewhere. Advice???

    Reply
    • turek

      David, I really doubt that this is an obstruction or blockage. Most men with this have no sperm counts (azoospermic). Sounds more like lifestyle issues or a varicocele correctable). PJT

      Reply
  5. DrTurek

    David, I thought that there was a variocele in the picture…I would check hormones (T, LH, FSH, Prolactin) and consider medical therapy to boost production and antoxidants to boost motility. PJT

    Reply
  6. David

    Had grade 2 varicocele, fixed may 2008. Still, no change. I am the epitome of dietary and lifestyle health. Still think no blockage???

    Reply
  7. David

    I would like to add that all analyses have been severely low. last one had one viable sperm.

    Reply
  8. ZINE karim

    Hello Dr. Turek.

    I am French from Paris, I have a non-obstructive azoospermia with large varicocele, I wanted to know if having a few sperm cells lines is a good hope. Thank you for your work. I sent you an email. Karime ZINE

    Reply
  9. ZINE karim

    I meant to have some cells in the ejaculate sperm lined before varicocele repair.

    thank you very much. Of Paris.

    Reply
    • turek

      Karim, From our published research, the chance of having sperm is 60-65% with FNA mapping done in the office under local anesthesia in an hour or so. Be glad to help! PJT

      Reply
  10. ZINE karim

    Thank you for your information.

    Where I find this type of care in Europe …?? where ?

    Reply
  11. ZINE karim

    I’ll make my final sperm then I see it I might come see you

    thx Dr.

    Reply
  12. Joy

    My Nobel Prize is when patients name their kids “Paul.” PJT

    you tease xaj

    Reply
  13. Kerri

    Finding out my husband had azoospermia was a very big shock. We’ve been trying forever and like most women I thought the problem was with me. After a while we both got tested and realized that my husband had a zero sperm count. I just can’t seem to get over the ‘why us’s’ because it just seems like our whole lives, things that have been easy for everyone else have been insanely had for us. But we’re trying not to dwell and are just praying that there is hope for us. We were just about to schedule a biopsy when I started reading about the sperm mapping. It gives me some hope that there is a less invasive and more accurate method for finding out if we will ever be able to have a baby.

    I just find myself so scared because I have no idea how we’re gonna pay for any of this. I am a teacher and he works in the office at a school, so we definitely do not make a lot of money. I am almost 36 and I’m just scared that I am running out of time. I’m scared of trying to take out a loan to pay for these procedures. None of us have any children and we have waited our whole lives until we found each other and now we are both worried that our dreams of being parents may never happen. I just applied for a flexible spending medical account at my job, but that is only for about 2,500 dollars. I was wondering if you think it would be wise to do the biopsy (which would be covered under our insurance) and try to use the account, and loans to actually pay for the actual ivf procedures, or is the mapping the best option?

    Reply
    • turek

      Kerri, great question! Where do you put limited funds? Certainly a biopsy can be helpful. There is about a 30% chance that it will show sperm. FNA Mapping is better with a 60% chance of showing sperm. So, if covered by insurance, it may make sense to do the biopsy first, knowing that it is an OK test but not perfect. If the biopsy shows sperm, then you are on your way and can save for IVF. If it doesn’t, then you either throw in the towel and choose donor sperm and IUI (cheapest alternative), adopt, or consider FNA mapping. Remember this: these decisions are some of THE hardest of your life and that’s why they are difficult to wade through and make. Please think of it as a journey, one of many in life. Setting financial limitations on things is critical to your quality of life and relationship and so must be considered in every decision. If you as a couple can make it through this, you can make it through any challenge to your relationship in the future: death, disease, house burning down, whatever. PJT

      Reply
  14. Eric

    Is it possible to produce sperm even if a testicular biopsy revealed no Sertoli or Leydig Cells in somebody with Kallmans Syndrome?

    Reply
  15. Jessica

    My husbands first SA showed only 3 sperm (only 1 moving) and the I don’t know the exact number from second but “there were a few” and “just about the same” is what I was told. The only bw results we have so far are testosterone (442) & prolactin (5.90). Everything felt normal during physical exam. We are going back in one month for transrectal ultrasound.
    The urologist told us that since there were a few sperm there is a good chance that they can find some through TESE or if the numbers go up even slightly he may be able to use a fresh sample for ICSI/IVF. The fresh sample seems risky to me. What if I produce 15 eggs but they only find 1 good sperm? What happens to the rest of the eggs?
    What would you say the chance of finding sperm through TESE would be since there were at least a few? Is it much different than if there weren’t any at all?

    Reply
    • turek

      Jessica, That is a tougher question…When men have ejaculated sperm of any kind, I tend to use this first. Finding sperm in testicles can be vverrry hard in some cases like this. In fact, its these kinds of cases that led me to invent testis FNA mapping in the first place, as random biopsies to get “backup sperm” failed. So, I would make sure the the sperm lab does a thorough “centrifuged pellet” analysis of the semen for sperm. It’s an extra step that requires skill but could identify 50, 200 or 1000 sperm in each ejaculate that would be worthwhile freezing if motile. The ultrasound is indicated with a low ejaculate volume and normal FSH, but I don’t see the FSH here. Alternatively, I often recommend aggressive medical management of hormones to get men to make 20-30% more sperm than at baseline and to faciliate a reliable, motile ejaculated sperm count. I make more friends by avoiding sperm retrieval procedures…

      Reply
  16. DrTurek

    Jessica, I really must refrain from giving medical care over a blog so advising you and your husband on proper medical treatment is inappropriate here. However, we can continue this conversation off-line. Feel free to call 415-392-3200 (www.TheTurekClinic.com) and have Makenna set something up. PJT

    Reply
  17. Jessica

    Thank you for your reply. We just received FSH/LH/Estrodiol. FSH was 6.9, LH 5.43, and estrodial was 24. What type of management of hormones do you normally recommend? I have read about some men given clomid or hcg shots. Do you think something like that would help in our situation?

    Reply
  18. mohamed

    my husband haveazospermia then he make atesticular biobsy but we cant find sperms then hetake ahormonal theraby -merional amp-and-purigone-amp-then make abilateral biobsy and we cant find sperm also iwaud ask you about the next step or we stop

    Reply
  19. mohamed

    iwould like tosay that allhormones inthe normal form the testecular biobsy says onlylate spermatids seen ,nocrypservation this inthe secondbilateral biobsy but inthe first RTtesticular biobsy sayes(germ cellaplasia-sertoli cell only syndrom) please try to helpme please

    Reply
  20. KARIME ZINE

    Hello everyone, Hello Dr. TUREK

    I have a question. Thank you in advance for your reply.

    As you know I had a varicocele level 3.

    In my ejaculate there were only a few sperm cells lined.

    Think you a maturation arrest?

    Or a hypospermatogenesis?

    Or Germinal aplasia?

    Thank you for your understanding, I am far from you and it helps morale to have some answers.

    Good luck to all and thank you Dr.

    Reply
    • turek

      Karime, Really can’t tell the biopsy pattern from the ejaculate or history. Besides, it doesn’ t really matter what that pattern is as there are no real pattern specific treatments available. I would just make sure that the varicocele has not recurred by getting a doppler color ultrasound. A recurrent varicocele could be the reason for poor sperm quality. Doc Paul

      Reply
  21. Karim

    Hello Dr. Paul

    I have azoospermia with fsh to 23, inhibin B less than 15

    I wanted to know how long does it take to remake a semen analysis after varicocele operation. ?

    And what vitamins to take to strengthen the production?

    Thank you in advance I’m in Paris so hard to come see you.

    Reply
    • turek

      Karim, It takes about 2-3 mos to make a sperm, so I generally check the semen for sperm every 3 months after varicocele repair for azoospermia. I expect to see sperm at around 9-12 mos in this situation. If no ejaculated sperm develop, there may still be sperm in the testis that can be detected with FNA mapping. I recommend a good “antoxidant” group of vitamins (see blog post: “Why Blueberries Matter”: http://theturekclinic.com/why-blueberries-matter-antioxidants-male-infertility/. In fact, our group is producing an organic, California-made antioxidant herbal based vitamin called “Essential Beginnings-XY” that includes lycoprene, glutathione and Vit D in addition to the usual antioxidants. It should be available at at very reasonable price on line (www.EssentialBeginnings.com) in a few weeks. PJT

      Reply
  22. Karim

    thx for ur help Dr TUREK, I wait 1 year and I dont have changement. maybe I com in L.A

    Reply
  23. Karim

    Hello Dr.

    Thank you for your encouragement and your support.

    I just did a semen analysis dated April 12.

    They found a single spermmatozoide slower after three months of treatment varicocele.

    I’m happy so I continue my treatment. We’ll see.

    What do you think? And if I come to SA I saltiness with pleasure.

    Sincerely, Karim

    Reply
    • turek

      Congrats Karim! Good things come to all who wait. Your story will be told in another 6-9 mos. Doc Paul

      Reply
  24. Abdul Majid Puri

    Hi Dr.Turek

    7 years gone to my marriage life, after 6 month of my marriage doctor recommend me to test and after results of that test I was shocked because I heard that I am AZOOSPERMIC.
    After that I had tried so many medicines like allopathic, homeopathic and herbal, but there is no change in my test reports in all that period. Dr. every thing is normal in my life but Dr. I would to be a father, please advise me what can I do I am from Karachi, Pakistan
    Cell num is 092-300-9229441 or 092-321-8733953

    Reply
  25. josh smith

    dr. turek..

    SA = one un-centrifuged was azoospermic. second centrifuged 5 motile 3 immotile. normal volume, + fructose, normal ph . . .

    free testosterone, fsh, lh, prl, all within normal limits. physical exam by urology -unremarkable.

    risk factors: Did sit in a very hot tub perhaps once maybe twice in past 3 months. 5 months ago was rotating in the OR and did not wear lead often and there were many X-ray shots per case.

    should i wait 3 months and repeat analysis or proceed with bx and U/S

    Dr. Turek labs do not point to pituitary dysfunction or end organ dysfunction. but if obstructive azoospermia why is the volume not decreased and normal fructose and pH?

    thx Doc.

    Reply
    • turek

      Josh, interesting case. Your wet heat exposures are severe enough to cause this; your Xray exposures are a consideration but would have to amount to about 100 Xrays in total to cause temporary sperm count loss. Wonder how “normal” your FSH really is (4 is ok, but 8 is high). Did you have a flu in the last several months? I agree with waiting 3 months to see signs of reversibility. I would then consider proceeding with genetic testing for Y chromosome deletions and a karyotype. Not sure why the ultrasound, as only clinical (exam detected) varicoceles matter. Biopsy can tell you about production but may also be entirely uninformative. FNA mapping is better. Note: obstructive azoospermia implies a blockage in the system. Only one form of blockage causes low volume and low fructose and pH and that is ejaculatory duct obstruction (see: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/ejaculatory-duct-obstruction-resection/, other types do not show changes in these parameters. Doc Paul

      Reply
  26. Tara

    Speaking of wet heat exposures:

    My husband’s SA came back yesterday. Previously we had thought difficulty conceiving was due to my having been on the Mirena IUD for many years and getting back to a regular cycle, but it turns out that my husband has low sperm count (2Million); low motility (5%) and poor morphology (6%). We are crushed. BUT, my husband has been in hot tubs frequently in the past few months (skiing in Feb/March), as well as a prolonged illness at the beginning of January. Would that affect a test done last Friday (May 13th)?

    We might come see you, as we are in San Francisco, depending on insurance, etc.

    Reply
    • turek

      Tara, in our published work, recovery from hot baths and tubs took 3-6 mos, but most of the recovery occurred after 3 mos. A febrile illness in January is of no concern at this point. Depending on the dose and frequency of tubbing in Feb/March, he could still be recovering from that. However, although these exposures COULD explain the recent abnormal SA, I am not sure that they explain the entire course of infertility. It depends on how long you have been trying. PJT

      Reply
  27. steven

    I was diagnosed with azoospermia 3 months ago. Centrifuged pellet showed no sperm, but normal volume, pH, liquefaction etc.

    All infection tests (both blood and urine based) came back negative.
    Hormone levels showed normal LH, normal estradiol, and normal (but low end of normal) testosterone, but FSH was 22. I was then told that this was non-obstructive azoospermia. Karyotyping and molecular analysis are being done, but not back yet.

    The only risk factors that I can think of are:
    1. The week before I did the sperm test I had been away in the Caribbean, had probably 5-6 alcoholic drinks per day, and would spend up to an hour at a time in the evening in a hottub on several evenings.
    2. I have excema, including on my foreskin sometimes, and so had for several months put 1% hydrocortisone on my foreskin and head of my penis.

    My urologist tells me that he expects that I likely have a sertoli-cell only syndrome, and that there is some chance (but not great) that he will find sperm during a TESA procedure. Should I go this route for sure, or is there any chance (even with that elevated FSH) that this was due to the wet heat exposure and alcohol the week before? I plan to redo the sperm test again sometime in the next month.

    Reply
  28. Tara

    Thanks Dr. Turek. We have been trying since last September (2010), but only using OPKs and timing for 3 months.

    Doctor has me on Clomid right now to “improve the quality” of my ovulation) but so far it has only delayed my ovulation from it’s normal CD21. *sigh*

    This journey is very frustrating.

    Reply
  29. Heather

    Hi Dr. Turek, has there been sperm mapping success in azoospermic men with y micro deletions but normal FSH and normal testicular volume? Thanks.

    Reply
    • turek

      Heather. Yes there has. Sounds like a case of maturation arrest of spermatogenesis. If this is due to AZFa or AZFb deletions, the detection rate is very, very low worldwide by any technique however. AZFc deletions on the Y chromosome have the most potential.

      Reply
  30. Heather

    Thank you so much for your prompt response. My husband is still waiting for his test results, but it looks like we would try the sperm mapping route if there is an AZFc deletion. Thanks again for the info.

    Reply
  31. karim

    Hello Doctor,

    I hope you are well.

    Here I have a semen analysis one week ago.

    Result: Zero sperm

    While the last time I had one.

    I am 6 months varicocele treatment

    What you think of this, I still have hope.

    thank you Karim

    Reply
  32. Nina

    Hi Doctor,
    I am a woman and I write you from France
    We discovered that my husband has an azoospermia without obstruction on july 2010 (one year ago)
    The examinations show:
    -FSH raised 16, normal LH, normal proclatin and normal testosterone, inhibine B low: 29
    - Testicular size is almost normal
    - Normal karyotype and no microdeletion deletion of Y chromosome
    - the echography shows that there is no obstruction just microcysts on the left head of épididymides and both heads of épididymes are upsided down but our Dr says that it’s mild and it doesn’t cause the azoospermia
    -In each of 5 semen analyses there was a leuckospermia but the germs aren’t dangerous and in priori dosn’t cause the azoospermia
    6 months of treatment of vitamins (E, zinc, selenium, B9) whom friends advised us
    4 days before the testicles’ biopsy: 15 sperms are found whom 2 sperms motiles!!!
    The day of the biopsy(15 days ago): the medical team was confident thus request to make 2 semen analysis but result: 0 sperm in the éjaculate and a few hours later my husband had the biopsy on 2 testis but result 0 sperm!! NEGATIVE BIOPSY
    The medical team asks to redo, 3 months later, a semen analysis and to redo a biopsy in 2 years …
    my husband and I are ready to come in the USA to see you, but we would like to know before what do you think about this case? Is there some hope for us or we have to make the mourning to have a child?
    Thanks doctor

    Reply
    • turek

      Nina, Your story is complicated and full of ups and downs. In my practice, we have reported that ejaculated sperm counts vary widely when they are low to begin with. In men with <10,000 sperm in the ejaculate, about half the there is sufficient sperm found there on the day it is needed for IVF-ICSI and about half the time there is not. And, I actually developed fine needle aspiration mapping (http://www.theturekclinic.com/testicular-mapping.html) because I was faced with a case like this in which a routine, random TESE failed to find sperm. Mapping can be done in advance of IVF-ICSI and creates a “template” to look for testicular sperm if the ejaculate fails to produce the necessary sperm the day that you really need it. In essence, it “directs” the testis biopsy for sperm like GPS. And, mapping doesn’t really affect the ability to generate ejaculated sperm after it is done, unlike the much more invasive microdissection technique. Banking sperm before IVF-ICSI in such cases is also an excellent solution to the “no sperm that day” problem but needs advanced planning. With a combination of these techniques, we can usually makes sure that the band and food are present on the “wedding day” of IVF egg retrieval.

      Reply
  33. DrTurek

    Karim, Would love to help. Why don’t we take this conversation off line. Feel free to call the office to set up a call at 415-392-3200. Doc Paul

    Reply
  34. Karim

    Hello Doctor,

    Thank you again for your valuable advice indeed!

    I think seriously to come to you.

    I give myself another year, see if after my cure of varicocele I am better.

    I wanted to know if Fna practiced at home in your closet was possible to report the results in France to have the operation here in Paris, because insurance takes care of everything.

    I wanted to know the price of this consultation FNA. As I can save now.

    Thank you in advance for your response, and take care of you, and thank you for helping us.

    Karim

    Reply
  35. Nina

    Thanks doctor for your answer , we will contcat you when we will decide to come to USA, maybe with Karim! thanks to him I found your web site!
    Nina

    Reply
  36. sara

    hello doctor…
    my husband has done freezing for about 30000 sperms in a IVF centre… can they use it for our next IVF procedure or they will do testicular biopsy for him as now he is azoospermic…
    Best Regards
    Sara

    Reply
    • turek

      Sara, It depends. Here are some of the factors that determine the usability of sperm: Source? (ejaculate, testis, epididymis); Motility? (yes or no); Viability? (yes or no); Quantity? And even more important: laboratory experience at the IVF center that is planning to thaw the sperm and use it. How many similar cases does the lab see annually? Hopefully more than 15-20 similar cases to give them proficiency.

      Reply
  37. sara

    Thank’s Dr. for reply
    it was from an ejaculate,with occasional motility about 10%,its quantity is about 2-3ml,but i don’t know about its viability….and about the center it has been working in this field for many years but i don’t know actually how many cases they meet like ours.
    i want to add that my husband was having a sperm count about 2 millions from 18 months but unfortunantely his sperm count decreases till zero in a very very rapid way without a known reason..we did last year an ivf but it failed and then he did testicular biopsy but they didn’t find sperms then he took ttt with merional injections and clomid and sperm appear againt but now he become azo…his dr. says that he has chronic epidimitis as sometimes he has high no. of pus cells….sorry for being too long but if u have any advice plz tell me…,thanks..

    Reply
  38. Karen

    Dr. Turek,
    I have to say that your website has offered me much more positive information, which is hard to find on the internet. My husband recently went through his first semen analysis. It came back with 4 dead sperm. His second SA showed zero. He did have a swelling of the left testicle last year, which was cured by antibiotics. Given this information, do you suppose he has a blockage?
    With many thanks,
    Karen

    Reply
    • Paul Turek, MD

      Karen, hard to know at this point, but certainly possible. He needs a blood test for reproductive hormones (T, FSH, LH, prolactin) and a good physical exam by a specialist. I’d be happy to help but its best done offline. Consider a call to us at 425-392-3200.

      Reply
  39. ZB

    Dear Dr,

    I have been reading and searching all possible article/blogs since the time we found out that my husband has an azoospermia in 2010, two bad news in same year. I lost my mother at the same time.

    We did my husband SA test in may 2010 which showed zero sperm count, after with our doc asked us to do blood test. His blood report showed high FSH level. His FSH level was 23% (as per the Indian style of report). Looking at my husband SA and blood report the doc said that his testis are not functioning and are not producing sperms.

    Also, my husband has only one testical, his left testical is an undescended one. His right testical is normal in size (as per scrotum scan report). He was operated for hernia on his right testical ard 4 years back.

    Doc please advice us what shuld we do next. After looking at our cases do u thinking we have any chances of finding sperms from only one testical and with HIGH FSH level? Do u thinking its possible to find sperms through TESE. My husband is ready to do biopsy, but he is scared as to what wuld be the result. I would love to become a mother….and my hopes r dying :(( pls advice!

    Reply
    • Paul Turek, MD

      ZB, hard to provide care over the internet. However, your husband seems like an excellent candidate for newer technologies such as extended FNA mapping of the testis to find sperm. < 1 hour, local anesethesia, minimally invasive. This is a routine type of case for us. Consider a call at 415-392-3200.

      Reply
      • pkm

        Dr.turky.i m from indian….i was married before five year during dignosis indian dr, told me that u r suffering from azoospermia…..i m very simple person dr, also told me that ur primary testicular is failure….it cannot produce sperm ….it is not possibe to come to ur clinic due to financial problem please any suggestion trhrough my email id……..

        Reply
        • Paul Turek, MD

          Dear Pkm, Although new and fantastic strategies like FNA mapping are not done everywhere, simpler things like testis biopsies are done in India. There might be a 30% chance that you have sperm just based on a simple testis biopsy. You might consider this…

          Reply
  40. ZB

    Dear Dr,
    Thank you very much for ur response. I really appreciate you taking time out of ur busy schedule and responding us. I am sure everybody on the site must b greatful to u.

    Just one more question since u said tht FNA mapping wuld be helpful for us I wuld like to knw what are the chance of finding sperm? As we wuld be putting lots of thing on stake before coming (money, his job plus our emotions).
    Also, I wuld like to knw how many similar cases u and ur expert team hve handled before and hve been successful in achiving pregnancy. I jst need a bit of an assurance before taking this big step.
    Thank u once again!

    Reply
  41. DrTurek

    ZB, Best to take these kinds of details offline. Send a e-form to the website (www.TheTurekClinic.com) and we can set up a call to discuss further.

    Reply
  42. ZB

    Dear Dr, Thanks for all ur help. I will surely contact u after discussing it with my hubby. thank you!

    Reply
  43. Amie

    What a great resource! I wish my husband and I found this a ferw years ago when he was diagnosed with non obstructive azoospermia. I agree with your article- we were fortunate enough to receive a sperm donation from my husbands brother and have a beautiful 10 month old girl. The minute she arrived into this world my husband forgot about the challenges we went through. He is so in love with his daughter- its wonderful and he is a fabulous father. I do have a question- can azoospermia ‘go away’? will he ever produce sperm? Can his hormones correct themselves?

    Reply
    • Paul Turek, MD

      Amie, Quite a story! Yes, azoospermia can show some reversibility, but it depends on what causes it. If due to hot baths or tubs, Kallmann syndrome, varicocele, mediations (Propecia) chronic illness, or other fairly well described causes. Most times, sperm counts will not be enough for conception at home though.

      Here is an amazing example: I recently took care of a young man with azoospermia who failed a microdissection TESE in New York and then called me to see what else is possible. I found out he had tuberculosis at that time. Once the TB was treated, instead of trying another sperm retrieval procedure, I told him to just wait and see if things turn around. Sure enough, 9 mos later, he has enough ejaculated sperm for IVF and may develop enough for IUI!!

      Reply
  44. pshtiwan

    dear doctor,
    I am an azospermic man. six years ago i performed testicular biopsy it reported that sertoli cell only syndrom (primary maturation arrest) my testosterone level is too little, is there any hope to my case?
    best regards

    Reply
  45. edina

    my husband has azoospria with high fsh and low testoston. do you have any hormonal teraphy for him?

    Reply
    • Paul Turek, MD

      Edina, this situation suggests that there is primary testicular failure. Hormone therapy may be possible but unlikely to boost production to the point of natural conception. However, it may be considered to optimize sperm production for a testis sperm retrieval. Options: Anastrazole, hCG injections.

      Reply
  46. Karim ZINE

    Hello Doctor,

    I wish you my best wishes for this year.

    I do not know if you remember me …?

    Karim Paris with azoospermia, varicocele treatment in January 2010, a sperm in April 2010 and nothing since.

    I have a repeat semen analysis in January 2012 and we still found a sperm alive but immobile.

    We have a biopsy scheduled for February 20 this year.

    In your opinion what are my chances?

    Really thank you for your answer.

    Reply
    • Paul Turek, MD

      Karim, hard to say. Typically, when even small numbers of sperm are found in the ejaculate, FNA Mapping can find sperm in the testis. However, with a testis biopsy, things are much more variable. Ask your doctor! Good luck.

      Reply
  47. AA

    Hi doctor. My husband just found out that he too is azoospermic but not due to a blockage but the doctor thinks its because there is a part of his y chromosome which is reversed.Is this considered a deletion? Is there still a chance that he can produce sperm and if not is there a chance that there could be viable sperm if we do a biopsy.

    Reply
  48. rabah

    docteur je vous remercie pour le nobles services offert aux steriles comme moi. jai une azoospermie secretoire depuis 20 ans..biobsie= nombre de spermatozoide mals formes…fsh eleve..ya til un espoir avec vos efforts…je viens en mars a san fransisco pour une consultation..merci docteur de me repondre.

    Reply
    • Paul Turek, MD

      Rabah, I understand French. I am sorry that you have been suffering for 20 yrs. You are good fit for evaluation here. Consider calling 415-392-3200 to continue off line.

      Reply
  49. Arnaldo

    Hello doctor! I am from San Juan, Puerto Rico.48 yr old male with hx of azooespermia diagnosed at age 30 from a mumps orchitis at age 25-26. I had all tests and evaluations done at 30 and the doctor said my only chance was to do a testicular biopsy, but he said that chances were around 50%. Now I am having low T levels. My new wife would love to have children of my own. What are my chances? Do you any good colleague that you may recommend around my area? Thank you so much for your help. You may reply to my email: arnaldo.guzman1@upr.edu
    Thank you!
    Dr. A Guzman

    Reply
  50. KVR

    I went for semen analysis last week, here is the report details

    PHYSICAL EXAMINATION
    ———————————–
    Volume = 1.0 mL
    Liquefaction Time = 30 mins
    Viscosity = Reduced

    CHEMICAL REACTION
    ——————————-
    Reaction = Alkaline
    Fructose = Present

    MICROSCOPIC EXAMINATION:
    ——————————————
    Sperm count = No Sperms

    OTHER MICROSCOPIC FINDINGS
    ————————————————
    Pus Cells = 8-10/hpf
    RBC’s = Nil
    Epithelial Cells = Nil
    Sperm Aggregation = Nil

    Please tell me, how can in interpret this analysis.
    Is this obstructive azoospermia or non-abstuctive azoospermia
    or anything else.

    I am devastated, please kindly help

    Reply
    • Paul Turek, MD

      Dear KVR, a semen analysis, when properly performed, can be very revealing. This one suggests a low volume ejaculate which could indicate a blockage either from ejaculatory duct obstruction or congenital absence of the vas deferens. The presence of fructose (if correct) suggests that at least one duct and seminal vesicle are open. Typically, one must explain the low volume ejaculate to explain the azoospermia. What’s missing is a centrifuged pellet analysis to see if even 1 or 5 or 10 sperm are present in the entire sample, which would make it more likely nonobstructive. Of course most valuable are the history, physical exam, and reproductive hormone levels (T, FSH, LH, prolactin) to complete this.

      Reply
      • KVR

        Dear Sir,

        Thank you so much for previous reply, i went for couple more SA to confirm whether its a true azoospermia. All repeated (3 times) shows nil sperm count, so that confirms its azoospermia.

        As per my doctor here, i went for physical examination, T, FSH, LH, Prolactin test, all came normal. But when they did FNSA, they could found the following.

        Presence of Primary and Secondary spermatocyte and few spermatids, occasionally observed steroli cells.

        How can i interpret this? my Doc said, the only option is ART(IVF/TESE) etc.

        Is there anything i am missing here?

        Reply
      • KVR

        Hello Dr,

        More details below

        I took biochemistry tests like TSH, LH, Follicle Stimulating(FS), Prolactin and Testotirone all came back with normal range
        and doppler ultrsound of scrotum+Trus came back with normal finding but “Midline simple prostatic cyst measuring 1.3 x 0.8 x 0.8 cms seen, vol-0.5cc. The cyst is seen at the antero superior aspect of the prostate” Dr said, no need to worry on it.
        In FNAC – Testis, test found “Primary, Secondary spermatocytes and few spermatid. No sperm could be identified. Occasional Sertoli cells seen in the smears studied. Sertoli Cell index is 2-3/100 cells. and hence confirming MATURATION ARREST – Right and Left Testis.”

        Reply
        • Paul Turek, MD

          Dear KVR, hard to give accurate advise on-line. Sounds like nonobstructive azoospermia and not ejaculatory duct obstruction. Not sure if you had a “mapping” procedure as part of your FNAC as I have described or not, but when “few spermatids” are found on mapping, there is almost always a mature sperm nearby. Consider sending me the glass slides from the “FNAC” procedure and I would be happy to review them again.

          Reply
          • KVR

            Thanks you very much for the response sir.
            Please provide me the address, i will send you the slides.

          • Paul Turek, MD

            The Turek Clinic
            55 Francisco St
            Suite 300
            San Francsico, CA 94133
            Call 415-392-3200 to organize

          • KVR

            Hello Dr,

            We sent the slides to your address,
            We are in California, please let me know when we can meet you.

          • KVR

            Hi Doctor,

            Did you get a chance to look into my glass slides? I sent you while ago!

          • Paul Turek, MD

            KVR, contact the office at 415-392-3200 to set up a call and hear about results if they have been read. The internet is no place to talk about your privates!

  51. sekar

    Dear Sir,

    My friend got married 7 months before. They are having good sex life and trying for baby. His wife is not getting pregnant. He did Semen Analysis and got report as follows.

    Semen Analysis (azoospermia)

    Color : Greyish White
    Volume : 10ml
    Viscosity : High
    Reaction : Alkaline
    liqufication : prolonged ( a case of azoospermia)

    My question is
    1) what is azoospermia?
    2) Any natural way to overcome this?
    3) Any further testing required for this?

    Please revert ASAP

    Regards

    Sekar K

    Reply
  52. Sam , H

    Hi doctor ,
    I’m really glad to find you on the website ,
    I’m having a problem since when I get married ,
    I can’t have babies ,because I don’t have any sperms count !
    But till now I don’t know the rason why ?
    And non of the doctors I went to try to explain to me why ?
    I have normal life and my family all have kids , sisters and brothers !
    I’m 43 years old , and my wife 31 years old ,
    Maybe I have some hope with you Doctor .
    And you can help me with something !
    At least just to know the reason ?!
    I live in Tampa – Florida .
    Pleas doctor let me know if we can do something !
    I can send you all my papers , if you need it ,

    Thank you so much ,
    Hope to hear from you soon

    Reply
    • Paul Turek, MD

      Sam, Depending on what going on (blockage or no blockage as cause of no sperm count) the reasons can differ. In about 1/3 to half of cases, we can “explain” the problem. But in rest, they remain unexplained. HOWEVER, because they are unexplained DOES NOT MEAN that you cannot have a kid! Having a kid is simply a matter of looking hard enough for sperm. Consider a call to 415-392-3200 and setting up a call with me.

      Reply
  53. Brian Choi

    Dr. Turek,
    I have recently been diagnosed with Azoospermia. Its been confirmed on 2 separate SA, one done with strict morphology. I have an FSH level of 41.9 mIU/mL whereas my LH and testosterone levels are normal. I also had a doppler ultrasound it was also normal, with testicles are roughly normal size and no signs of varicoceles. The next step, given by the specialist that I’m seeing, was a biopsy and/or TESE/microTESE. I was wondering what sort of alternatives there were and between a biopsy and TESE/microTESE which one works best? And finally, where does FNA mapping fall w.r.t. to microTESE, as they sound somewhat similar from my novice perspective. Thank you.

    Brian

    Reply
    • Paul Turek, MD

      Brian, Great question.
      The “best” technique for finding out whether you have usable sperm in the testis when there are no sperm in the ejaculate depends on several factors: cost, convenience, accuracy, risks, complications etc. Here are the most common approaches taken however:
      1. Single testis biopsy. Defines whether a blockage is present. There is a 20-30% chance it will identify sperm if there is no blockage. Relatively invasive (requires a cut). Sperm is not saved in general from this approach.
      2. FNA Mapping. Defines whether a blockage is present. There is a 60+% chance that it will identify sperm if there is no blockage. Minimally invasive (no cut, mean recovery 1-2 pain pills); Sperm is not saved using this approach. Creates a “map” of testicular sperm production.
      3. TESE (multibiopsy). Not great at defining obstruction, but tells you whether there is sperm present. Sperm can be saved. There is a 30-50% chance that sperm will be found if there is no blockage, but this depends on how many different biopsies are taken. Probably one of the most invasive of these techniques(many cuts).
      4. Microdissection TESE: Not great at defining obstruction, but tells you whether there is sperm present. Sperm can be saved. There is a 40-60+% chance that sperm will be found if there is no blockage, depending on the expertise of both the surgeon AND the lab that the surgeon uses. The most invasive approach among all approaches (very large cut). Has a measurable chance of damaging the testicle to the point in which temporary or permanent testosterone replacement will be necessary afterwards.
      Hope this helps. Feel free to set up a call with me by contacting us at 415-392-3200.

      Reply
      • Brian Choi

        Dr. Turek,

        Your answer helps a lot, and is one of the reasons I scheduled a 10 mins consultation call to your office. I do not have a lot of money at my disposal, but I would like to survey all techniques and avenues in terms of sperm recovery (since I have a high FSH even amongst azoospermics from the medical papers I have read). Look forward to speaking with you very soon and discussing some quotes on pricing on FNA mapping as compared to other techniques. Thank you again.

        Brian

        Reply
  54. Brian Choi

    A follow up question on FNA mapping. Typically for a biopsy there is a 6 month lead time that follows to allow sufficient time for sperm to develop. Is there a similar time frame after an FNA mapping and sperm retrieval for IVF in this case? Thank you again for your time.

    Brian

    Reply
    • Paul Turek, MD

      Brian, another good question. After FNA mapping, I suggest that men not do any further sperm retrieval procedures as follows:
      When TESA (40% of men) indicated after mapping: proceed immediately
      When TESE (40% of men) indicated after mapping: proceed immediately
      When mTESE (20% of men) indicated after mapping: wait 3 months before proceeding

      Reply
      • Brian Choi

        That is also very helpful information Dr. Turek, and though my wife and I still have to figure out the finances of all these procedures, it is helpful to note that there is very little downtime between a positive FNA mapping result for finding sperm and a procedure to retrieve sperm for ICSI-IVF. Thanks again for your time and look forward to speaking with you and your staff very soon.

        Brian

        Reply
      • Brian Choi

        Dr. Turek,

        When you mention “after mapping: proceed immediately,” I just wanted to make sure I understood this correctly. I am assuming you mean that if FNA mapping results in positive results for finding sperm, then proceed immediately to TESA/TESE whereas wait ~3months if moving forward with mTESE? Also, when you say proceed immediately, are you stating that one can literally undergo TESA/TESE a few days (for instance) after FNA mapping? Thank you again for your time.

        Brian

        Brian

        Reply
        • Paul Turek, MD

          Brian, it takes about 10-14 working days to get the results after FNA mapping. The slides are reviewed by a specially trained team of pathologists, including me at the end. So, the earliest a sperm retrieval can be done after FNA mapping is 2- 3 weeks.

          Reply
  55. Laura

    Hi Dr. Turek,
    My husbands testicular biopsy showed sertoli cell only. Is there still a chance we could find sperm with a different technique?

    Reply
    • Paul Turek, MD

      Laura, yes there is. In one of our original FNA mapping papers that we published in 2000 (12 years ago!), we found that sperm could be detetected in 27% of testes in which a prior biospy showed no sperm (like Sertoli cell only). In addition, the opposite testis had sperm 20% of the time. This study employed a “maP’ of 8 sites. Now we use 18 sites/testis!

      Reply
      • Laura

        Thank you so much for the response. My husband and I are looking forward to exploring this option. We will be calling to schedule a consultation soon. Thanks for your time.

        Reply
  56. Brian Choi

    Dr. Turek,

    When you mention “after mapping: proceed immediately,” I just wanted to make sure I understood this correctly. I am assuming you mean that if FNA mapping results in positive results for finding sperm, then proceed immediately to TESA/TESE whereas wait ~3months if moving forward with mTESE? Also, when you say proceed immediately, are you stating that one can literally undergo TESA/TESE a few days (for instance) after FNA mapping? Thank you again for your time.

    Brian

    Reply
  57. Brian Choi

    Dr. Turek,

    I have a general question regarding FSH and testicular volume. I have been reading many medical papers and journals regarding the likelihood of retrieving sperm and FSH, testicular volume, Johnsen’s score, and the presence of spermatids. It seems from these papers, there is almost a consensus that azoospermic men with FSH levels > 25 or so have an extremely slim chance ( < 5%, in many cases 0%) of having any sort of spermatogenesis and, hence, finding any sperm. As I stated before, my FSH level is 41.9 mIU/mL, with testicular volume of approx 6-7mL (for each testis). Though my testicular volume seems fine (from the studies I've read), my FSH level is far higher than ANY patients for which they found sperm (the highest FSH value was 19.4, amongst all the papers I've read). Can you please shed some light and your opinion on this matter? I'm a bit disheartened by these findings which seem, as far as I can tell, to have been performed rather well in a controlled and careful experimental environment. Many thanks again.

    Brian

    Reply
  58. shahid

    Dear Doctor,
    I live in Pakistan. I am 32 and my husband is of 33 years old. We got married in October 2010. In Feb 2011 I got to gynecologist to get my check up for why I could not get pregnant. She got ultrasound report and my menstruation cycle all was normal. On her advice we got to get sementic analysis. And it was figured out that my husband has no semens to be tested. I took to consult gynecologist and urologist in my first attempt. They took a blood sample and FSH(found to be 8.7) and Testosteron(found to be 2.9) hormone was tested and urine test showed an infrction causing blood drops from 2-3 in urine. Report datwd: 28 May 2011 was as under:
    Physical Examination:
    Color: yellow
    Sp.Gravity: 1018
    Turbidity: Nil
    Deposit: Nil
    Chemical Examination:
    PH: 5.0
    Sugar: NIL
    Protein: Nil
    Ketone : Nil
    Urobilinogen: Normal
    Bilirubin: Nil
    Blood: Nil
    Bile salts: Nil
    Nitrite: Nil
    Microscopic Examination / H.P.F :
    Pus cells: 1-2
    Epithelal cells: 2-3
    Red Blood Cells: Nil
    Crystals: Nil
    Crystals: Nil
    Casts: Nil
    Casts: Nil
    Amorphous: Nil
    Organisms: Nil
    Others: Nil
    Renal Funtion Tests Dated: 15 May2011 are as under:
    Serum Creatinine 1.3
    Blood Haematology Dated: 14 May 2011 as under:
    Haemoglobin: 13.4
    T.L.C: 6800
    E.S.R: 55mm/1st hour
    D.L.C:
    Neutrophils: 60%
    Lymphocytes: 35%
    Monocytes: 03%
    Esinophils: 02%
    The Urologist had examined him and said that he needs to take an X-ray of testes and a tissue of testis will be taken to examin whether sperms are produced or not. After hearing this my husband never turned up to medical treatment he simply refused. He is inclined more to take herbal / homeopathic medicine to increase the fluid at ejaculation. We have taken herbal medicin which took him to svere cough and its impact was such that he found difficulty in erection or lost of erection. Homeopathic treatment effected in this regard that his erection is controlled now. But to get a pregnancy is still a dream. He psychologically is disturbed as he wants to get a baby if I want but have no interest in sincere medication and its me who want to get information atleast from internet to find the word azoospermia for his problem. In Feb 2011,after marriage, he revealed that before 7 years he got worried of no semens and tells that he has not experienced more than a drop in his early adulthood. Now I again asked him not to waste his and my time to these herbal or homeopathic medication and go to the same urologist for that treatment he is not agreeing for that even.
    What he has done is got a shipment from USA for a medicine named Volume Plus Semen Booster manufactured in USA for Moving Ahead Inc. containing : Zinc as Zinc oxide: 50 mg,L Arginine as L-Arginine Hydrochloride, L-Lysine as L-Lysine Hydrochloride, Homy Goat Weed (Epimediumsagittatum), Muria Puama(Ptychopetalum olacoides); Hawthorn Berry (Crataeguspinnatifida), Cranberry juice(Vacciniium oxycoccos), L-Camitine(as L-Camitine Fumarate), Catuaba Bark (Erythroxylum catuaba), Pumpkin seed (curcubitamaxima), Tribulus fruit(tribulus terrestris), oat straw10:1 PE (Avena sativa), maca root (lypedium meyenii), longjack root (eurycomalongifolia), sarsaparilla root (smilax species),Licorice root (glycyrrhiza glabra).
    I have not let him use this volume plus for semen boosting. I do not want to harm any of his health side to intake unadvised medicine. I beg you to kindly help me in this regard I have been reading all the day and night on internet how to get pregnant and reached your webpage. I look forward to read from you soon as I have kept all the incidents before you from A-Z. I want you to hear me and advise us and tell us what is the right way to adopt and what is less hazardous. And whether I can have a baby or I will die without anything in my lap………Please advise me can I get this mapping if it suits my husband in Pakistan???? What should I do doctor??

    Reply
    • Paul Turek, MD

      Dear Shahid, That is quite a story! I must admit, the reaction that your husband is having to hearing the news of having no sperm count is common. It is tough to take. I will also say that you may need some time for him to “come around” as most men want what their partner’s want in the long run. Keep the faith. Keep the hope.

      Regarding the homeopathic approach, it is very popular in some countries. I believe it has a role but what you can ask from it might be more limited than, say FNA mapping or assisted reproduction. Consider a Second Opinion http://theturekclinic.com/services/get-a-second-opinion/ by contacting us to see if we can provide information that may help you both.

      Reply
  59. George C

    I was first diagnosed with Azoospermia by a local (Australian) fertility specialist 18 months ago……..or at least I was advised he was a specialist. He informed me that I had a 5% chance at best of providing enough sperm to allow my wife to conceive and this was by undergoing a testicular sperm asiration / biopsy and testicular microscopic exploration. This is virtually like cutting them open wide and hoping for the best…..I imagined this like like driving in the dark with a blindfold on, with no lights on and hoping not to hit anything.

    After taking several months to come to terms with what this meant and the potential lifelong impact this would have re testosterone replacement etc, my wife and I decided not to proceed. We understood that we would be childless.

    A few months later we could not accept this result, there had to be another way. How could it be that this is the only method practiced and accepted here in Australia?

    So we hit the internet, typed in azoospermia and The Turek Clinic came up.
    After reading the information on FNA mapping my wife and I began to smile ……….. we knew straight away that this was a much better, safer and far more accurate way of determining if sperm were able to be retrieved.
    After a few phone calls, a couple of emails later we were booked on the flight over to SF to visit TTC. Who cared that it was 16hrs flight away.
    From driving in the dark with a blindfold on to having a detailed GPS on in the middle of the day on an outback road! This is where we were now.

    From the moment we were greeted by TTC staff, we felt both welcomed and comfortable. TTC does not appear to be a surgery, its more like a cross between a office with unusual furniture and memorabilia hanging from the wall to a friends place whom keeps everything neat and tidy.

    After conducting the FNA procedure we left SF after 3 days and headed back home to Sydney . At no point in time was I ever sore, felt discomfort or was in pain what so ever. The procedure went well without a hitch.

    Almost two weeks later to the day we received the unbelievable news from Dr PJT that enough sperm was located to allow fertilization via IVF. My wife and I cried for about an hour after the news was received. It was honestly the best news we have ever heard.

    Thank-you so much Dr PJT (I now speak of Dr PJT to my wife as Saint Paul) and also Paula Chavez (Paul & Paula…..lol) for your wonderful care, compassion, professional attitude and friendly nature you provided while in your care.
    The news still has me on a high 7 days after the fact.

    Cant wait to see all you guys again soon for the next step in our journey.

    God bless with love from afar
    GKC

    Reply
  60. Mark b

    Jsut a quick question…what on earth could cause a sample of 19mm 6 months ago, to 9mm but no motility 5 weeks ago, to ‘azoospermia’ diagnosis last week? I have variococele that may have worsened, but honestly, I’ve never read anywhere it can take sperm count to zero, only to low levels. I’m a 42 yo old male, and we have no children. I also have recently been diagnosed with poor urine flow…seems unrelated but maybe not?

    More specifically, would I be a candidate for FMA mapping or does this sound like a hopeless case of testicular failure? Thanks

    Reply
    • Paul Turek, MD

      Mark, It is unusual when sperm counts disappear that quickly. In these situations, one can usually find the reason. Things that are reversible (a flu, hot tubbing, new medication, urinary tract infection etc) are usually present. Occasionally, something irreversible is found (testis cancer, diabetes). Regardless, a hard look at potential causes is a must. Unlikely to be due to a varicocele with such rapid progression. One goal is to try to get the sperm count back by figuring out the reasond and reversing it. So time may be your ally here. FNA mapping could be helpful if there is no recovery of ejaculated sperm with time. This does not sound hopeless at all.

      Reply
  61. Erica Adams

    We found out 10 months ago that my husband has NOA. All hormonal, chromosomal tests came back normal. The testis biopsy showed predominantly Sertoli-cell Only with a few tubules exhibiting early maturation arrest. The doctor put him on 25 mg Clomid a day. When he went back for his 6-week blood test his testosterone had jumped from 380 to over 900, which seems considerable to me. Based on these results, is there a chance my husband could begin producing sperm if he continues taking the Clomid? Have any of your patients with Sertoli-Cell Only benefitted from taking Clomid as far as sperm count goes?

    Reply
    • Paul Turek, MD

      Erica, testis biopsy patterns are often “mixed” with two or more patterns present. The use of medical therapy attempts to “push” the most advanced pattern to complete the germ cell sequence anb become sperm. It is not possible to make sperm from a testis full of only Sertoli cells, as you have suggested, as the testis germ line stem cells are absent. So, here the doctor is attempting to push the maturation arrest tubules to make sperm. The likely result is that there will be no sperm in the ejaculate after 6 mos, but there could be slightly more sperm production in the testis that could be detected by testis sperm retrieval or mapping procedures. Frankly, I have not seen sperm develop in any man with an FNA map showing global Sertoli cell only.

      Reply
  62. kishwar

    dear doctor!
    i m kishwar, 29years, male.
    i have just give testicular biopsy test, where i got jhonsons score “2″ .
    now i would like to ask is there any chance for me to b father of a baby?
    will FNA mapping be helpful for me?
    is there any other option?
    please sugest and help.

    Reply
    • Paul Turek, MD

      Dear Kishwar,

      A single testis biopsy showing what sounds like Sertoli cell only syndrome is not great news. However, remember that sperm production in testicles from azoospermic men can occurs in “islands” or “patches.” Looking at a single site like a biopsy does may in fact be insufficient to determine whether testis sperm are present somewhere in the testicle. Using an 8-site map, we published (http://en.wikipedia.org/wiki/FNA_Mapping) that sperm could be found in 27% of the same testes in this situation (having had a prior biopsy showing no sperm) and in 20% of the testes on the opposite side. That was with 8 sites/testis. Now we do 18 sites with a modern map! So, you should certainly consider FNA mapping before you write off the sperm issue!!

      Reply
  63. Krishna

    Please refer my above post – Krish

    Recent two months I have seen the sperm like object in my semen under my home seminal analysis microscope after 2 years.

    These videos are taken in 40X microscope zooming.

    Could you please let me know what these are? Even if it is immature sperm or elongated spermatid, I will be happy considering my YCM deletion, abnormal karyotype and Azoospermia.

    The videos are taken with 3 different sperm like objects in semen and hence kindly be patient to look all three videos hence One video can be better than other.

    Video 1 : http://www.youtube.com/watch?v=S9WcNIctV5E&feature=youtu.be
    Video 2 : http://www.youtube.com/watch?v=NxFRRBEk2Nk&feature=youtu.be
    Video 3 : http://www.youtube.com/watch?v=ehRbA8EJLmU&feature=youtu.be

    Thanks very much for your time,patient and kindness.

    Reply
    • Paul Turek, MD

      Krisha, pretty nice videos! Looked at all three. Honestly I do not think that they are sperm as mature sperm heads have a light half (acrosome) and a dark half (nucleus). These do not quite have that look. However, I may be wrong. A differential stain by an andrology could identify them further.

      Reply
      • Krish

        Doctor,

        Agree that these cannot be sperm. May I know what are all these could be? I have never seen such things in my semen in past 1.5 years. Just seeing these for in past two months only.

        Thanks & Regards,
        Krishna.P

        Reply
  64. Krishna

    Hi Turek,

    Do you have any suggestion to try for my condition? I am from India and did you train any doctor in India or in any other Asia Pacific country for FNA mapping?

    I wonder whether FNA mapping helps me. Considering the fact of my YCM deletion and abnormal karyotype mentioned below.

    ** Married on June 2010

    ** Tried 6 months for child

    ** Semen analysis in November 2010 which shows Zero sperm and Azoospermia

    ** Repetitive Semen analysis in one year period until 2011 shows the same – Zero Sperm and Azoospermia

    ** December 2010 – Tested for Varicocele and found a large Varicocele – Grade III(Severe) bilaterally.

    ** January 2011 – Corrected Bilateral Grade III Varicocele through surgery(varicocelotomy) and tied up 10 big valves.

    ** January 2011 – Testis Biospy done. Revealed maturation arrest at Primary Spermatocyte stage and pre-dominant Setroli cells. No spermatoza is evident.

    ** April 2011 – Done Karyotype and “Y chromosome microdeletion test and found abnormal Karyotype(45,X[33]/46,X,i(Y)(p10).ish
    i(Y)(SRY++)) and YCM deletion in AZFb and partial AZFc deletion(only STS markers sY255, sY269 are found in AZFc). The full AZFa region found without any defect.

    **The very initial Hormone Analysis shown the FSH is slightly above normal level(13 IU/L) and LH is in normal level(5.07 IU/L). The Testostrene is very Low level(5.20 nmol). However I am under Clomid tablet to increase the Testostrene from May 2011 until now(where I have stopped it couple of times in between). The Clomid worked for me and increased the Testostrene to normal levels – 18.5 nmol (side by side the FSH also got elevated 21 IU/L).

    Even though clomid is worked, I am not able to see any sperm in the ejaculation till date. I have imported a home seminal
    analysis microscope from USA and checking the semen every month.

    I were under multi Vitamins, Supplements like Fish Oil, L-Arg, L-car, Flaxseed oil etc. I understand from the research so far these things will
    not helpful for YCM candidates in AZFb+AZFc deletion but want to try this in a little hope.

    **I HAVE DONE THE KARYOTYPE ANALYSIS FOR BOTH MY FATHER AND MY ELDER BROTHER AND BOTH ARE HAVING NO YCM AND BOTH ARE HAVING NORMAL KARYOTYPE.

    Waiting for your kind reply.

    Kindly let me know your mail address if possible to send all my diagnosis copies.

    Regards,
    Krish.

    Reply
    • Paul Turek, MD

      Krish, a complicated story. What matters most to me is this: Men with Y chromosome AZFb deletions, if complete, are very unlikely to have either ejaculated or testis sperm. This is unlike AZFc deletions, of which 60%+ of men have sperm in the ejaculate or testicle.

      However, this statement must be qualified since there are not many men with AZFb deletions that have been investigated thoroughly to date. Probably less than 100-150 men. So the answer to your question is: It is possible, but not very likely, that you have sperm in the testis with an AZFb Y chromosome deletion.

      In this case, some men simply want FNA mapping done to confirm this, for closure in a sense, and to know for sure. Doing a microdissection for the same reason is a much bigger commitment as its side effect profile is much greater (pain, low testosterone) than that observed with mapping.

      Reply
  65. Krish

    Dear Turek,

    Once again Krish from India.

    Did you train any doctor in India or in any other Asia Pacific country for FNA mapping? If so, It will be easy for me in both Economic and Travel to do this procedure.

    If no other Asian Pacific country you have trained other than Israel, could you please give me any doctor contact whom you trained in Israel since its nearest to India.

    Thanks & Regards,
    Krish.

    Reply
  66. Krish

    Dear Turek,

    Thanks for all your help in the field of male Infertility. Your help is really wonderful.

    1. May I know for those patients who have both YCM and sperm growth arrested at Spermatocyte level, did the Spermatogonia or Spermatocyte will be having the deleted Y chromosome as well?

    I know the Spermatogonia is a stem cell which contains 23 Chromosomes and just wonder whether it contain deleted Y chromosome as well.

    Please note my mosaic pattern for this question : abnormal Karyotype(45,X[33]/46,X,i(Y)(p10).ish i(Y)(SRY++))

    2. In case if scientist are able to grow the sperm outside my body and in case of female embryo grown in test tube, will the female embryo having two cell line of mine? Pls refer my mosaic pattern above. For your kind information, my wife dosen’t have any type of chromomal abnormality.

    3. Referring my above chromosome abnormality, may I know is there any implication invented so far for men of having two SRY genes? I have more sexual desire. Just wonder it’s one among them.

    4. What you think about IVS(In Vitro Spermatogenesis) in my case in case no sperm will get identified in sperm mapping and since I have Spermatogonia and Primary Spermatocyte? I can choose female embryo considering the YCM and chromosome abnormality of mine in case of successful pregnancy. I believe it’s been done on animals successfully. Even in rare labs in world, IVS applied successfully on few humans based on online reports. I even have a contact of Portugal doctor who says she can try that for me. Please let me know if any one in the world whom you know well can do IVS?

    **I believe even though 99 doors are shut, one door still open for me and I am trying to find that ONE.

    Regards,
    Krish.

    Reply
  67. Bhimashankar. M. S. from India

    Doctor I am also a azoospermia patient, my family doctor suggested me to go through testicular biopsy, and result was nil count in testis specimen and result was maturation arrest was there, so please give me what to do, is it this curable or incurable. please please god sake help me… I am waiting for your replay.

    Reply
    • Paul Turek, MD

      Dear Bhimashankar, Read more of these comments as men with maturation arrest patterns on testis biopsy can often a) have pockets of sperm on more extensive analysis (e.g. mapping) or b) be “induced” to make sperm through varicocele repair, removal of toxins, improved health or through injectable medications.

      Reply
  68. Jay

    I recently had a basic SA done with revealed low to no sperm
    my info.

    appearance: norm
    liquef. time : 40 mins
    volume: 2.5 ml
    viscosity: normal
    pH: 8.0

    LH: 12
    FSH:11.7
    Test: 118

    Could my sperm count be a hormonal problem with these number and if corrected could my count be restored?

    Reply
    • Paul Turek, MD

      Jay, Hard to know but it appears that both the LH and FSH are high and that both the testosterone and sperm production are down. This implies that testis failure exists both in the sperm and hormone compartments of the testis, whether correctable or not. Medical therapy to correct your testosterone and also keep your fertility can be tried, but I doubt it will normalize your sperm count.

      Reply
        • Paul Turek, MD

          Jay, Research is always chancey. Stem cell research especially. Maybe this is why there are very few true stem cell therapies available some 30 years after they were discovered. Hard work usually pays off though! We are counting on it.

          Reply
  69. moorthy

    Hello Doctor,

    After my Bilateral Grade III Varicocele surgery, In my groin, Testicle and left, right sides of the spermatic cords, I feel the heat blood flow or kind of heat in every 3 hours. I feel no pain, no redness or any other issues in these areas.

    I only feel the heat and this is fixed if i apply cold water around the areas where the varicocele surgery done and Spermatic cord, Testicle and Groin areas.

    If i don’t apply the water then it become worst. I feel the heat spreads to my chest area, the buttocks and my head, the testicle feels kind of bruising when the heat is intollerable.

    This issue happening after few days of the varicocele surgery
    . I just want to mention two more incidents. Just before a month of surgery, my wife affected with Urinary Tract Infection and she was cured from it. I was not affected that time and was normal. Also I have stopped my 15 years of smoking habit from the day my surgery was done.

    This problem started occurring only after the surgery. Before this surgery, I never felt this issue or apply water like this.

    I feel the heat starts from my abdominal most of the times and spreading down to my testicle, spermatic cord and groin areas. Later spread to chest and head. The condition get fixed when I apply the cool water near my testicle, abdominal, buttocks and groin.

    I feel the heat extremely internal to body and others(including urologists) are not able to feel the heat when they touch the areas outside while checking(other than mild heat).

    I am not sure what is this condition. Whether this is due to my Grade 3 Varicocele surgery where 10 valves are tied up(In usual cases it will be 4 to 7 if I am not wrong) and whether the blood is struggling to flow to the testicle after the surgery due to the reduced valves.

    Or whether it is due to any Infection(I feel no other issues other than the heat)?

    Or its due to my low Testostrene levels? (Because the number of times I apply the water is greatly reduces when I have good Testostrene levels after the surgery. But I had low Testostrene even before the surgery but no issues that time)

    Or is it due to any kidney or liver abnormalities(wonder how that is possible just from the surgery)?

    Or did this is due to any nerve damage during the Varicocele Surgery?

    I need to apply the water every 3 to 5 hours interval(I rush to toilet after I feel the heat starting from abdominal to testis and goes intolerable level). Even In office, I need to apply the water like this, otherwise I am unable to tolerate the heat. Sometimes in nights occasionally I woke up from sleep because of the feeling of the severe heat in these areas.

    I even fear to do long travels due to this condition since I need to apply water frequently.

    Sometimes I feel why did I do this varicocele surgery.

    I have consulted 3 urologist so far and all are done physical analysis of the areas mentioned and saying that nothing abnormal and this is my subjective feeling only. They haven’t taken any particular tests.

    Please , Please , Please don’t say once again its my subjective feeling. Because I was without this issue until my surgery. How come a subjective feeling can affect me this much? I was never do apply water before the surgery like this.

    kindly give me a suggestion what is this condition? what test i need to take? Since the urologists just saying its subjective feeling and stop with just physical checks, I am confused what to do and continuing with this cold water approach for my problem.

    I am 30 years old male with no health issues other than infertility. I am a successful Engineer in Information Technology.

    WAITING FOR YOUR KIND REPLY.

    Thanks and Regards,
    Moorthy

    Reply
    • Paul Turek, MD

      Dear Moorthy, Do not worry. Lots has happened: infertility, wife’s UTI, varicocele surgery, smoking cessation. You are not on fire, and things will not get worse…only better. Have trust!

      Reply
  70. Steve

    Hi,

    I have a doubt reg the Y Chromosome Microdeletion. I have AZFb+AZFc deletion along with low hormone and maturation arrest.

    1. Any Azoospermia study you take, where 40-60% of cases have the same clinical condition as I have(Maturation arrest, Low Hormone and Azoospermia) but they are without YCM and normal Karyotype with no other abnormalities. So what is the root cause for them?

    2. Some occasional cases of AZFb+AZFc YCM, the patients have normal sperm production and few cases are Oligospermic . So how could this be possible since AZFb+AZFc deletion means no sperm(not even one) as the medical world believes.

    Thanks.

    Reply
  71. Steve

    Hi,

    I have a doubt reg the Y Chromosome Microdeletion. I have AZFb+AZFc deletion along with low hormone and maturation arrest.

    1. Any Azoospermia study you take, where 40-60% of cases have the same clinical condition as I have(Maturation arrest, Low Hormone and Azoospermia) but they are without YCM and normal Karyotype with no other abnormalities. So what is the root cause for them?

    2. Some occasional cases of AZFb+AZFc YCM, the patients have normal sperm production and few cases are Oligospermic . So how could this be possible since AZFb+AZFc deletion means no sperm(not even one) as the medical world believes.

    Thanks.

    Reply
    • Paul Turek, MD

      Steve, Good points.
      1. In the world of fertility genetics, there are probably 1000 genes that control sperm production. We have clear knowledge of maybe 25-20. My view is that many of these currently “unexplained” cases will be genetic.

      2. Good observation. One critically important thing to consider is the quality of the genetic testing. Not all labs are equal; some cut corners to save time and money. With Y chromosome genetics, they may use too few STS markers to adequately call a spade a spade. Many cases of “complete” AZF deletions are actually partial when you look more closely, and men with “partial” deletions may very well have sperm.

      Reply
  72. Krishna

    What we got for male Infertility? Europe nears first approval for gene therapy
    ———————————————————————————————————
    treatment?
    ——————-

    Dear Turek,

    I have seen the first gene therapy approval soon coming out of Europe for a fat gene treatment and I believe you are aware of it. Links for this news given below:

    http://www.nature.com/news/europe-nears-first-approval-for-gene-therapy-1.11048

    http://www.reuters.com/article/2012/07/20/us-genetherapy-europe-idUSBRE86J0M820120720

    I understand gene therapy is tough and gene therapy is prevented in USA due to a girl death by gene therapy before.

    But the current Europe gene therapy approval proposal giving me some light and I wonder why the same is not even tried in YCM AZF deletions? I am saying it because there are 0 clinical trials in world for YCM patients (proof: USA government clinical trial website : http://clinicaltrials.gov/ ).

    Instead of doing very less promising procedure(mTese , ICSI, FNA mapping etc etc) for these YCM Deletion candidates, why not the medical world concentrating on a high promising technologies like Gene Therapy for these growing number of YCM candidates(atleast for AZF deletions)? If YCM candidates are successful through gene therapy then I believe most tough cases of infertility due to genetic origin in both male and female can all get most benefit.

    I would like to know your thoughts on this since you are one of the major player in field of Infertility.

    Regards,
    Krishna.

    Reply
    • Paul Turek, MD

      Krishna, You raise good points. The US FDA is “gun shy” about gene therapy. It is even more gun shy about “germ line gene therapy” which means altering a subject’s genome not only to cure him but also to cure future generations. This is a highly political situation that may make sense for male fertility (e.g. missing Y chromosome genes) but it is not clear where the line is drawn. For example, do we select for an enhance intelligence, looks, height and sex?

      As we speak, we are working hard trying to create human sperm from embryonic and adult stem cells and testicular stem cells. I think that this is the solution of which you speak. Using adult stem cells, say from a skin biopsy, to make sperm would need to be safe but would not be all that political (no embryos used, no germ line gene therapy). Stay hopeful.

      Reply
  73. Krishna

    Dear Turek,

    Thank you for all your help.
    May I know what are all the parameters can be identified other than finding sperm in FNA mapping?

    For example :
    1. Early maturation arrest at Primary spermatocyte.
    2. Late maturation arrest at Spermatid level
    3. Pre-dominant Setroli cells with Early maturation arrest at Primary spermatocyte
    4. Basement membrane thickened(which is usually identified through Testicular Biospy)

    Can we identify such findings as above?

    I am planning to do FNA mapping in your clinic by next year February. Just want to widen my knowledge about this procedure.

    Reply
  74. Krish

    Dear Turek,

    Thank you for all your help.
    May I know what are all the parameters can be identified other than finding sperm in FNA mapping?

    For example :
    1. Early maturation arrest at Primary spermatocyte.
    2. Late maturation arrest at Spermatid level
    3. Pre-dominant Setroli cells with Early maturation arrest at Primary spermatocyte
    4. Basement membrane thickened(which is usually identified through Testicular Biospy)

    Can we identify such findings as above?

    I am planning to do FNA mapping in your clinic by next year February. Just want to widen my knowledge about this procedure.

    Reply
    • Paul Turek, MD

      Krish, FNA mapping can identify all germ cell stages up to and including sperm. This makes it more precise than either a simple testis biopsy or microdissection TESE and, in fact, gives it alot of its power as a diagnostic tool. To answer your question, it can identify #1-3 above. We have also found cancers with this technique, before they become visible on ultrasound or palpable by hand. It currently does not identify basement membrance thickening.

      Reply
  75. shivendra

    dear doctor i am from India

    I went for semen analysis last week, here is the report details
    Testorane,LH,TSH,are normal

    PHYSICAL EXAMINATION
    ———————————–
    Volume = 3.0 mL
    Liquefaction Time = 30 mins
    Viscosity = normal

    CHEMICAL REACTION
    ——————————-
    Reaction = Alkaline
    Fructose = Present

    MICROSCOPIC EXAMINATION:
    ——————————————
    Sperm count = No Sperms on first 3time but on last <5millions/ml

    OTHER MICROSCOPIC FINDINGS
    ————————————————
    Pus Cells = 1-3/hpf
    RBC’s = Nil
    Epithelial Cells = Nil
    Sperm Aggregation = Nil
    and i have also done ultrasound of testis no any block seen
    and went FNSA it shows" Occasional sperm seen" .after doctor give me medicine for increase sperm and after 2 months go for IVF ICSI
    now i am totally confused that if i have no blockage and sperm in testis than why they called me for ICSI. please give me right advise what to do and what are the possibility

    Reply
  76. Krish

    Thanks very much Turek. It’s great.
    Really proud of seeing your expertise in field of male infertility.

    1. May I know at what stage the artificial testicle project is in?
    2. Do you have any rough timeline until how long it will take to come in clinical practise?
    3. I heard from few countries (one among is Portugal) that the researchers succeed in IVS and successfully produced human child’s through In-Vitro Spermatogenesis using Spermatogonia Stem Cells from human testis. Per your knowledge is that true? If you wish I can provide you the web link for these research papers.

    Thanks & Regards,
    Krishna

    Reply
    • Paul Turek, MD

      Krishna, many groups around the world are trying to make sperm in a dish. As far as I can tell, none have published success at this in reliable, peer-reviewed journals as yet, despite claims to have done so. Not sure when this will happen or when it will be ready for prime time. Stem cell research takes money, patience and time.

      Reply
  77. Brian B.

    I am a 15 year cancer survivor and I have had a semen analysis where volume was 2.0 and sperm count was 0. I have read your article The Quiet After the The Storm of Cancer, http://theturekclinic.com/the-quiet-after-the-the-storm-of-cancer/. After reading this article this gives us hope about having a child. I had chemotherapy and not radiation. I was 15 years old while going thur cancer and I am now 31. Do you think this is azoospermia? I plan to get further testing to determine the problem. I have briefly researched the mapping procedure. Do you think it might be a blockage? We would like to come and see you, however, we are across the country in KY. Should I see a urologist or endrocronologist? Any recommendations for specialist in KY? Thinking that I might never be a father biologically is very troubling to us. We want to do all of the right things to know for sure….

    Reply
    • Paul Turek, MD

      Brian, Many questions and hopefully many answers down the line. It appears that you do have azoospermia. THe FSH level will tell us whether it is likely to be obstructive (<8 mIU/mL) vs nonobstructive (>8 mIU/mL). For sure, see a urologist. With FNA mapping, understand that we routinely find sperm in cancer survivors! And, Kentucky is not that far for a 1/2 visit day visit to sunny SF. Spend the weekend seeing the GG bridge, Saucilito and Alcatraz!

      Reply
  78. Brian B.

    Thanks for your comment and much needed information. It does give us hope.

    I was seen today by my primary care physician and had a discussion about this issue. He did not know of any medical centers and physicians that perform the FNA mapping….Still searching for one that would be a little closer home for us….Who know’s we might end up in your office later down the road??? Thanks again.

    Reply
    • Paul Turek, MD

      Krish, this work confirms earlier work that my colleagues at Stanford published in 2010 or so. These new findings come from a good group that is doing good work. However, their findings are similar to what’s been published before: you can take embryonic stem cells and adult stem cells and only push them so far down the germ line sequence of 13 stages in a dish. They go about half way and stop. It appears that a more “natural” environment is needed to go the distance and to make a sperm. We are hoping that our artificial testicle is just that place.

      Reply
  79. Eric

    Dr Turek,
    I discovered that I was azoospermia 7 years ago when I performed my own Semen Analysis because I am laboratory technologist. I had low sperm count (<2ml), and no sperm in micriscopic examination. Normal FSH and LH. Normal testiscular biopy with normal sperm production. I knew then, it was brokage, but I didnt know there was a microsurgery surgery to correct the dfficiency. My wife agreed to IVF with my own sperm, where the fertility doctor use a needle to extract sperm from my testicles to fertilized my wife egg. We have two girls now, a 4 yr old and 1.6 yrs from the same frozen embryo. We will prefer to have another child, hopefully a boy, but there is no more embryo, and my wife do not want to go through the medication and injection anymore. Besides, the procedure is expensive. My question is, how much does the micro-surgery cost to remove the brokage which is definately, the solution to my problem. Thank you.

    Reply
  80. hoefullady

    dear dr.Turek
    my husband was diagnosed 3 months ago with azoospermia after doing three semen anaylsis and all came back zero !
    his hormones came back all normal, ultrasound normal. genetic test came back normal as well.
    he recently have done diagnostic single biopsy, and there werent any sperm found,
    my question is where to go next , we are confused and shocked.
    is he diagnosed with maturation arrest and could it be treated.

    Reply
    • Paul Turek, MD

      Dear Hopeful, sounds like he has nonobstructive azoospermia. Yes, despite the 3 semen samples showing no sperm and despite the single biopsy showing no sperm, there is still a chance that he has sperm that can be used for kids. You will need to consider visiting a center that specializes in this. FNA mapping and microdissection TESE are two possible approaches, but very unique and different that can find sperm. I would love to help. Consider setting up a free talk with me about your case: http://theturekclinic.com/urologist-beverly-hills-los-angeles-san-francisco-california-contact/

      Reply
      • hopefullady

        dear Dr,
        thank you for your help:), we are waiting for the result of the diagnostic biopsy. could you refer us to any medical center in europe or middle east region. since going to the usa is a little bit difficulte.

        aslo from your own experience what is the chance for us to find a health sperm considering he have normal horomnes, normal ultra sound, normal karyotype test.
        also in your opinion what is the most cost effective procedure is it micro tese or fna mapping

        looking forward for your reply and thanks alot :)

        Reply
        • Paul Turek, MD

          Hopeful, hard to answer the question without knowing the details. FNA mapping is diagnostic and minimally invasive and very informative (60-65% chance of finding sperm). A targeted sperm retrieval is needed with IVF-ICSI afterwards which is usually also a minimally invasive procedure. It is a “know before you go” procedure. mTESE is therapeutic but is also much more invasive, with a similar detection rate.

          Reply
  81. hopeful

    dear Dr. Turek

    it is hopeful again :)
    thank you so much for answering my questions, i was wondering is there any chance to improve maturation arrest by medication or hormones therapy, and in what level.

    thank you so much

    Reply
  82. Kris

    Hi Doctor,

    I really appreciate you for educating patients like me suffering from azoospermia.

    My blood test results are as follows:

    a) FSH 3.7 mIU/mL (normal)
    b) LH 1.3 (lower than normal)
    c) Prolactin 2.7 (normal)
    d) Total Testosterone 151 (lower than normal)

    My last few semen analysis results showed azoospermic and normal volume, pH=6.8

    I had biopsy 3 years back in India but the it was not done properly meaning the tissue that was cut was bigger. I had to rest for 2 weeks. Lab technicians were not experts in testicular biopsy. Results showed spermotids (no spermatozoa). Few sertoli cells and leydig cells were also seen.

    Now I am back to US.

    a) Is it obstructive or non-obstructive?
    b) My doctor prescribed tamoxifen for low T. Is there any hope of normal spermtogenesis? What is the probablity that sperms will be seen in the ejaculate?

    Thanks a lot for publishing useful info.

    Regards
    Kris

    Reply
    • Paul Turek, MD

      Kris, no one can tell you exactly what your story is over the internet. However, a professional reading of the biopsy slides would be VERY informative. We do this as part of care here at TTC. My slogan is: Where there are spermatids (your word: spermatoids?) there are usually sperm.” Consider sending the biopsy slides (not the report) to us for review. Assuming sperm were not seen on the biopsy, and the biopsy was done properly (a question here) then by definition you are not obstructed. Whether you have any sperm, enough to have a child, is a different issue that needs more investigation. Be happy to help http://theturekclinic.com/urologist-beverly-hills-los-angeles-san-francisco-california-contact/

      Reply
  83. Karrisa

    Dear Dr. Turek:
    My husband was diagnosed to be non-obstructive azospermic in 2009, he completed a TESE procedure which some sperm was found, we also complete ICSI-IVF after successful ferterlization we now have a 2 year old. we recently tried another session of the IVF-ICSI with my husband repeating the TESE again but unfortunately we didn’t have as much luck. no sperm was found. why we ask? his physician could not explain to us. He also used Clomid and Arimidex before undergoing the recent TESE (same as the 1st time). He is now put on HCG injection once a week to help improve the sperm count. is this the right move. recent testesterone level was in the 600 which was higher in April before using clomid and arimidex. is there any hope for us? do you think we should undergo another TESE procedure for the 3rd time?

    Reply
    • Paul Turek, MD

      Karrisa, All good questions! Generally when a TESE sperm retrieval works once, it works again. But this depends on lots of issues. As one of my goals with such procedures is to get enough sperm for several IVF-ICSI cycles with a single sperm retrieval, I assume that this is not the case here.

      If the first TESE was actually a “microdissection TESE” then there may not be any more sperm left in the testicle, as this is a pretty invasive and excavating procedure. If it was a simple testis biopsy TESE, then it may be because sperm production within the testis is occurring in “pockets” and they are hard to find with randomly taken biopsies typical of TESE procedures.

      I find FNA mapping particularly useful here. Through this relatively simple and non-invasive procedure, I can learn whether and where there might be pockets of testis sperm available for another TESE. Overall, we have over a 95% chance of finding sperm by TESA/TESE after FNA Mapping shows where it is in the testicle. That makes couples more comfortable proceeding with IVF-ICSI and fresh sperm retrieval, knowing that there is an excellent chance that sperm will be found.

      Reply
  84. Azoo

    Dear Dr. Turek

    I was diagnosed with azoospermia after semen analyses and blood test. Fsh was 13.8 and lh was normal. Physical exam was normal. Testosterone was low. The doctor put me in clomid and vitamins aafter one year of treatment on clomid
    got blood test done and seman analysis still no sperm. But t/e ratio was low. He put me on arimidex. All genetic testing was normal. In your experience with patients. What do you think my chances are with the new medication. I take both clomid and arimidex, thank you

    Reply
      • Azoo

        Thank you for your response Dr. Turek. I will definitely consider this. Is this available in NY? Also what are my chances with FNA mapping considering my situation. And according to your research, is low t:e ratio curable? Have you treated patients with this situation and what were the outcomes? I would appreciate your help. Thank you

        Reply
  85. E.A.

    Dr. Turek,
    My husband was diagnosed with NOA a year and a half ago and was told he had a predominant Sertoli cell only pattern when they did a testis biopsy. The doctor put him on Clomid but said he didn’t really expect to see any improvement. However, after taking it for 4-5 months our SA showed sperm! We were thrilled, but the numbers are very, very low. One SA showed 52 sperm (half of them motile) and a second SA showed 20 sperm (13 motile, 7 not). My question for you is, is it possible to do IVF/ICSI with such a low number of sperm in the ejaculate? Or would we need to do some kind of sperm retrieval technique (PESA, MESA, TESE) for better success? The fact that he has any sperm at all making it into his ejaculate would mean that he is producing quite a few sperm, correct? I am hoping we would be able to retrieve sperm from the vas deferens or the epididymis rather than directly from the testis, as these would be less invasive.

    Reply
    • Paul Turek, MD

      Dear EA, Congratulations! This is called cryptozoospermia, where small numbers of usable (motile) ejaculated sperm are found in the semen that is otherwise devoid of them. Goes to show you that a single testis biopsy, showing any pattern whatsoever, does not represent what is happening elsewhere in that same testicle or the other one.

      We recently presented our findings from 40 such men over the last 2 years in our practice at the national fertility meetings (ASRM) in San Diego in October. Basically, we found that 85% of men were able to move forward with IVF-ICSI using only ejaculated sperm (fresh or banked) and 15% needed “backup” procedures to get enough sperm. Normal fertilization rates were easily 60% and ongoing clinical pregnancy rates were 46% with female partners averaging over 35 years of age. THIS SPERM WORKS! So, I would: 1) bank samples until the IVF lab has enough to go forward without a sperm retrieval procedure (this might be hard as many labs don’t handle such low numbers of sperm), 2) realize that sperm retrieval procedures with this condition can be VERY difficult (easily involving the heavily invasive microdissection technique) and have a high chance of failing as that tiny island producing small numbers of sperm may be hard to find.

      Reply
      • E.A.

        Thank you for taking the time to respond to my question! Your reply has given my husband and I some hope regarding our chances of having our own biological child. We are very excited that he has any sperm at all, but recently got discouraged when we visited an IVF clinic where the doctor told us he didn’t feel confident using such low numbers of sperm to do IVF/ICSI. He said we needed to get our numbers up to somewhere in the hundreds before he would consider helping us. We left the clinic feeling like we were back at square one. Based on what you have told me, it sounds like we need to find a clinic willing to work with our extreme situation and help us bank what little sperm we have. We are in the East Tennessee area.

        Reply
  86. Kristy

    Dr. Tureck,
    My husband & I have been TTC for over a year. He had surgery for a hernia repair & left testical removal (due to deformity) when he was 2 years old. After being unsuccessful in conceiving, we went for 2 seperate semen analysises. First SA was 1.0 mL with 0 sperm. Second SA was 0.8mL and 0 sperm. Further testing revealed Prolactin 10.3 ng/ml, LH 5.2 miu/ml, FSH 7.6 miu/ml, testosterone 397.40 ng/slow. His seminal fructose was positive. We had a prostate ultrasound, and his urologist said everything was normal. He said from bloodwork to ultrasound it was all normal, just low volume and no sperm. He stated we would need some sort of IVF or insemination to become pregnant but offered no explaination as to why azoospermia. It seems to me that he just wanted to wash his hands of us. We have an appointment with a Floridia fertility clinic, but I am terrified they will say he has no sperm to use, or use up all of our money doing more random testing. We have limited funds and no health insurance, so we don’t want to waste time and money for further heartbreak, but are completely lost.
    Could his condition be a result of his hernia? Testical removal? Blockage? Is it even possible for him to father a child naturally or through IVF?
    Please help point us in right direction.
    Thank you so much.

    Reply
    • Paul Turek, MD

      Kristy, the facts of the case are that he has one testicle (small or normal size?), relatively normal reproductive hormones (although that FSH is slightly at the high end of normal, which is 8) and low ejaculate volume. Here are some other facts:
      1. Men with one testicle are generally as fertile as men with two.
      2. Having a hernia repair or a testicle removed does not cause a low ejaculate volume

      So, it is not clear whether he is blocked or not at this point. By having fructose in the ejaculate and a normal prostate ultrasound (if well performed) then ejaculatory duct obstruction is unlikely.

      Best bet is to determine whether sperm production is normal or not. My choice for this (least invasive and damaging, most informative) is FNA mapping (http://theturekclinic.com/services/male-fertility/sperm-mapping/). Hope this helps.

      Reply
  87. LaShawn

    My husband and I have visited your clinic in San Francisco almost 2yrs ago. You explained to us that my husband has azoospermia and that sperm mapping was the way to go. Also that my husband was suffering from malnourishment. We have recently discovered that he has an intolerance to gluten. He is feeling better and vitamin levels are rising. Do you think that Gluten can be the cause of his azoospermia??? Fingers crossed!!!

    Reply
    • Paul Turek, MD

      La Shawn, Interesting! I would say that any disease that “starves” the body will sacrifice infertility…it’s one of the first things to go in a stressed body. Whether this stress is severe enough to cause the sperm count to go to zero is another matter. Less likely but possible. He should check his sperm count again.

      Reply
  88. TTC

    Hi Doctor Turek,

    My husband is azoospermic with a y-chromosome microdeletion (AZF B+C). His hormonal test results are normal & he’s fit & healthy. As expected, no sperm were found during a biopsy (the surgeon said he “had a good look around” in both testicles, but it was a standard biopsy, not micro) … the lab analysis was SCO.

    My question is, has sperm *ever* been found in men with AZF B+C deletions via FNA mapping (& if so was it then able to be retrieved, & suitable for IVF/ICSI)? We are trying to decide whether it’s worth making the (international) journey to your clinic or if we’d just be wasting our time/money/emotional energy! All the research points to the latter, but as you’ve mentioned, so (relatively) few cases have been closely examined.

    Unfortunately for us (I’m in my mid-late 30s) any success from your wonderful work with the artificial testicle will probably be a few years too late :-(

    Kind regards,
    TTC.

    Reply
    • Paul Turek, MD

      TTC, I have found sperm on mapping in men with complete AZFc deletions (as have many others) and in men with partial AZFb-c deletions. The “partial” really applies to the AZFb deletion part of this as finding sperm in a man with a complete AZFb deletion is highly unusual. Regarding the artificial testicle and its time to clinical use, you could consider freezing your eggs (not embryos) now for use later….

      Reply
  89. Jacek Olszewski

    Dear Dr Turek,

    I’m 38 years old. I’m azospermic and live in Poland. FSH 30 mlU/ml, LH 12 mlU/ml, Testosteron 3 ng/ml. Genetic ok. I am preparing for microTESE in Poland. In this reason I have a question. Will microTESE damage my testis and I will have to take testosteron to the end of my life?

    Kind regards
    JO

    Reply
    • Paul Turek, MD

      JO, You certainly need to talk to your doctor about the chances that your planned procedure will affect your testosterone balance, either temporarily or permanently.

      Reply
  90. Sandra

    Hi dr. Turek,

    I’m Sandra, from Indonesia. My husband had an Obstructive Azoospermia. All the hormones are in a normal range. Testiscular USG done, and the result were Varicocele grade-III at the left testicle, and grade-I at the right testicle. Also had a Spermatocele on the left testicle. The Urologyst examine my husband, and my husband revealed to have a gonorrhea in 10 years ago (according to my DH, said that it’s been cured). In Jan2012 my husband got varicocele operation along with tese biopsy. The result were 3 straws of sperms (don’t know the exact numbers of sperm), it were all immotile before washed, but then it were motile. It were all frozen till September2012. We had IVF with ICSI methods. I got 12 follicle, 12 are mature (all are contained with oocyte), after ICSI, only 3 embryos come as the result. 1 is poor grade, 1 is moderate, and one is good. The poor and good are 6 cells, and the Good are in 8 cells.

    So, dr Turek. i would like to ask your opinion. What would be the case of our failure IVF Program? How to increase my husband sperm?

    Thanks for your time :)

    Last September 2012 we got IVF with ICSI method.

    Reply
    • Paul Turek, MD

      Sandra, this is certainly a complex case. If your husband is truly “obstructed” then the sperm should really be fine for IVF-ICSI and they should not be the cause of either poor fertilization or poor development of embryos. I would suggest that female factors or laboratory issues be examined for risk of poor quality embryos. Regarding ways to improve his sperm counts, that gets complicated…no simple answers. But, consider a Second Opinion if you want (http://theturekclinic.com/services/get-a-second-opinion/).

      Reply
    • Paul Turek, MD

      Sandra. They use the same tool (fine needles to aspirate) but FNA mapping is done on the testicle and PESA is done on the epididymis. Testis FNA will not block the system upon healing but PESA can block the subsequent flow of sperm out of the epididymis, and possibly in an irreversible way. In other words, sticking needles in the epididymis can lead to a irreversible blockage in the reproductive tract that may not be reconstructable with microsurgery. Consider having such procedures done only on one side…

      Reply
  91. Jacek Olszewski

    Dear DR Turek,

    Thank you so much for replying. But taking into consideration your experience can microTESE lower the testoseron level since it is invasive procedure as you mentioned in your blog?

    Reply
  92. Karl

    Dr. Turek, I am a 28 year old male diagnosed with azoospermia. After doing a testcular biopsy (microTESE) no sperm were found, and I was diagnosed with sertoli-cell only syndrome. The doctor gave me a 0% chance of becoming a biological father. He said I was born without sperm and won’t ever have sperm. What’s your take on this? Do I have a chance at all with sertoli cell only syndrome?

    Reply
  93. Jacek Olszewski

    Dear Dr Turek,

    I have one more question. I decided to take microTESE in Poland. My urologist suggested put off the surgery and presrcribed Tamoxifen and Undestor Testocaps to lower my high FSH 30 ng/ml and rise Testosteron 2,6 ng/ml. What do you think about this procedure? Regards
    Jacek Olszewski

    Reply
    • Paul Turek, MD

      Jacek, I get the idea of giving tamoxifen to improve testosterone balance before looking for sperm in the testis, but am totally unclear about the rationale for “undestor testocaps” for same. Lowering FSH has not been shown to improve sperm production in men with high FSH. Get a good explanation and maybe some literature on this approach!

      Reply
      • Jacek Olszewski

        Dear Dr. Turek,

        Thank you so much for your help. I got back to my urologist with your feedback and he maintains that combination of Tamoxifen and Undestor may improve quality and number of sperm. I don’t know what to do now. I wish to make mTESE or mapping in your clinic but its far i.e. 20 hours by plane from Poland… Distance is only one obstacle.

        Kind regards
        Jacek

        Reply
  94. james

    Dear Dr Turek, Harmone Test was done this month
    FSH = 6.56miu/ml
    testosterone = 2.3ng/ml
    estradiol = 53.05pg/ml

    I am non obstructive azoospermic since last year and half. Doc has prescribed tamoxifen citrate 10 mg daily . Is it possible to find sperm in my testis during ICSI after 2 months of treatment.

    Reply
    • Paul Turek, MD

      James, Tamoxifen will raise your testosterone level which could help optimize sperm production. However, it can also raise your estradiol level which might impair sperm production. The way to know is to check the T/E ratio 4 weeks after starting the pill. Generally, it is advised to give medical therapy for at least a full cycle of sperm production, which is 3 months.

      Reply
  95. Damien

    Dear Dr. Turek

    I have non obstructive azoospermia for 3 years. My doctor said microdissection TESE is a proper surgery in my case. Taking into consideration my hormone resuults: FSH 31 mlU/ml, LH 12 mlU/ml, Testosterone 3 ng/ml he decided to implement medical treatment: Tamoxiffen 40 mg per day for 6 weeks. After 6 months my results are: FSH 46 mlU/ml, LH 19 mlU/ml, Testosterone 574 ng/dl. He said I had to stop medication now and wait maybe 4-6 weeks for surgery. Is it normal that all my hormones grew up significantly after medication therapy? Could it worse my situation?

    Reply
    • Paul Turek, MD

      Damien, On a very significant dose of tamoxifen, you have increased pituitary drive to the testicle and increased native testosterone production. Although commonly used to increase testosterone levels to “normal” prior to “looking” for sperm in the testicle, medical treatments like this are believed to “optimize” sperm production. However, good data to suggest that this actually happens is not available (i.e. no randomized trials). So, in fact, it is not clear whether it might worsen the situation.

      Generally, I maintain the treatment while “looking” for sperm with mTESE or FNA mapping and do not stop it before looking. Given that your baseline testosterone level is low to begin with and that you are not likely to be taking tamoxifen for the rest of your life, mTESE has a measurable risk of resulting in temporary or permanent hypogonadism, possibly leading to chronic testosterone replacement therapy. For this reason, you may want to consider a far less invasive, but also highly informative approach to finding pockets of testicular sperm: FNA mapping. Contact us it you want to talk further,

      Reply
  96. Damien

    Dear Dr Turek,

    Thank you for reply! Sorry I made the mistake in my post. I meant not 6 months but 6 weeks after medical treatment my hormons evaluated. Last Friday I stopped with medication. Should I wait now for FNA mapping or mTESE couple of weeks to normalize my hormones FSH, LH, Testosterone, since my FSH is very high right now 46 mlU/ml?

    Reply
  97. Malak

    Dear Dr.
    Im a 35 years old woman married to a 34 man with NOA since he was 26. He went through 2 FNA, one of them revealed 2 round spermatids that where used to fertilize 2 eggs of his ex wife but no pregnancy was achieved. They performed another 2 biposies with zero sperm or spermatids. All this in an arabic country.

    2 years later we got married and we have just perfome and icsi procedure with ROSI. His hormone levels has always been normal, no cromosome Y delation. They made a biopsy and they found that right testicul has no spermatids but round spermatids where found on the left one. They found 8 and used in Icsi with the result of 4 fertilized. 1 embrio was 8 cells, 1 6 cells, another of 5 cells, and a late fertilized one of 2 cells. all with fragmatation and where describe in the report as 2:3 quality. all this was done in Europe. They transfared the 3 better ones but today we got our negative beta result.

    my question is…is there any thing we can do? hormone therapy? mapping? I dont want my husbend to go under other procedure that can harm his hormone levels for life or make damage in his testis but our relgion dosent admit donation options. we have 12 oocytes frozen to be used if we find any solusion as my stimuation results on 20 mature oocytes.

    Reply
  98. Malak

    Dear Dr. Sorry to write again, just want to add that my husbend never took hormonal therapy, only vitamins and that the urologist of the last biopsy in europe sayed the testis are still ok and can support a new biopsy but i dont want a new procedure if the case is imposible.

    Reply
    • Paul Turek, MD

      Dear Malak, Wow, what a story! I see several facts here:
      1. ROSNI/ROSI are technologies that are not routinely performed in the U.S. as they are considered entirely experimental.
      2. If it is true that your husband has round spermatids on testis biopsy, then we have learned from FNA Mapping that in most of these cases where there are spermatids, there is also sperm.
      3. Many cases of late maturation arrest can be “pushed” to make mature sperm with aggressive management of overall health, fixing varicoceles and potentially giving medications. Might be worth a call to us.

      Reply
      • Malak

        Dear dr, than u for your asnswer, we wil contact u soon to discuss the possible trearments. just a questin, if there is no variciceles is it still posible that hormonal therapy makes a diffrerence? What % of patients with maturation arrest have succeed with this “pushing” treatment? Thank u so much.

        Reply
  99. Andrew

    i’m at the stage were I’ve just been told and ever since I haven’t been myself. my partner has had her checks and is fine thankfully….but I cant seem to get over this feeling, Ive no idea whats going to happen, Ive only had one sperm count of zip (0) and a examination by a ‘expert’ at a hospital and he said it was congenital as my testis’s are smallish… i hadn’t noticed, but never went round comparing.
    all I know is that I’m extremely down at the mo, family have tried to comfort me but…Im just not feeling it. there’s not many people to talk to it seems and writing on this site is hard, but i think I really do need some help and advice, but I’d really like some factual answers.

    Reply
  100. Nemanja

    Dear doctor Turek,
    I have azospermia…I was at biopsy before three weeks and now i wait final report.
    After biopsy doctor which performing biopsy in Slovenia told me that 3 biology seen multicells mooving parasite in my testicule tissue and after few days he told me that parasitologist didnt sucess to izolate parasite…
    Can parasite damage my spermatogenesis, what do you think?
    He told me that they didnt find sperm only imature cells but i will wait final report…
    about my hormons FSH is high =20, Lh= 8, testosteron= 9 and i have varicocele ( grade III) on my left testise…
    can tou wtire me your opinion please?

    Reply
    • Paul Turek, MD

      Nemanja, I have seen Trichomonas in sperm but have never seen a “parasite” in the testicle (just TB). Not sure about this. Regarding whether or not you have mature sperm, it really depends on how hard they looked. Be happy to give you a detailed Second Opinion if you so desire.

      Reply
  101. Nemanja

    Thank you very much for you answer,
    they telll me that day when i have biopsy that they suspect on parazite called shistozoma something like that. Can I send you my report when he comes on some e mail because i an planing to come to you to do FNA mappin very soon

    Reply
  102. CP

    Dear Dr Turek

    My husband’s first semen analysis came back as zero/azoospermic. He was sent for blood tests LH and Prog normal and FSH 12.1 which I understand is just within the normal range? Is this correct? Hvaing read some of the comments on your website I wanted to ask you if you thought his habit of having at least two hot baths a week for the last 3 years could be the cause of the zero sperm? Can it also contribute to the raised FSH? Thank you so much for your advice.

    Reply
    • CP

      I should add that I took the temperature from our hot water tap recently ( as when he bathes it is almost entirely from the hote water tap) and this showed a temp of 40 degrees

      Reply
      • Paul Turek, MD

        Remember, any temp above 35 degrees C would be too high for sperm production. Good investigative work! Let’s see what happens when he stops the baths! Keep me informed.

        Reply
    • Paul Turek, MD

      CP, YES, the baths could be the thing. In my published study of men in tubs, the dose, duration and frequency of baths that your husband has been taking would be considered “high.” We saw azoospermia in men with this dose of tubs. The elevated FSH is also possible. The answer will lie in stopping the baths (use showers instead) for 3-6 months and seeing what happens. After 6 mos, I would attribute the azoospermia to other causes.

      Reply
      • CP

        Dear Dr Turek

        Thank you for taking the time to respond to my post. I will certainly let you know the outcome in the next 3 -6 months. Fingers crossed….!

        Reply
      • CP

        Dear Dr Turek
        I wanted to update you. My husband has stopped the hot baths – this has been for almost 3 months now since he last took a hot bath. He had his blood test done again and the FSH was still ‘slightly elevated’ at 12.1 in your opinion is this hopelessly high – or would it indicate we still have a chance of finding sperm. He has yet to repeat his second sperm sample – he will do this in early October. We are hoping that with the fertility supplements and cool showers we will not have another zero result. I would be itnersted on your thoguhts regarding this second FSH result though… thank you so much as always

        Reply
        • CP

          Dear Dr Turek

          Further to my prvious post his FSH actually came back as 14.8 on the second blood test ( 12.1 The first time) The doctor said this was high and it coudl mean bad news for us. But I have read online that normal range is between 5-15? Which would mean he was still in a normal range. However I suppose given that his first semen sample was ZERO this is why the doctor has reacted this way. However we are still waiting for the second sperm test follownig 3 months of no hot baths. As his other hormone levels were normal – do you think he needs to be tested for normal chromoomes? Or would some of the other hormnes been out of kilter is this was a genetic reason why he does not produce sperm? Thank you for you thoughts… it is another month before we can see a sepcialist and it feel like a long time trying to know answers.

          Reply
          • CP

            Dear Dr Turek
            What do you think to the above? Could it still be hot baths and 3 months just wasn’t long enough for him to start producing sperm again? What are our chances?

            Please reply if you can – thank you so much

  103. rubens

    Dr. Im a azfc delections, i made two biopsis they found esperamtics. The dr. toldo me to go to IAD what is your opinion?

    Reply
    • Paul Turek, MD

      Rubens, 60-70% of azoospermic men with AZFc deletions will have sperm, but it depends on how hard you look. FNA mapping is better than two simple biopsies in this regard. Consider it before going to IAD (donor sperm insemination).

      Reply
    • Paul Turek, MD

      Rubens, I trained a fellow named Dr. Marcelo Cohen in Buenos Aires. Look him up and say hi to him for me!

      Reply
  104. rubens

    Excuse me, are yousure is that name, I cant find him in google

    Reply
  105. jomo

    Hi Dr. Turek,
    My husband had a sperm analysis and unfortunately resulted in azoospermia. He had blood work done & the results came back as follows: FSH=8.6, Testosterone=286, & all other hormone levels normal. In the same blood they ran the Y chromosome microdeletion and results came back positive for a deletion of AZFb, AZFc, and AZFd. We saw a urologist last week specializing in infertility and he said that my husband has Grade 2 & 3 varicoceles on each scrotum. He sent us to re-do the blood work. This made us hopeful since he said that his hormone levels didn’t show signs of infertility however, he said that the lab agency should have not reported the AZFd. Since I work in the medical field & have researched this if he has a microdeletion of the Y chromosome there will be no point in doing additional test or a micro Tese right? We would only have the varicocele repair for his comfort I am assuming. Please advise

    Reply
    • jomo

      Just to add we are awaiting the blood work he sent us to re-do. We had it done on Friday. The information I supplied is based on the first blood work we had done.

      Reply
    • Paul Turek, MD

      Wow, that’s pretty complicated. Regarding AZFd, many of us don’t believe it exists as a separate entity. What is absolutely KEY here is whether the AZFb-c deletion is complete and contiguous. If not, the chances of sperm are much higher than if it is. The FSH does not predict much of anything; it should definitely be below 8.0 to be called normal. To me, this FSH is elevated. The role of varicoceles here is much more complicated. We have published that it is not worth fixing them to IMPROVE NATURAL FERTILITY in the setting of genetically define infertility, but the data in men who are just interested in improving sperm production in the testis is much weaker.

      Despite a potentially bad prognosis with certain Y deletions, some couples want to pursue things further but not as invasively as a microTESE (with a baseline borderline T). In such cases, FNA mapping can be very informative and is much less invasive.

      Reply
  106. sara

    Hello, my husband got his results back and the chromosome was 46 which is normal and there were two other tests that were ok, one of which showed no microdeletion. All the tests were normal. Does he have non-obstructive azoospermia or obstructive? His semen sample was zero. He is also HIV positive, does this affect his fertility, in terms of the medication? He drinks alot and smokes too.
    His testicles are very small.
    I am trying to figure out what this all could mean? How could his hormones and chromosomes all be normal but there is no sperm? is it non obstructive or obstructive?

    Reply
    • Paul Turek, MD

      Being HIV anything should not affect sperm production unless he is physically ill from it (or taking testosterone replacement to prevent muscle wasting). Nonobstructive azoospermia can exist in men with normal hormonal profiles as the hormones don’t accurately reflect what is going on in the testicle.

      Reply
  107. sara

    …. pardon me again doctor, we live in the UK and the doctor told us that they would do surgery to see if there is sperm in the tubes and if not they would proceed further to see if there is any being produced at all. With the results of the tests being normal as mentioned above, what are they likely to find? Can you be in the normal range and be non obstructive? Does non obstructive mean you are just not producing? If so, how can your hormones and chromosomes be normal but one is not producing?

    Reply
    • Paul Turek, MD

      Sara, these are great questions for your doctor. Yes, you can have nonobstructive azoospermia with genetic tests that are negative, since we do not know the entire genetic universe of male fertility yet. It could be “genetically undefined” male infertility. Yes, you can have normal hormones and not be blocked due to a form of nonobstructive azoospermia termed “maturation arrest” or “meiotic arrest.” Microdissection TESE in such cases is quite difficult as all seminiferous tubules look the same to the operating surgeon and distinguishing those containing sperm vs no sperm is complex.

      Reply
  108. Ivana

    Hi doctor,i was wondering what are your statistics in sperm retrival in man with non obstructive azoospermia after chemo ?wath are the chances to find sperm with micro tese if all tests are normal including hormones?do you think that bilateral varicocele in these man must operate for better results?what are the chances to find sperm?thank you

    Reply
    • Paul Turek, MD

      Ivana, Many men with post-chemotherapy and azoospermia will have sperm. We have published that about 65% of men in general in this situation will have sperm. I have even found sperm in men after many, many cycles of chemotherapy and then bone marrow transplantation! I am not sure that fixing varicoceles after chemotherapy makes sense if there are no germ cells in the testicle to respond in the first place.

      Reply
      • Ivana

        Doctor,do you suggest to do diagnostic biopsy first to see if there are germ cells present and than to fix varicocele or to go direct for micro tese?is there any theraphy like clomid to take for better results?please advice us what to do next

        Reply
  109. abraham

    i am 43 years old and before one year my semen count was 210 million per ml and after one year it became 2 million is this will happen , why or test will be credible, other two time it was 210,230 millionper mi

    Reply
    • Paul Turek, MD

      Abraham, sperm counts can vary widely, even among normal individuals. If this difference in sperm counts persists over time, I would highly recommend a thorough evaluation with a history, physical exam, medication and medical history and look closely for some explanation, some change in health.

      Reply
  110. Nas

    Hi Dr aturek,

    Its Nas, you may remember i had a fna mapping a year or so ago. I am looking to do another micro tese and wanted to ask, the fna mapping how much of a percentage is the testis explored for sperm. Are all the sites covered all only a selection?

    I have been on clomid and preg injections. I have noticed a change in my testes size.
    I will keep you updated on my development.

    Reply
    • Paul Turek, MD

      Nas, good to hear from you. Great question! The total area of testicle that is sampled after FNA mapping is unclear. But, since the sample size is high, my gut after over 1200 cases is that it fairly accurately represents what is going on in the testicle. You can ask the same question of microdissection as typically 100% of the testis is not sampled through this technique either.

      Reply
  111. Damien

    Dear Dr. Turek,

    I suffer from azoospermia (FSH 33 mlU/ml, LH 10 mlU/ml, testostreone 3,5 ng/ml). I had the phone consultation with you as well as wrote hier in April. I got microTESE in Poland three months ago.

    Result – 90% of tubules are SCO, the rest that keeping spermatogenesis consist of just few round and elongated spermatids. No mature sperm were found.

    I have a question. Does it make any sense to proceed with one more microTESE? Do I still have chances or they are rather low? I would like to add that prior to microTESE I had taken 6 weeks medication Tamoxifen + Undestor Testocaps + Agapurin which rised my Testosterone, FSH and LH, than I stopped with taking medication for 2 months to normalize my hormones.

    Reply
    • Paul Turek, MD

      Damian, that is unfortunate. However, with FNA mapping, I have found that where there are spermatids, there are usually sperm nearby. The problem with mTESE is two fold: 1) testis tubules with late maturation arrest (spermatids present but no sperm) look the same as normal tubules so the surgeon cannot distinguish the two during the mTESE procedure, and 2) the lab that gets the tissue can really only tell you if there is mature sperm or not, as finding earlier germ cells is quite unreliable.

      If these are really your findings, you might consider 1) waiting 6 mos before another procedure 2) stop the testosterone and other supplements 3) consider FNA mapping instead of another mTESE as the latter, if repeated enough, poses serious risk to your testosterone levels for life.

      Reply
      • Damien

        Dear Dr. Turek

        Many thanks for your detailed explanation. During microTESE I had 3 cuts per testicle (top, middle, bottom). From each cut the doctor collected two the best looking samples. So I understand it is also a type of mapping and the number of samples should be representative?? All the samples were very precisely searched and no mature sperm were found!

        What do you suggest in my case. Where can I take the new procedure and how to link it with ICSI since I live in Europe? Do you also use Tamoxifen prior to sprem extraction as I had recently?

        Reply
    • Paul Turek, MD

      Raj, begin to read and get educated about what is possible. Although you may not be able to have ejaculated sperm in your life, you may still be able to have kids. Read more about azoospermia.

      Reply
    • Paul Turek, MD

      Raj, since many cases of azoospermia are genetic in nature, there is often not much to do “naturally” to fix it. However, there are “correctable” causes of azoospermia (blockage, ejaculatory duct obstruction, Kallman syndrome) and these can certainly be pursued. A visit with a male reproductive specialist should be able to identify the correctable causes of azoospermia.

      Reply
  112. Shilpa

    Hi Doctor,
    I think my previous post was on a wrong thread and hence it was removed. Hoping to get some response here.

    My husband got his semen analysis done earlier this month and the result was Azoospermic.
    His FSH is high at 24 and Inhibin is very low around 8.
    Our Andriologist suggested a Micro TESE done. No sperms were retrieved even after centrifuge method was performed. The final TESE reports are sent for the lab and we are waiting for them.
    My husband has had a testicular surgery done at the age of 14 for an undescended testicle. We assume that right now, only one testis is functioning as expected.
    At this junction, doc do you think we still stand a chance? Could a FNA mapping help?
    Please help! Totally clueless and waiting to hear from you.

    Regards,
    Shilpa

    Reply
  113. A.ali

    Dear dr. Turek,
    I have already made 2x tese op. With the diagnosis Sertoli-cell only Syndrome. Now we still try to stimulate, with Brevactid 1500iE 2x a week. Do you have any experiences with the therapy? Or do you know a better therapy for this Diagnose?
    I Look forward to your response.
    Sincerely A.Ali

    Reply
    • Paul Turek, MD

      Dear A.ali, Brevactid is the same as human chorionic gonadotropin (hCG). It is the molecule LH that stimulates the testicle to make testosterone. It can be used for medical treatment of male infertility but works best in hypogonadotrophic hypogonadism to help men with this condition make ejaculated sperm. In the case of biopsy proven (is your case biopsy proven?) Sertoli cell only syndrome, in which testicular stem cells are not present to stimulate in the first place, this therapy might boost your testosterone levels but is unlikely to help you generate sperm. It is considered “empirical” therapy for your condition. There may be no better therapy than looker harder with FNA Mapping or waiting for stem cell technologies to improve (=years).

      Reply
  114. Mrs C

    My husband had mtese done in New York with Dr Schelgel. Unfortunately no sperm was found and we were told my husband does not have the cells at all that produce sperm. We were told this was just down to genetics and there is no hope for us ever having our own child. Is there any point trying the mapping with that diagnosis??

    Reply
    • Paul Turek, MD

      Mrs C. I have done FNA Mapping on several of Dr. Schlegel’s failed mTESE procedures and have not found sperm. The number is low. With maturation arrest pathology, the chances are higher as mTESE does not offer much benefit over simple TESE.

      Reply
      • Mrs C

        Could any medication be used to help my huband and then try FNA mapping or repeat mtese? I dont want to give up on the hope of us having children.

        Reply
  115. Sarah

    Hello Dr Turek,
    My husband has a child from a previous relationship. However when we went for fertility tests (i have pocs and endometriosis) he was diagnosed with azoospermia?? Is this possible and what could have caused this?? If you can please provide any information I would greatly appreciate your help. We have been struggling to find answers.
    Many thanks

    Reply
    • Paul Turek, MD

      Sarah, I am sorry about your struggle. The fact that your husband has children in the past just means that he had sperm in the ejaculate; it does not necessarily mean that his sperm count was normal. Conception can occur with low sperm counts as well. Alternatively, he may have incurred a blockage of some sort. Be happy to help. Contact us!

      Reply
      • Sarah

        Many thanks for your response. I am convinced that my husband does have a blockage. He does get a swelling come up and pain in his testicle he had ultrasound scan and Dr’s confirmed small blockages but we’re unhelpful as to removing them. Can you recommend anyone in the UK that could help? We are also considering going to Poland for TESE and IVF as the costs in the UK are too high! Many thanks

        Reply
        • Ralph

          Hi Sarah,

          I am from Poland and have azoospermia. Which clinic are you following in Poland for mTESE?

          Reply
  116. TD

    Hi Dr Turek,
    My husband was recently diagnosed with Sertoli Cell Only Syndrome. His fsh was slightly elevated (around 17-18), genetic testing all normal and no deletions on the Y chromosome. He also has a varicocele on both sides. What are the chances of finding sperm through FNA mapping?
    Thanks

    Reply
    • Paul Turek, MD

      Dear TD, it’s hard to say. It depends alot on how many biopsies were examined to make the diagnosis of Sertoli cell Only Syndrome. The more you sample the more you find. The question is doing it safely. With a single testis biopsy, I would suggest that there is a 30-40% chance (conservatively) of finding sperm with an extended FNA mapping procedure with 18 sites/testis.

      Reply
  117. Nabi

    Hi Doctor Turek

    I was dianosed with Azoospermia 2 years ago and needed your expert advise on my present condition

    Did my first SA in Jan 2012. Semen Volume was 1 ml with normal PH. Zero Sperm Count. Second SA a week later also showed same result. Testosterone Total was very low. Inhibin-B was also way low. My Free Test and Bio Avail Test was in range though and SHBG was less than normal. FSH -> 8.86, LH -> 7.45, Testosterone (T) -> 1.83ng/ml, Free T -> 0.181 ng/ml, SHBG -> 13.88, Free Test Index -> 45.75%, Bio-Avail Test -> 4.24, prolactin -> 8.62, Estradiol -> 24, inhibin-b was 6.8 ml and L-> 5.9 ml

    Underwent trial FNAC on right testes. Testis Biopsy was done, and confirmed Sertolli Cell Only Syndrome

    Tested for y chromosome microdeletion and Karyotyping. Both were normal

    Underwent HCG Injections for ~4 months. Testosterone climbed upto 7. Did SA again. Still no count. Doc here advised me to take injections for 2 more months and do microTESE. Knowing this was pretty invasive, I didnt want to go through this unless i had exhausted all options to increase sperm count otherwise and also needed to know some acceptable % of finding sperm when microTESE was done. My wife and myself dont want to go through a emotional rollercoaster trying to do so .

    Since Injections eventually did not help in increasing my Sperm Count though Testosterone increased, i Had stopped injections for past 7 months. i also read somewhere that too much of HCG can cause other illness and cause Prostate issues. Did latest hormone readings and SA 2 days back. Testosterone went down again to 2.18 probably because i stopped taking injections. FSH -> 7.74 and LH -> 7.73. SA showed 1 ml volume with Psu Cells (1-2/hpf) and Fructose Test was negative. I assume this means Fructose was absent and had confirmed with pathologist. Is this Primary or Secondary Hypogonadism. ?. I am trying to figure out what kind of azoospermia i have and my doctor was unable to tell me my exact condition which is pretty frustrating to hear

    I needed your advice on what to do next regarding medications and treatment. Is there any treatment to increase sperm count in my current state. ? I live in india and would have come directly to you if my financial situation had allowed me to do so. So please help. Is there hope ?

    Reply
    • Paul Turek, MD

      Dear Nabi, You have detailed your case greatly here. Although the specifics of your care should not be discussed in public, a few of your details are generalizable. They are: 1) you have nonobstructive azoospermia if Sertoli cell only cytology/histology was found and sperm were not seen on testicular tissue sampling, 2) Your FSH is slightly high (<8 is normal for FERTILE men) which would support this diagnosis, and 3) the assessment of whether or not you may have sperm in the testicles is not as comprehensive and complete as is possible. It sounds like you had a single FNAC and a ?single biopsy. If true, with more intensive sampling with FNA mapping or mTESE, sperm may be present. Correction of testosterone to normal levels for 3-4 mos prior to sampling and sampling the testis at least 6 mos after a prior testis biopsy is recommended to get the best results.

      Reply
      • Nabi

        thanks for the reply dr turek,

        i had few more questions based on your reply. hoping you will reply to this also

        1) its been 7months since i stopped hcginjections to which i had responedand now testosterone levels are at 2.18. i have done only a single fnac and biopsy till date. is it advisable to go for another fnac now or should i get my testosterone levels back to normal again?. i believe there is no option for sperm mapping here in india.
        2) are there any side effects to hcg injections after long use ?
        3) are there any other medications available to icrease testosteroene levels apart from hcg injections.
        4) do i need to make my fsh levels normal. is it even possible ?
        5) are there any long term side effects that can be caused due to mtese.
        6) assuming that there is a 50% success with mtese the first time, how would the success % vary for the second mtese in the event the first one fails and how long we need to wait to try mtese again after the first time.
        7) wanted to know what % of success would you have seen from patients with my clinical history with my current levels of fsh,lh, testosterone and sertoli cell only syndrome.

        eagerly looking forward for your reply
        thanks

        Reply
  118. Aju

    Dear Doctor,

    I have nonobstructive azoospermia.I had done semen analysis twice and no sperms were found.Later I went to a fertility centre.They had performed TESE and no sperms were found.The biopsy report mentioned ” early stage of spermatogenesis with early maturation arrest and absence of spermatids.No granulonma or malignancy identified”. My blood report were as mentioned below.

    DHEA-S : 170.2
    Progesterone – 17 OH : 1.15
    FSH :14.62
    Testosterone : 3.94

    Do you think the condition is curable.Really hoping a reply from you.

    Aju

    Reply
    • Paul Turek, MD

      Aju, You have nonobstructive azoospermia. Although most forms of this condition are not “curable” (meaning reversible with restoration of natural fertility), they may in fact be associated with sperm that could be used with assisted reproduction (IVF-ICSI). Our research has shown that a proportion of men with maturation arrest pathology on biopsy can be “induced” to make more mature germ cell forms, including sperm. Alternatively, “pockets” of sperm may often be found in men with this biopsy pattern, depending on how thoroughly the TESE was done.

      Reply
  119. MrsP

    Husband had no sperm in two samples: blood work results were: FSH 12.1 IU/l
    LH 6.5 IU/l
    Testosterone 22.2 nmol/l

    Bloods repeated due to elevated FSH
    This time results were
    FSH 14.8
    LH 8.2

    we are based in London – so far none of the doctors have suggested TESE. he is 31 years old and otherwise seems healthy. What % chance would you suggest we have in finding any sperm? Many thanks for your advice

    Reply
    • Paul Turek, MD

      MrsP

      Your husband’s evaluation is almost complete. Be nice to know if his physical examination reveals a varicocele. Also do you know if he has a Y chromosome deletion or a karyotype abnormality (30% chance). If these are negative, then FNA Mapping can find sperm in about 60% of men like your husband.

      Reply
      • Mrs P

        Dear Dr Turek
        I wanted to up date you, if I may. We have since learned ( from getting a record of historical medical notes) that my husband had a ‘primary repair to inguinal hernia’ at the age of two. He didn’t remember this so we didn’t have the information until now. How possible is it that this is the course of the azoospermia and can anything be done to help him? Regarding his SA – I noticed the ph level was 8.1 which is just outside of normal range. What would this mean? thank you

        Reply
        • Paul Turek, MD

          Dear Mrs P: generally an inguinal hernia repair is not a risk factor for azoospermia. If it is performed along with an orchidopexy, then it may be a risk factor, and a favorable one at that. The pH of 8.1 probably does not relate significantly to azoospermia. A hard look at the testicle, with techniques such as FNA mapping, might be your best chance at finding sperm for pregnancy.

          Reply
          • Mrs P

            Thank you. We have the Chromosome and Karotyping tests booked shortly and following that we will have to investigate options for Micro TEse. I cannot find anyone in the UK that offers the FNA mapping – though if there is someone you would recommend please do let me know. We won’t give up hope or faith that sperm will be found. x

  120. Varuna

    Hi Doctor, 29 yrs Trying to concieve 1 year , twice semen analysis detected azospermia both times but positve fructose (may be no blockage) and ph 7-8. Normal FSH (3.5) , LH (6) testostreone(500) and prolactin (13) levels. Undergone operation at 8 years of age for left undescended testicle.Ultrasound of scrotum showed left testicle slightly small but right is ok.No veriocele.What can be cause of azospermia..Since FSH is normal that means we can retrieve germ cells from testes or cant be said.Since right testicle is ok then why did we got azospermia ? Please suggest i am very worried.

    Reply
  121. varuna

    Hi Doctor Please help!
    Husband and me 29 yrs age.TTC 1 yr 3 months.Went for SA twice- azospermia , positive fructose,PH – 7-8.volume was less 1.5 ml.
    Husband had surgery at 8 yrs for unilateral undescended testicle( only left).Hormones – fsh -3.3 testosterone – 507 , LH (6) , prolactin (12) (all normal).
    Ultrasound of testes – no variocele, hydrocele, right testes normal size and left is slightly small (though insignificant).
    Is it indicative of non obstructive azoospermia? If left testes has problem due to surgery then right should be ok and able to generate sperms , then why azoospermia was detected? Will we able to get sperms with biopsy? Please suggest if unilateral undescended testicles surgery has any side effects on fertility and testes impairment? If yes , then why we got FSH , Testo hormones normal? we are very worried .Please give your kind advice.
    Thank you so much in advance

    Reply
    • Paul Turek, MD

      Dear Varuna, this is a relatively complicated case. It is not clear whether there is blockage or testis failure as a cause of azoospermia. The normal hormones and normal testis size suggest the possibility of blockage. The low ejaculate volume suggests that it could be ejaculatory duct obstruction. The history of a unilateral undescended testicle goes along with a sperm production problem, as a problem on one side can affect the other with many testicular conditions. Consider a transrectal ultrasound to rule out blockage or missing seminal vesicles (CAVD). A testis biopsy can define a blockage but may not fully inform you of whether there are sperm present for assisted reproduction if there is testis failure. FNA mapping is much better a procedure for this purpose.

      Reply
      • varuna

        Thanks doctor for your advice.We had scrotum ultrasound done twice. 1st time size of RT = 3.88X1.92X2.59 = 19.29cc and LT (orchipexy done at 8 yrs) = 2.36X1.55X1.87 = 6.85 cc)
        2nd ultrasound showed RT 3.62X1.74X2.40 = 15.12cc) LT = 3.58X1.78X2.55 = 16.25cc)
        Epididymis size Right = 3.34X1.03 Left = 2.99 X 0.81
        Fructose was positve in semen test.
        Please suggest if left testicle is smalle but right is normal size , we can find hope in testicular biopsy or go with FNA mapping.
        Thanks for help doctor

        Reply
    • Paul Turek, MD

      Stefan, Wow! I looked at these sites. As a physician with a track record of publishing in stem cell journals and having coffee with some of the best stem cell scientists in the field, I am simply appalled by what these sites claim to do. The Chinese site does not include male infertility among the 40 or so other diseases it cure with stem cells. Where are the stem cells coming from? The German site is inexplicable! The FDA in the US would NEVER allow a clinic to inject the cells from sheep into a human without years of clinical trials showing safety and benefit. If it were only this easy, there would be several Nobel prizes awarded already to these institutions. The words that come to mind when I see what they claim to do: SNAKE OIL.

      Reply
  122. Stefan

    In China, claim to work with stem cells from the placenta of newborn babies…You think this is a classic scam???

    Reply
  123. Stefan

    One more question for you…What do you think about ROSI or ELSI injection? When you will solve treatman with stem cells :( ?
    Thank you

    Reply
  124. Damien

    Dear Dr. Turek,

    We used to talk and correspond here as well. I suffer from non obstructive azoospermia. According to your new post, would it be possible to come to San Francisco and chceck my situation using radiation-free, MRI scanner istead of FNA or microTESE and than proceed with artificial testicle if the result is positive?

    Reply
  125. paul

    Hi Dr. Turek we have spoken several times over the phone and reading your latest success story revitalizes my own hopes to become a biological father. Several years ago I was diagnosed with non-obstuctive azospermia. After months of hormone therapy and FNA mapping I learned to find I had absolutely nothing. In the back of mind I always wondered if my physician was the best at what he did. Im on the east coast CT/NY and found your website only days after my results. But what if I went to you, a master and pioneer at what you do, what if. My wife and I were running out of money to pay for all the procedures and decided to just move on. Im on trt now for a couple of years but always wondered should I take a flight out to see you. thx Dr.t

    Reply
  126. Priyantha Wijayatunga

    Dr Turek,
    I had low sperm counts (15 million/ml) and 2% rapid sperm about 5 months ago. Now it has gone down to almost no sperm except rare non-motile sperm. I have not changed my life style. Any reason?

    Reply
    • Paul Turek, MD

      Dear Priyantha, In case of dissolving sperm counts, I generally can find a reason. It is VERY uncommon to just have one’s sperm count “tank” for no reason. Evaluation should include a history, physical and reproductive hormones for sure by a qualified specialist.

      Reply
  127. Denis

    Hello Dr. Turek.
    My husband have non-obstructive azoospermia (maturation arrest) normal testis,normal hormones.. A year ago he had a biopsy, Results: sertoli cells,spermatogonia & primary spermatocytes… What are the chances of finding sperm through FNA mapping?
    Thank you.

    Reply
    • Paul Turek, MD

      Dear Denis, Finding sperm in men with early maturation arrest really depends on 1) if the cause (genetics, environmental, varicoceles) can be defined and 2) how hard (i.e. how many biopsies) they looked. Some of these cases are “inducible” and can be converted into making sperm by lifestyle changes or varicocele repair. Others are global and these cases are more likely genetic. Assuming that none of these issues exist and that a single biopsy was taken, I would estimate that the chance of finding sperm on extended FNA mapping to be 25-35%.

      Reply
  128. venky

    I am Azoospermia patient. Please find the details

    Noticed Grade 2 Varicocele in left side(2.8mm) and Grade 1 on right side (Bilateral Varicocele).

    Please suggest me best way to overcome this problem.

    Whether I should go for varicocele repair ? What is the reason to get azoospermia in my case.

    History Details : -

    Fructose is positive in semen analysis report

    Chicken Pox : at age 2

    Testis Increased in size at the age of 7 for 4 days.(May be orchitis not sure it went off after 4 days)

    3 to 4 times small injuries (Cricket Ball hitting testis and someone hitting testis)

    Hormone levels :

    First time checked before 8AM without breakfast :

    FSH : 2.16 mIU/ml
    LH : 1.91 mIU/ml
    Testosterone : 2.63 ng/mL
    Prolactin : 12.69 ng/ml

    Second time checked at 9 AM morning without breakfast :

    FSH : 5.40 mIU/ml
    LH : 3.92 mIU/ml
    Testosterone : 4.61 ng/mL
    Prolactin : 3.54 ng/ml

    Karyotyping : Normal

    Y chromosome micro deletions : Normal

    Reply
    • venky

      I have not done Biopsy still I have doubt whether it is obstructive or non obstrutive ?

      Please tell me how to proceed from here .

      whether varicocele(Bilateral Grade 2 on left and Grade 1 on right) surgery required ?

      I had mild increased in my chest that even my father had and other male factors are fine

      Reply
    • Paul Turek, MD

      Dear Venky, If we assume that your semen volume is normal and that your testicular volume is normal, then this could represent either an obstruction or not. The classic approach is to do a simple testis biopsy as it can define obstruction. However, if it is not obstructed there is only a 30% chance that sperm will be found. FNA mapping provides far more information either way (defines obstruction, 60% chance of finding sperm without obstruction) and is far less invasive. To me, the varicoceles are a secondary issue and repair of them should only be considered once sperm production is better defined, as it may be needless surgery.

      Reply
      • venky

        What caused azoospermia in my case ?

        Semen Volume (2 ml) normal , Testicular volume also normal , Testis and epididymis are normal in size and shape except Varicocele (Bilateral grade 2 on left and Grade 1 on right ) as per doppler study and Genetic test normal

        Do you think my hormone levels are normal ?

        Testostrene is 2.63 when I checked early morning 8AM and it is 4.61ng/mL at 10AM . Do you think testosterene is in normal range ?

        What I can expect in my biopsy report can u please guess it

        Also fructose is positive and FSH and LH normal .

        irst time checked before 8AM without breakfast :

        FSH : 2.16 mIU/ml
        LH : 1.91 mIU/ml
        Testosterone : 2.63 ng/mL
        Prolactin : 12.69 ng/ml

        Second time checked at 9 AM morning without breakfast :

        FSH : 5.40 mIU/ml
        LH : 3.92 mIU/ml
        Testosterone : 4.61 ng/mL
        Prolactin : 3.54 ng/ml

        Karyotyping : Normal

        Y chromosome micro deletions : Normal

        If the biopsy report says maturation arrest can I do varicocele surgery ?

        Please suggest me

        Reply
        • Paul Turek, MD

          Dear Venky, hard to predict a biopsy result before you have it done. I suspect this is early maturation arrest (nonobstructive azoospermia) or normal (obstructive azoospermia). FNA Mapping might offer you much more information than a simple biopsy (and is much less invasive) of the problem is the first of these two.

          Reply
          • venky

            Thanks Turek

            Okay I will go for Biopsy
            .
            Please guide me below questions

            1. Tell me whether my Testosterne level is normal or not

            2. If it is maturation arrest shall i go for varicocele repair or not

          • Paul Turek, MD

            Dear Venky, I am not able to provide you with personal care over the internet. Consider a call to the office if you would like to take your case to the next level.

  129. Christina

    Hello Dr. Turek. My husband has the sertoli cell only syndrome. A TESE was negative (no sperm, no germ cells) we still have a chance to have a baby? maybe in a few years?

    Reply
    • Paul Turek, MD

      Dear Christina, There is always hope! Maybe worth a talk, as finding sperm with Sertoli cell only syndrome depends alot on HARD HOW YOU LOOK. For example a simple TESE (biopsy) will not show sperm as often as FNA Mapping or a micro-TESE. There may still be CURRENT opportunities. I see such patients every day in my practice.

      Reply
  130. Christina

    Thank you for your reply. We live in germany, but I hope we can come soon in your practice.

    Reply
  131. ria

    Dear Doctor
    My husband 30 yrs diagnosed with azoospermia.Underwent orchiopexy for unilateral crypto at 8 yrs of age of right testes.
    We performed ultrasound and they say right testes size is smaller than left testes.But left testes is normal size.all hormones are also normal and no elevated fsh.semen volume was 1ml and 1.5 ml only and postive fructose was seen.
    I was reading his article http://humrep.oxfordjournals.org/content/18/12/2534 which says
    ” Our data suggest the existence of congenital or acquired obstructive anomalies of the seminal ducts in azoospermic orchidopexed men”
    Does this mean unilateral crypto can result in obstruction of seminal tubules and have more chances of sperm retrieval as compared to unknow NOA?
    I was bit hopeful after reading this.
    Please suggest what procedure should we go forward with – TESA,PESA.MESA,TESE or micro TESE?
    Thanks so much

    Reply
    • Paul Turek, MD

      Dear Ria, In men with a history of undescended testes (or cryptorchidism) and nonobstructive azoospermia, our rate of finding testicular sperm is 65-69% by FNA mapping. Once found on mapping, a later sperm retrieval is usually at least 95% effective getting sufficient sperm for IVF-ICSI. This rate (65-69%) is slightly higher than men with unexplained or genetic nonobstructive azoospermia without undescended testis (Ref: Shefi, Kaplan, Turek

      Reply
      • ria

        Thanks doctor
        If we come for sperm retrieval from you , where can we go for ivf procedure.Will you also take care of ivf process for female? Please advise how will the whole process work? Thanks

        Reply
        • Paul Turek, MD

          Dear Ria, I work with several/many IVF programs in California and around the world. If an FNA mapping procedure is done and finds sperm, then a subsequent sperm retrieval can be done locally where you live, or done with me in association with neighboring IVF programs in Los Angeles or San Francisco. Whether you can stay locally or need to come hither for sperm retrieval depends mainly on the FNA map findings and the projected complexity of the sperm retrieval procedure. Easy retrievals (TESA) can easily done locally with high success, but more complex sperm retrieval procedures (mTESE) are advised to be done with me.

          Reply
          • ria

            Thanks Doctor.We stay in Santa Clara so we SFO is local for us.Can you send us list of IVF centers you have collaborated with or please suggest us where can we go for consultation of IVF-ICSI for this procedure.
            Regards
            Ria

  132. akash

    Dear Sir,

    I am azoospermia patient. i have done testicular biopsy which signifies:- “Mainly hyalanized seminiferous turbules with ocassionally seen sertoli cells and leydig cell hyperplasia” Result-no sperm
    please tell me what does that mean
    and i got my fsh and lh checked – FSH- 38 & LH- 24. But i am getting treatment locally my fsh came to- 29 and lh- 17. does that mean my testes start functioning and what are the chances of getting normal sperm ?

    Reply
    • Paul Turek, MD

      Dear Akash, A testis biopsy showing Sertoli cells and Leydig cells and hyalinized tubules is simply a variation of what is called “Germ cell aplasia” or “Sertoli cell-only” patterns. In essence, the biopsy showed no germ cells, which means neither the seeds (spermatogonial stem cells) nor flowering plants that those seeds make (mature sperm) are present. So that’s not good news.

      HOWEVER, depending on how many biopsy pieces were taken and from how many places, there is still a good possibility that mature sperm could be found in locations other than where the biopsy was taken. In essence, the harder you look, the more you will find sperm in the testicle, regardless of FSH levels. FNA mapping is one of the most comprehensive yet noninvasive ways to “look harder” for sperm. As to whether the sperm is “normal” or not is not really knowable, but we assume that mature sperm with tails are acceptable for use with IVF-ICSI in general.

      Reply
  133. veeru

    Thank you doctor for your service to all patients

    I am azoopsermia patient . One doctor said it is Non obstructive azoopspermia.

    My testis size

    LT = 3.5*1.8*1.7 cms

    RT = 3.7*2.7*2.2 cms

    Hormone levels

    FSH : 2.20 mIU/ml
    LH : 1.91 mIU/ml
    Testosterone : 2.64 ng/mL
    Prolactin : 12.54 ng/ml

    Genetical test is normal

    Please answer me below questions

    1. Do you think my testicular size and Hormone level are normal ?

    2. If u say everything normal then What should I do to improve my sperm count . Any chances to get sperm in ejaculation ?

    Reply
    • Paul Turek, MD

      Dear Veeru, Your hormone levels are fairly normal. Your testicular size may or may not be normal, depending on your ethnicity. Generally azoospermia is more complicated than simply taking a pill to get a sperm count. For example, if it is due to Y chromosome microdeletions or a chromosomal issue (karyotype) than it not likely fixable but you may still have usable sperm in the testicle. On the contrary, if you are blocked, then it may in fact be fixable. A testis biopsy or FNA mapping procedure can tell which which one of these that you are and is generally considered to be you next step.

      Reply
      • Veeru

        Thank you sir

        Karytoping and Y chromosome is normal

        I had bilateral varicocele(Left>right) and if biopsy report says maturation arrest. Shall I undergo Varicocele repair ?

        or

        Let me know how to get sperm in ejaculation before proceeding with FNA mapping

        Please guide me

        Reply
        • Paul Turek, MD

          Veeru, About 39% of men with varicoceles and azoospermia will developed ejaculated sperm after varicocele repair. An EARLY maturation arrest biopsy pattern is less likely to respond to surgery and result in sperm compared to a LATE maturation arrest biopsy pattern.

          Reply
  134. Michelle

    Dear Dr. Turek
    My husband has been diagnosed with non- obstructive Azoospermia Sertoli Cell only. In 2010 he had a Micro- TESE biopsy and we were able to find little sperm to be able to have a beautiful girl. Ever since then we have tried three Micro – TESE biopsies to show no sperm found. We have now been advised that it’s very difficult to find anymore sperm. My husband has testosterone levels of ( 12.1 nmol/L) LH levels at (27.0 IU/L) and very high FSH (53.8 IU/L).
    The histology of the testicular biopsies showed prominent Sertolic cell only components but some tubules with residual spermatogenesis were also obtained through micro-dissection. However, these tubules were affected by maturation arrest with most advancement to primary spermatocyte and rarely round spermatid stage .
    D o you think we still have a chance in finding sperm?
    We would like to do one more micro- TESE biopsy but before that we want to try and increase our chances of finding sperm. Do we try to increase his testosterone levels before we do it by taking natural herbs or by using a testosterone gel? Should we give the spermhope supplement for six months a try or should we consider sperm mapping as an alternative to micro- TESE? If we don’t find any sperm again do you recommend we stop our hope or continue again every year jeopardising my husband’s health in the reduction of testosterone levels.
    Your response would be so much appreciated. Thank you so so much in advance

    Reply
  135. Micheline

    I’m writing to you from Sydney Australia. My husband has been diagnosed with non- obstructive Azoospermia Sertoli Cell only. In 2010 he had a Micro- TESE biopsy and we were able to find a little sperm to be able to have a beautiful girl. Ever since then we have tried three Micro – TESE biopsies to show no sperm found. We have now been advised that it’s very difficult to find anymore sperm. My husband has testosterone levels of ( 12.1 nmol/L) LH levels at (27.0 IU/L) and very high FSH (53.8 IU/L).
    The histology of the testicular biopsies showed prominent Sertolic cell only components but some tubules with residual spermatogenesis were also obtained through micro-dissection. However, these tubules were affected by maturation arrest with most advancement to primary spermatocyte and rarely round spermatid stage (Stages too early in DNA maturation to be used for fertility treatment).
    D o you think we still have a chance in finding sperm?
    We would like to do one more micro- TESE biopsy but before that we want to try and increase our chances of finding sperm. Do we try to increase his testosterone levels before we do it by taking natural herbs or by using a testosterone gel? Should we give the spermhope supplement for six months a try or should we consider sperm mapping as an alternative to micro- TESE? If we don’t find any sperm again do you recommend we stop our hope or continue again every year jeopardising my husband’s health in the reduction of testosterone levels.
    Your response would be so much appreciated. Thank you so much in advance

    Reply
    • Paul Turek, MD

      Dear Micheline, this is a VERY complicated case. When microdissection fails, it probably will fail again. Its a technique quite limited by the need to find visually “normal” looking tubules, as such tubules might contain sperm or not. Maturation arrest tubules are the classic confounder for the microdissectionist: these tubules appear “normal” to even the most experienced eye, but may not contain sperm if biopsied. This represents the limit of the technique. FNA mapping, however, evaluates tubules differently and is far less invasive and may in fact show sperm. After that, a microdissection can be “targetted” to a certain testis and even regions within the testis, to make sperm retrieval more focused and successful. Consider this option going forward.

      Reply
      • Micheline

        Dear Dr. Turek

        Thank you very much for your response. We look forward to contacting your clinic and having the pleasure of speaking to you.

        Reply
    • Paul Turek, MD

      Dear Kareem, we are very excited by how well our paper was accepted around the world last week!

      Reply
  136. Param

    Hello Doc,

    My husband did semen analysis 2 days back and doctor is saying i can not see any sperm.We are in shock.how is it possible since my husband is very healthy and we have no problem in intercourse.

    He is a very very good person but after hearing this news he broke down and not talking much .
    1. Is it possible like suppose I check today sperm count and find no sperm count and some other day test again find some sperm count?
    2. Is there any way to produce sperm by my own (like some food,tablets).
    3. Can semen analysis test give wrong result.

    Reply
    • Paul Turek, MD

      Dear Param, I am sorry about that news that you received! Certainly having no sperm can be temporary and due to, for example, illness, fevers, chemotherapy, wet heat exposures and hormonal issues. Repeating the semen analysis after a month or two is important for this reason. Sure semen analyses can vary in quality, some centers finding sperm when others do not. In some men, hormonal treatments can be used to stimulate treatment and in others a blockage can be repaired microsurgically. However, in most men it is unexplained and the best you can do is find sperm and use it with IVF-ICSI.

      Reply
  137. Param

    Dear Sir,

    This is param from india but my husabd working in USA. My husband went for the semen analysis , and no sperm found. and my primary doc suggest for urologist, I went there and he did not check anything and only said you have only thing to do i.e IVF. I asked him is there any blockage? he said no blockage i am 100% sure.
    My question is , Is there any test to find out blockage ? he did not test any blockage . I am very much worried about it. What should i do now?
    I am in charlotte,Nc , Could you suggest please suggest me good specialist for this here who is your under guidance since i can not come to CA . Please sir help me out …(my English is not good so please consider it)

    Reply
    • Paul Turek, MD

      Dear Param, Having azoospermia just means that there is no ejaculated sperm. If serum hormones show elevated FSH (<8 mIU/mL), then it is likely due to nonobstructive azoospermia and not a blockage (obstructive azoospermia). With reasonable certainly, this tells you that a blockage is not present, but having a high FSH does not accurately tell you that you do or do not have sperm. A testis biopsy or FNA mapping can confirm whether sperm production is normal and therefore truly defines a blockage, but does not tell you where that blockage might be located.

      Reply
  138. payam

    Dear Dr. Turek,
    I am Payam wrote on your nice blog few times. This time I would like to know if you know well trained doctors in doing FNA in Iran or Turkey. I live in Iraq and I can’t afford travelling and getting treatment in US.
    Many thanks to you Doctor

    Reply
    • Paul Turek, MD

      Payam, thanks for circling back. I have a fellow that I trained named Dr. Sela Cayan, who practices in the university in Mercin, Turkey. He may be doing sperm FNA mapping.

      Reply
  139. Param

    Thanks a lot sir.

    Could you please suggest me trained doctor for ICSI IVF in charlotte ,NC?

    Reply
    • Paul Turek, MD

      Dear Param, Consider searching the national IVF registry (SART.org) to find programs in your area. Be sure to talk with them regarding their experience with cases like yours.

      Reply
  140. meera

    Sir,

    According to you what is the normal range of FSH , LH and Testosterone in men ?

    When FSH is considered low and when it is considered as High ?

    What is the best time to check hormone level ? whether this should be with empty stomach ?

    Thanks

    Reply
    • Paul Turek, MD

      Dear Meera,

      The normal ranges of reproductive hormones vary by the laboratory that does them. In general, testosterone should be between 300-800 ng/dL; FSH 2-8 mIU/mL, and LH 2-12 mIU/mL. The lower the FSH the better (think of it as gas being sent to the engine to help it run; well tuned engines need less gas to run than ill-tuned engines). Best time to check FSH and LH is whenever, but the best time to check testosterone is in the morning before 10am as T levels are highest in the morning and lowest in the late afternoon. In fact there can be a 30% difference in T levels in an individual over the course of a single day.

      Reply
      • meera

        Thanks paul,

        Why FSH is normal in some NOA patients ? considering other Parameters hormone level ,y chromosome , Karyotyping are normal , Why these patients still suffer with ZERO count

        Reply
  141. Param

    Hello sir,
    As I told you my husband did semen analysis second time and doc was saying no sperm found …i asked him for the hard copy of the report and he gave us but we did not see in report no sperm found.
    Here below are the report …please help me out sir i am in need….
    Abstinence 4.0
    Phsemen L
    Appearance semen normal
    liquefaction at 20 mins normal
    viscosity semen normal
    htf addition no
    gel particles normal
    round cells <6
    cellular debris normal
    mucus normal
    rbc none
    other cellular components none
    sample volume 2.0
    motile count see comments
    wbc per 100 sperm 0.0

    Reply
  142. Param

    Hello sir,
    As I told you my husband did semen analysis second time and doc was saying no sperm found …i asked him for the hard copy of the report and he gave us but we did not see in report no sperm found.
    Here below are the report …please help me out sir i am in need….
    Abstinence 4.0
    Ph semen L 6.4
    Appearance semen normal
    liquefaction at 20 mins normal
    viscosity semen normal
    htf addition no
    gel particles normal
    round cells <6
    cellular debris normal
    mucus normal
    rbc none
    other cellular components none
    sample volume 2.0
    motile count see comments
    wbc per 100 sperm 0.0

    Reply
    • Paul Turek, MD

      Param, you are correct. Neither the sperm count nor the sperm motility is given in the report that you post.

      Reply
  143. Stefan

    Doctor Turek,

    can you please give me name of doctors that you are train for FNA mapping in Europe?
    We wont do mapping but we are vwey fahr from you

    Reply
  144. Stefan

    Doctor Turek,

    can you please tell me manes of doctors that you train for FNA mapping in Europe?
    We are very fahr from you, Who would you recommend to us?

    Reply
  145. meera

    Thanks paul,

    Why FSH is normal in some NOA patients ?
    considering other Parameters hormone level ,y chromosome , varicocele , Karyotyping are normal ,

    Why these patients still suffer with ZERO count

    Reply
    • Paul Turek, MD

      Meera, Great questions! We are not sure why the FSH is normal is nonobstructive azoospermic men with early maturation arrest histology or in 10% of men with Sertoli cell-only histology. Regarding why men with genetic-negative azoospermia are azoospermic, its because we do not yet understand the entire universe of genetic infertility. See the blog post “Fitting into Your Genes” for a better explanation.

      Reply
      • meera

        Thanks Paul,

        Do you have any patients whose maturation arrest is converted to sperm after treatment ?

        Reply
        • Paul Turek, MD

          Dear Meera, Yes we do. Pretty regularly. I would estimate that between 10-20% of men with maturation arrest patterns on testis biopsy or microdissection TESE can be found to have sperm after aggressive medical and lifestyle treatments after 6-9 mos as evaluated by FNA mapping.

          Reply
  146. ria

    Hi Doctor
    We have appointment with you on 16th June.We just went for SA test at Kaiser and it came Azoo with positive Fructose.
    We had previous SA 4 months back also with same outcome. However volume is always less 1ml or max 1.5ml Also FSH = 3.3.
    Does this mean Obstructive or NOA?My husband had rectractile testes Left only which doctors corrected at age of 8 yrs.
    Do you suspect NOA? We are seeing you on coming Monday, desparately waiting for appointment to clarify so many questions.Can physical examination by you rule out obstruction!
    Thanks

    Reply
    • Paul Turek, MD

      Ria, so looking forward to meeting you on June 16th. Not a great way to give care over the blog. But, yes the history and physical can get us a long way to deciding whether there is a blockage or not. The low volume and positive fructose suggests that blockage of the ejaculatory duct is unlikely. The FSH is consistent with either blockage or nonobstructive azoospermia due to maturation arrest histology pattern. I will do my best to help you figure this out.

      Reply
      • ria

        Hi Doctor
        It was so nice to see you today..I just loved the way I am feeling relieved after consulation with you.I feel hopeful.
        Thank you
        Ria (Ruchi)

        Reply
        • ria

          Hi Doctor We were planning to order Pre natal for him and myself from essential beginings.Wanted to confirm the dosage from you.On the website it says 6 tablets per day.Can you please guide us if we actually need 6 or lesser tablets per day.
          Thanks so much
          Ria

          Reply
          • Paul Turek, MD

            Ria, Essential Beginnings XY is a prenatal, preconception pill for men. It was designed by several doctors, including myself, and a cancer nutritionist. What I really like about it is that the “binders” that we melded with the vitamins, herbs and minerals in it lead to good absorption, and are the best in the business. This means higher levels of absorption and higher chances for improvement. The twice daily dosing (3 pills 2x daily) is based on the fact that water soluble vitamins have a short half life and need replenishing.

  147. om

    Hi Doc,
    i gave my semen test and no sperm found .here is my test result…….Please suggest what to do?

    WBC [3.6-10.4 K/uL] 6.4 K/uL
    RBC [4.16-5.83 M/uL] 5.64 M/uL
    HGB [13.0-17.4 gm/dL] 15.9 gm/dL
    HCT [39-52 %] 48 % 4
    MCV [82-99 fL] 85 fL 5
    MCH [27-34 pg] 28 pg
    MCHC [32-35 gm/dL] 33 gm/dL
    RDW [12.2-16.3 %] 12.0 %
    *LOW*
    Platelet [142-328 K/uL] 185 K/uL
    MPV [6.0-9.5 fL] 8.7 fL
    Diff Type AUTOMATED
    Absolute Neut [1.60-7.71 K/uL] 2.92 K/uL
    Absolute Lymph [1.05-3.20 K/uL] 2.70 K/uL
    Absolute Mono [0.20-0.90 K/uL] 0.48 K/uL
    absolute EOS [0.00-0.50 K/uL] 0.27 K/uL
    Absolute Basos [0.00-0.11 K/uL] 0.05 K/uL
    Neutrophils [41-74 %] 45 %
    Lymph [15-48 %] 42 %
    Monocytes [5-13 %] 8 %
    Eosinophils [0.0-7.0 %] 4 %
    Basophils [0.0-2.0 %] 1 %
    Sodium Level [136.0-145.0 mmol/L] 139 mmol/L
    Potassium Level [3.5-5.5 mmol/L] 4.0 mmol/L
    Chloride Level [98.0-107.0 mmol/L] 100 mmol/L
    CO2 [22.0-29.0 mmol/L] 27 mmol/L
    Glucose Level [70-100 mg/dL] 87 mg/dL
    BUN [6.0-20.0 mg/dL] 8 mg/dL
    Creatinine [0.70-1.20 mg/dL] 0.70 mg/dL
    Estimated GFR Non-African American [>59 mL/min/1.73 m2] >59 mL/min/1.73 m2
    Estimated GFR African American [>59 mL/min/1.73 m2] >59 mL/min/1.73 m2
    Calcium Level [8.4-10.4 mg/dL] 9.5 mg/dL
    Albumin Level [3.50-5.20 gm/dL] 4.7 gm/dL
    Total Protein [6.6-8.7 gm/dL] 7.9 gm/dL
    Total Bilirubin [0.0-1.2 mg/dL] 0.8 mg/dL
    Alkaline Phosphatase [40.0-129.0 IU/L] 77 IU/L
    ALT [0.0-41.0 IU/L] 80 IU/L
    *HI*
    AST [0.0-40.0 IU/L] 46 IU/L
    *HI*
    Cholesterol [<200 mg/dL] 155 mg/dL
    Triglycerides [<150 mg/dL] 148 mg/dL
    HDL-Cholesterol [40-60 mg/dL] 43 mg/dL
    LDL-Cholesterol [<100 mg/dL] 82 mg/dL
    Non HDL Chol (LDL+VLDL) 112 mg/dL
    TSH [0.270-4.200 uIU/mL] 1.100 uIU/mL
    Urine Color YELLOW
    Urine Clarity CLEAR
    Urine Glucose [NEG] NEGATIVE
    BILE [NEG] NEGATIVE
    Urine Ketones [NEG] NEGATIVE
    Urine Specific Gravity [1.001-1.030] <1.005
    Hemoglobin-Urine [NEG] NEGATIVE
    Urine pH [4.6-8.0] 7.0
    Urine Albumin [NEG] NEGATIVE
    Urobilinogen [0.2-1.0 mg/dL] 0.2 mg/dL
    Urine Nitrite [NEG] NEGATIVE
    Urine Leuko. Esterase [NEG] NEGATIVE
    Reducing Substance [NAP] NOT APPLICABLE

    Reply
    • Paul Turek, MD

      Dear OM, From the looks of it, your bone marrow is fine, urine is fine, cholesterol balance is good, electrolytes are good, thyroid is good, pancreas is good but your liver is a bit out of whack. None of these tests explain the 0 sperm count. An evaluation with a male reproductive health specialist is needed for a good history, physical exam and blood tests for reproductive hormones, along with a good semen analysis with extended search for low sperm numbers.

      Reply
  148. Heather&Daniel

    Dr. Turek, Daniel and I spoke with you on the phone today. We read your blogs and absolutely love them. You give us hope and we feel extremely confident to be on this journey with you. Thanks again.

    Reply
  149. Vivian

    Dear Doctor,
    I’ve been going through your blog and I am impressed and happy by all that I have read so far.
    My brother in-law was diagnosed of Azoospermia and he was told that there is no hope. Since then himself and his wife (my sister) have been so devastated but now my hopes are high for them. My challenge is that we live in Nigeria my Country. Considering the distaance please is there any way he can contact you?

    Reply
    • Paul Turek, MD

      Sure Vivian, By contacting the office, we can arrange either a 1) Free 10-min call to discuss his case or 2) 2nd Opinion to really evaluate the details (costs money). Try us from a distance. We have dozens of Nigerian patients in the practice!

      Reply
  150. Irish

    Hi doctor, I have PCOD Problem and my husband has no sperm count (Azoospermia with puscell 6-8). I’m really scared. Do we have any option?

    Reply
    • Paul Turek, MD

      Dear Irish, Of course you have options! Some you may like and others you may not. Your husband’s chance of having sperm in the testis ranges from 60% (nonobstructive azoospermia) to 100% (obstructive azoospermia). Just let me at him!

      Reply
  151. nat

    Hello Dr. Turek, I´m writing from South America, have been reeding a lot of your articles and interviews. Our case si that we are azoospermic, he is 42 and had a biopsy 8 years ago finding 90% with spermatids and 5% of tubules with spermatozoa, diagnosed NOA with maturation arrest. There is a varicocele on the left side(found in a physical examination), left testicle smaller in size than the right. Doctors here do not considerate this relevant for the azoospermia and even say there are cases where the surgery just make it worse, but we´ve read that in many cases there were improvements and even natural pregnancy (rare). Do you recomend surgery for the varicocele in this case? Are there any risks?

    Reply
    • Paul Turek, MD

      Dear Nat, I understand that you have nonobstructive azoospermia. However, you said that the biopsy showed “5% of tubules with spermatozoa.” This means that sperm are already present. If you goal is to only try naturally, then the varicocele repair has a 40% chance of resulting in ejaculated sperm and this is associated with a 5% natural pregnancy rate. You must decide if that is worth it. The side effects the subinguinal varicocelectomy are minimal. I require only a 1 day stay in town for this procedure and a return to full activity in 5 days.

      Reply
      • nat

        Dear Dr. Turek, thank you very much for your response. This is great news for us, as we feel natural that removing this problem would have at least some benefit. We will evaluate the possibility of going to L.A. and contact your clinic for further information.

        Reply
  152. AbhiS

    Hi Turek,
    I have azoospermia with FSH=2.41 miu/ml, LH between 3.5 to 7 miu/ml, Testosterone between 230 to 300, prolactin was 24 but now 16, TSH was 41 but now between 1-2
    with thyronorm.
    Normal testis size and volume.

    Not sure what to do next and what is the diagnosis. should i do karyotyping or go for FNA? Please advice.

    Reply
    • Paul Turek, MD

      Dear Abhis, You could do either, meaning either pursue the cause of the azoospermia with genetic testing (chromosome or karyotype testing along with Y chromosome microdeletion testing) or pursue whether you have sperm or not with mapping. It is only rarely that the genetic tests will actually tell you definitively whether or not you have sperm. And, if your azoospermia is due to a blockage outside the testicle (as suggested by the normal FSH and testis volume) then these genetic tests will be negative for sure. In this last case, another genetic test might be more appropriate: Cystic fibrosis gene mutation (CFTR) tests. So, in general, I suggest that if it is not entirely clear whether the azoospermia is due to blockage or not, figure that issue out first (with, say FNA Mapping) before you enter the relatively complex world of genetic testing.

      Reply
  153. Ahmad

    Sir, is there any chances of fertility of azoospermia because of undescended testis…. Please please help

    Reply
  154. Ahmad

    Hi Sir… Is there any hope for a person with azoospermia because of undecended testis. The sperm count is zero. One testical has been descended to colder part but not fully descended. Please sir reply I m so disopinted. Please reply . Regards Ahmad from canada

    Reply
    • Paul Turek, MD

      Dear Ahmad, MOST men with a single undescended testicle in the setting of azoospermia will have sperm. In fact, using FNA sperm mapping, our published data suggest that 69% of men in this situation will have testicular sperm present in one or the other testicle. It does help alot if at least one testicle is actually within the scrotum.

      Reply
      • Ahmad

        Hi Sir,
        Thanks for the reply. Both testis were undescended but one was moved to to colder spot ( as per to the doctor’s advice) at the age of 30. Reaction and testosterone is normal. If you think there is any chance for us, kindly give me time to visit you. Once again thanks for kind reply, I really really appreciate that you took time for me to reply.

        Reply
  155. CAMILLE

    My name is Camille bruno Valdez my partner and I have been trying for a baby for over two years now, We were going to a fertility clinic for about 5 months before somebody told us to contact this spell caster who is so powerful, We contacted him at this email; arewaspecialisttemple@yahoo.com, for him to help us, then we told him our problem, he told us that we will either conceive in February 2014 or March 2014,but after two years of trying we were at a point where we were willing to try anything. And I’m glad we came to Dr Dahiru, Because his pregnancy spell cast put us at ease, and I honestly believe him, and his gods really helped us as well, I am thankful for all he has done. contact him via email: arewaspecialisttemple@yahoo.com if you are trying to get a baby or want your lover back. he has powers to do it, he has done mine you can as well add him on facebook (Arewa Dahiru) To enable you have a taste of his nice work too.

    Reply
  156. Vivian

    Dear Doctor,
    My brother in – law was diagnosed of Azoospermia and this is the result of his test:
    Scrotal scan report:
    Scrotum- Normal scrotal fluid noted. No obvious sign of varicocele or hydrocele noted.
    Testicles – Rt testicle measures 20mm X 10mm while Lt testicle measures 22mmX12mm with mild compromised parenchymal echopattern. Both epididymis are small in sizes but other vessels are intact.
    Impression: Features noted are suggestive of testicular pathiology.

    Microscopy: Pus cells- numerous.
    Culture: Yielded moderate growth of stephococus.
    Semen Analysis:
    Colour- Grey white.
    Consistency- Watery
    Volume- 0.8mls
    Non motile cells- 0%
    Sluggish cells- 0%
    Motile cells- 0%
    Actively motile cells -0%
    Morphology:
    Normal cells – 0
    Abnormal cells- 0
    Count- 0
    Comment – Azoospermia.
    The doctor gave him and his wife treatment for the stephococus but he told them their is no hope for the Azoospermia.
    Pls doctor what type of Azoospermia is this and can he be treated?

    Reply
    • Paul Turek, MD

      Dear Vivian,

      It is not possible to tell what kind of azoospermia exists here. Hormones such as FSH, LH and Testosterone would help. Low ejaculate volume suggests either low testosterone or ejaculatory duct obstruction. The scrotal ultrasound assessment of testicular volumes suggest that the testes are small, indicating nonobstructive azoospermia. Sperm mapping likely has a 60% (nonobstructive) to 100% (obstructive) chance of finding sperm.

      Reply

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