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.
Clinic by the Bay is a locally funded, volunteer-powered primary care clinic in San Francisco that tries to meet the needs of our friends and neighbors who are medically underserved. We need your support to operate. 
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
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
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?
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
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???
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
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
Had grade 2 varicocele, fixed may 2008. Still, no change. I am the epitome of dietary and lifestyle health. Still think no blockage???
If so, this is more disappointing than before. Please email so I can contact you at your convenience. dsoleymani@gmail.com
Thanks. As I said, all hormones normal…what would boost production?
I would like to add that all analyses have been severely low. last one had one viable sperm.
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
I meant to have some cells in the ejaculate sperm lined before varicocele repair.
thank you very much. Of Paris.
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
Karime, Not so sure about Europe but I have patients from Europe every week…
Thank you for your information.
Where I find this type of care in Europe …?? where ?
I’ll make my final sperm then I see it I might come see you
thx Dr.
My Nobel Prize is when patients name their kids “Paul.” PJT
you tease xaj
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?
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
Is it possible to produce sperm even if a testicular biopsy revealed no Sertoli or Leydig Cells in somebody with Kallmans Syndrome?
Eric, yes it is. It is complicated though, as the person needs to be on testis stimulating hormones for some time. Remember, a biopsy only looks in a specific region and sperm may be found elswehere, in areas that were not biopsied. Kind of like apples on a tree, not all branches may have apples, so you need to find the ones that do have apples. FNA mapping is perfect for this as it can sample 18 sites in the testis and is far less invasive than a standard biopsy. Read more at: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/spermatogenesis/. Doc Paul
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?
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…
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
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?
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
Your husband has been through alot. In cases like this, sperm can be hard to find. Although the therapy (injections) may have worked and sperm might have been made, if you don’t sample the testis in enough places, then you may not find what you want. That’s where testis FNA mapping comes in. Samples intensively and finds those pockets of sperm that may be there. A testis biopsy just might not be good enough. Doc Paul
I think your wife also wrote in. See response below. The fact that one biopsy showed only Sertoli cells and the other showed germ cells (late maturation arrest) means that you might have pockets of sperm production. FNA mapping is an excellent way to figure this out and find sperm. See: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/spermatogenesis/
Dr Paul
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
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.
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
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.
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
Karim, Good idea. And stop by San Francisco where I am as well! PT
thx for ur help Dr TUREK, I wait 1 year and I dont have changement. maybe I com in L.A
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
Congrats Karim! Good things come to all who wait. Your story will be told in another 6-9 mos. Doc Paul
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
Abdul, be happy to talk. Please call my office 415-392-3200 or leave us a message on the website: http://www.TheTurekClinic.com.
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.
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
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.
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
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.
Steven, I do not think that the alcohol would cause this severe an effect. Nor would the excema or its treatment. A series of nightly hot tubs might but this effect would “wash out” after 3 mos. So, you should certainly recheck the semen analysis after 3 mos after the exposure. I am not sure that FSH would be that high after hot tubs, although this has never been studied. Your chance of having sperm is 60% with FNA mapping http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/sperm-mapping-testicular/ and 30% with a single biopsy. Its really your decision. Paul
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.
Yes, Tara, it may be frustrating but when it happens, it will all fade away… PJT
Hi Dr. Turek, has there been sperm mapping success in azoospermic men with y micro deletions but normal FSH and normal testicular volume? Thanks.
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.
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.
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
It may take 9-12 mos to see ejaculated sperm after varicocele repair done for azoospermia. Consider repeating the semen analysis in 3 mos; if still negative, consider FNA mapping http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/sperm-mapping-testicular/ to see if there is mature sperm in the testis. PJT
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
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.
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
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
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
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
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.
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..
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
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.
[...] is the word used to describe the lack of any sperm in the ejaculate. It is a devastating thing for men to hear as they try to conceive. It comes in two forms: as a consequence of blockage in the sperm ducts [...]
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!
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.
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……..
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…
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!
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.
Dear Dr, Thanks for all ur help. I will surely contact u after discussing it with my hubby. thank you!
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?
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!!
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
The ability for you to become a father depends in part on how thoroughly they looked for sperm in the biopsy and how many biopsies were reviewed. Most men get a single testis biopsy in testicle. We published in 2001 that if that same, previously biopsied testicle is sampled in 8 places by fine needle aspiration, 27% of the time we could find sperm in areas away from the biopsy. In addition, 20% of the time the opposite (unbiopsied) testicle would also contain mature sperm. Now, the FNA map consists of 18 sites/testis and so the sperm detection rate has increased from this original study. See: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/spermatogenesis/ Happy New Year!
my husband has azoospria with high fsh and low testoston. do you have any hormonal teraphy for him?
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.
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.
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.
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.
Marium, although some kinds of y chromosome deletions might suggest that there will be no usable sperm in the testis (AZFa and AZFb deletions in particular), others are associated with substantial chances (AZFc, 60-70% chance of sperm). A simple testis biopsy has the lowest chance of finding sperm compared to FNA mapping http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/sperm-mapping-testicular/ or a microdissection. Best of luck!
is sperm mapping only available in the states. I live in Alberta, Canada
It was invented in San Francisco and offered by me here and by fellows that I have trained in other countries including Israel, Argentina, Turkey, among others. Honestly, I haven’t trained any fellows who practice in Canada. Maybe consider a long weekend trip to San Francisco!
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.
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.
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
Arnaldo. Great to hear from you. I have many cases of azoospermia due to mumps orchitis and we have published http://www.ncbi.nlm.nih.gov/pubmed/19400985 that 60-70% of men will have sperm on FNA mapping of the testis. Consider a call to 415-392-3200 to discuss further.
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
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.
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?
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.”
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.
Thanks you very much for the response sir.
Please provide me the address, i will send you the slides.
The Turek Clinic
55 Francisco St
Suite 300
San Francsico, CA 94133
Call 415-392-3200 to organize
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
Dear Sekar. thanks for asking. There is no mention of the sperm count in this report. It could be that the sample contains no sperm (azoospermia: see http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/azoospermia-sample-causes-no-sperm-count-success-stories/ or that it has a few sperm that were missed. It should be repeated. Then he needs hormone blood tests. If due to blockage then sometimes it can be fixed with microsurgery (see: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/azoospermia-sample-causes-no-sperm-count-success-stories/. If not due to blockage it may either be treated medically or one can search for sperm in the testis with FNA mapping (see: http://theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count/spermatogenesis/. Your friend should start with a good local urologist. We can help if you want. Set up a time to call at 415-392-3200.
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
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.
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
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.
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
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
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
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
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
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.
Hi Dr. Turek,
My husbands testicular biopsy showed sertoli cell only. Is there still a chance we could find sperm with a different technique?
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!
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.
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
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
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??
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.
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
Holy cow! Your Welcome!!
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
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.
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?
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.
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.
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!!
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.
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.
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
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.
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.
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.
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.
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.
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.
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?
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.
Is there a reason it wouldnt?
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.
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
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!
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.
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.
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.
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.
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.
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.
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.
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.
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
Shivendra, Sounds like you have occasional sperm in the ejaculate and occasional sperm on a simple needle aspiration of the testis.
This means that you are both making sperm and that you are not blocked. There’s a subtle difference as described here: http://theturekclinic.com/fertility-from-sterility-azoospermia-sperm-retrieval-fna-mapping/
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
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.
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….
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!
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.
Dear Turek,
I have seen the latest news (28-Aug-2012) below where these guys grown early stage sperm from human skin. Did this research connected with yours or it’s independent? What’s your opinion on this?
http://www.dailymail.co.uk/health/article-2195010/Dream-fatherhood-thousands-infertile-men-step-closer-scientists-grow-sperm-skin.html
Thanks.
Krishna.P
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.
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.
Eric, excellent questions. Depending on the reason you are blocked (maybe you are missing part of the vas deferens which may not be rebuildable, a microsurgical reconstruction is cheaper than a single IVF cycle! Consider contacting us to talk and learn more: http://theturekclinic.com/urologist-california-contact/
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.
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-california-contact/
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
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.
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
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
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-california-contact/
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?
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.
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
Dear Azoo, I am not sure waiting another year on two medications will help you develop an ejaculate sperm count. You might consider trying to figure out whether there is testicular sperm available at this point. I would recommended FNA mapping for this (http://theturekclinic.com/services/male-fertility/sperm-mapping/).
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
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.
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.
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.
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.
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.
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!!!
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.
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.
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….
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
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.
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.
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/).
Dr Turek, i forget to ask u one more question.
Is FNA different with PESA?
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…
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?
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?
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
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!
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
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.
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.
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?
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,
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?
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.
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.
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.
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.