Fertility from Sterility

Do you think it is possible to have your own children with absolutely no sperm in the ejaculate?
Why yes. It happens on a daily basis in my practice.
Honestly, the word “sterility” has really lost much of its meaning nowadays with advances in reproductive technology.

The Affairs of Sperm

Azoospermia is the word used to describe the lack of any sperm in the ejaculate. It is a devastating thing for men to hear as they try to conceive. It comes in two forms: as a consequence of blockage in the sperm ducts outside the testis in the setting of normal sperm production in the testicle (i.e. vasectomy) or as a result of poorly functioning testicles and normal, open ducts beyond it. We routinely grab sperm from behind vasectomy sites to use with assisted reproduction to conceive. Finding sperm in men with poor sperm production, termed nonobstructive azoospermia, is a more complex matter.
One way to think about sperm production in men with poorly functioning testicles is to compare it to a mug with coffee in it. Say the mug is filled with ¼ cup of coffee. If you hold shake the mug, you may not see any coffee spill over the side. In this case, you might assume that the mug has no coffee inside. But, if you peer into the mug directly, you will see that there is actually coffee in the mug. Similarly, the testicle makes more sperm (coffee) than is found in the ejaculate (spilling over cup). There exists a threshold of sperm production, over which sperm shows up in the ejaculate and below which it will not. So, now you know the secret of making fathers out of “sterile” men with poorly functioning testicles.

Sperm from a Rock

Of course, it’s not quite that simple. There is one more layer of complexity here. Poorly functioning testicles may not make sperm evenly throughout their substance. In many cases, there are “pockets” or “islands” of sperm within a sea of otherwise empty tissue. Clinically, this makes sperm retrieval more difficult and has pushed this technology to a high art.
To find sperm, fertility specialists use several sophisticated approaches in men with nonobstructive azoospermia. The traditional testis biopsy works about 30% of the time to find sperm and, as a consequence, is no longer the de rigueur technique for this problem. Fine needle aspiration “mapping”, which I invented about 15 years ago, is easily twice as good as a biopsy in finding sperm and much less invasive. Lastly, “microdissection” of the testis another alternative and involves an all-out surgical assault on the testicle to find sperm making it the most invasive approach.  The elegance and complication rates for these approaches vary widely, but their intent is the same: to find enough sperm to allow biological fatherhood. Importantly, when expertly performed, these techniques will find sperm in the majority of cases. For the remainder, there is hope as even newer “no touch” scanning technologies are on the horizon…

369 thoughts on “Fertility from Sterility

  1. How much does this non-invasive Spectroscopy cost for people paying out of pocket. how can one request this. Is this already available in large hospitals?

    1. Amy, It is currently not available at all. We are working out the kinks. Then we will offer a clinical trial to set the bandwidth. Expect to see something out there in 2-3 years or so.

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

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

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

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

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

      3. Hello doctor. My urologist says that I have some early, also late maturation arrest but can’t tell if it’s actually late arrest or healthy tubules from the slides. My last biopsy produced spermatid but nothing mature. I was just prescribed not clomed but something similar, I’m going to get checked every month and for three months. Is there any advise I should give my doctor or any steps I should take other the the current path I’m on now. Please email me back [email protected]

        1. Dear Tony, The finding of LATE maturation arrest (with or without early maturation arrest) is encouraging. Medical therapy may help to “push” the pattern toward mature sperm production over a 6-8 mos period. If no ejaculated sperm at that point, consider FNA Mapping (over mTESE, which is a visual technique that has no real advantage here) to find mature sperm in the testicle, as “where there are spermatids, there are usually sperm.”

  2. Good evening Dr. Turek,
    I had a biopsy done and it determined azoospermia around six years ago. What is the next step? I thought all hope was lost.

    1. Well Javier, lots of things have happened over the last 6 years! All may not be lost. Be happy to speak with you about this. Call 415-392-3200 and we can chat.


    1. Ernie, Sounds like you have nonobstructive azoospermia. Wondering whether your doctors identified any genetic (y chromosome or other chromosome) or non-genetic (variocele, exposures, medications, illness) causes. In our previous research, we have observed that about half of men with this condition and this biopsy pattern have a genetic cause, either definable or not, and the others might not. Interestingly, we have also found that men with early maturation arrest can have sperm if: (a) you look harder than a biopsy does at more places in the testis (see: http://theturekclinic.wpengine.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count-male-doctors/sperm-mapping-testicular/, (b) remove insults such as recurrent fevers, illness, certain medication or varicoceles or (c) add FSH injections (expensive) for a period of several months to “push” sperm production past the point of the arrest. The point is that there is hope with this biopsy pattern.

  4. HI DR TERUK I had a biopsy done in 2008 the result was no sperm found and I had FNA mapping at your clinic a 2010 also no sperm was found .DR TERUK is there any hope in my sitaution. thank you DR TERUK.

  5. HI DR TUREK how are you I hope you are doing well DR TUREK I just iwant to thank you again trying to help me. if you asked me if i want to put me the list of men who are interesing in research the answer is YES Iam ready whatever you think will help me. it is depersing sitaution thank you offering me opportunity. goodbye gelle from johannesburg south africa.

  6. Hello Dr Turek
    Following on from your post. I have been diagnosed with Azoospermia almost 2 years ago, as well as bilateral varicolcel. I have done the varecocel operation almost a year and a half ago.
    i have also done testis biopsy and only setolli cells were found with very few germ cells with complete maturation arrest.
    I am not sure if your mapping technique can help in my case and wether the latest advancements in stem cell (Adult or Embrionic) can help.
    please let me know if you think I have hope before I make the trip to visit you in SF.
    Thanks a lot

    1. Wal, Having a biopsy showing Sertoli cell only with rare maturation arrest and getting a varicocele repair may not commonly lead to ejaculated sperm afterwards, but could lead to some improved sperm production in the testis. This, in turn, could be detected by FNA mapping. Let’s set up a call! 415-392-3200.

  7. Dear doktor,
    I am Ozcan, I come from Turkey but I live in the Netherlands.
    I am 33 years old and my partner is 29 years. We have a problem. I am
    patient azospermia, NOA and i am twice operated (TESE and Micro-TESE)
    and both operations without result. The pathology results is:
    non-obstructive Azoospermia with Maturation Arrest, I have round spermatid, but no sperm.
    I want to be father, can I ever be father?

  8. Dear Dr. Turek,
    I was diagnosed with Non-Hodgkin Lymphoma about 10+ years ago and I did not utilize a sperm bank at the time because I was so scared with the illness I had to deal with. I wish my Oncologist pushed the issue more about sperm banking… Moving on, I finally got the courage to do a semen analysis about a month ago because my wife and I have had no success with getting pregnant, the result showed no sperm found. I am going to do another semen analysis to find out definitively if that is the case. What do you think my options will be if the results are still the same and is there any hope after undergoing chemo treatment (R-CHOP) Rituximab,Cyclophosphamide, Doxorubicin, Vincristine, Prednisone?
    Thank you

    1. Myles, Of course there is hope! We and others have published on our ability to find usable sperm in men just like you. FNA mapping is an excellent technique to find small pockets of testicular sperm that just don’t make it out. See: http://www.theturekclinic.com/know-before-you-go-sperm-fna-mapping-azoospermia/. I can’t say that it is “routine” to find sperm after your heavy but curative chemotherapy regimen for cancer, but I certainly see men like you weekly. Give us a hoot!

  9. Hi Dr. I am 41 years old married 14 years ago, due to aesospermia unable to become biological father. I did biopsy in 2005 in Saudi Arabia but doctors didn’t find any sperms. Last year I shifted to Toronto, On, Canada. I am going to have have surgey again with Dr. Keith Jarvi working in Mount Sinai Hospital. Do you think it is good idea to spend more money, time and get emotional Trauma instead or should I try my luck?? Does there any treatment for Aesospermia has really discovered yet????

    1. You have done alot and you still sound motivated to learn more. Certainly, there is a chance that you have sperm, despite the findings from a simple biopsy in 2005 that showed no sperm. Remember, sperm production can be “patchy” in men in whom it is low. It really becomes a sampling issue. The harder you look, the more likely you will find sperm. I must agree that there is also an element of luck. Dr. Jarvi is a good friend and excellent doctor. Based on the numbers and statistics that he gives you, you can decide whether it is worth it for you to keep pursuing this strategy.

      1. Thank you very much D. Turek. I really pray and wish you long life and to all your colleagues doing research and treatment for human infertility. I already requested Dr. Jarvi to add myself in his research study. May be one day your team will reach to the permanant solution of Aesospermia.

  10. Dear Dr,
    Please help me. I have no child due to the fact that my husband is azoospermic. Initially he had ED,and also high FSH,and Low testerone,after much treatment and spending all we have all the hormones has normalised. We have done testicular biophys which says maturation arrest at an early stage.Please find below the details of his last three semen analysis since after the biophys:
    1st 19/09/2011.
    SEMEN: 1.O ML
    W.B.CS/H.P.F NIL
    R.B.CS/H.P.F NIL
    2ND SEMEN ANALYSIS 26/12/2011
    SEMEN: 1.5 ML
    W.B.CS/H.P.F: 2-3
    3RD SEMEN ANALYSIS 26/03/2012
    SEMEN: 2.0 ML
    W.B.CS/H.P.F: 2-4
    please Dr, advice me do i have any hope of being a mother one day? how do i get in touch with you for am currently based in Gulf country.
    Many Thanks.

    1. Dear Fortune, It appears that your husband has azoospermia and has had (correct me) a single testis biopsy? If so, think of sperm as apples on an apple tree. Not all branches have apples. One must look harder for apples and this is possible with FNA mapping. It is also possible that some forms of “maturation arrest” look on biopsy can be “pushed” to make sperm by treating correctable conditions such as diabetes, fevers, varicocele etc. Consider a call to talk more at 415-392-3200.

  11. I am 28 yrs and married 2 yrs back but yet no issue. I got examine by Dr. and seman exam. and Azoosperima came. I fear that I never become Father. I request to kinly help me and advised me further treatment. As i live in India but i can not come to your place due to ecominally condition. pl. help me.

    1. Ratan, I understand your situation. Although it is too big a deal to come see me in San Francisco, you can also consider asking for a “Second Opinion” on the website http://theturekclinic.wpengine.com/services/get-a-second-opinion/. In this way, I can comment on the quality of the care that you are getting, suggest what you may need and help out where I can. Works for many who live far away. And, recently I helped a couple with their first pregnancy and I never actually met them!!

  12. Hi doctor Turek,my husband is azoospermic after bone marrow transplatationn for non hodkgin deasese that he had 10 years ago .his hormone levels are normal so are the other tests but he has varicocele and doctors here in Croatia said it is not the reason for azoospermia and dont want to operate it.do you think that varicocele repair could start sperm production in patients with non obstructive azoospermia after chemotherapy?Can you advice me if there is a clinic in Europe that offers sperm mapping?thank you

    1. Ante, given this story, the bigger issue appears to be the treatment for NH disease, not the varicocele. Varicocele repair is a distant second issue. If one were to fix the varicocele and ended up with ejaculated sperm, that would be rare to the point of being publishable! Certainly varicoceles can be fixed for scrotal pain and this may be an indication for surgery. Best bet is to look at the testis for sperm, though. We have published finding sperm in men like your husband (see: http://www.nature.com/index.html. Consider emailing us http://theturekclinic.wpengine.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count-male-doctors/male-infertility-evaluation-sperm-test-semen-analysis-san-francisco-los-angeles-la-beverly-hills/ to set up a brief call!

  13. Thank you for your answer ,my husband did fine needle aspiration(not mapping)they didnt find any sperm.we should do biopsy to be sure in diagnosis.what should we do next ?is there anything to use or do to make results better?

  14. dear Doctor,
    my husband recently was diagnosed with azoospermia, he have done 3 SA and all came zero, his hermones levels are normals. his ultrasound shows that he got moderate bilateral varicocele and both epididymi are slightly prominent . we are schedualed for biobsy next week. the options for us according to the doctor is either obstructive or maturation arrest.
    we are davestated knowing that incase of maturation arrest the hope is very minial. kindly advise
    thank you

    1. Dear Hopeful, stay true to your name: hopeful. Sounds like good care. Consider talking with us if you have reached the end of the rope where you are. We may have some tricks up our sleeve for the maturation arrest…

  15. Dr. Turek, I already discussed with you my problem via this wonderful blog communication on your website on April, 03, 2012. Your answer gave me hope and courage that I underwent Micro Tese by Dr. Jarvi. Luckily he found healthy sperms by his expert surgery procedure. I was really over the moon that a person like me who declared aesospermia for more than 16 years, suddenly got that unique news. I must appreciate you and Dr. Jarvi who also worked with you for your extra ordinary hard work and research on human infertility problem.
    Dr. Turek, My trial doesn’t end up yet, I need your expert opinion once again, I hope you will guide me in this situation. Dr. Jarvi refer my case to Dr. Tom Hannam for IVF treatment and he did all the blood and hrmone work of mywife. He told us a shoking news that my wife’s AMH (Anti Mullerium Harmone level) is tremendouly low. It’s just 0.3%. Also the FSH level is too high. He told us clearly that your IVF success chancess are also less than 1%. He wrote a letter to Dr. Jarvi saying, “Wonderful news, as you know: From your procedure on the 9th of May, Javad had elongated spermatids from
    the right-hand side, plus the occasional mature forms (one per high-powered field). This was frozen in four
    vials. Perhaps we would have one opportunity at pregnancy, with IVF, from each vial.
    As you are also aware, Nazia has an extraordinarily low ovarian reserve. This precludes the expectation that
    there will be multiple eggs with fertility medications. Our intention, then, is to run a modified natural cycle
    this summer, after starting the supplement treatments directly.
    Please advise us what to do now in this stuation. I will be highly grateful to you.

    1. congratulation Jadi on finding healthy sperms i wish you all the best for a sucessful ivf and healthy baby .your story gave me hope than you so much 🙂
      please dont give up hope inshAllah everything will be a major sucess for both you and your wife
      my prayers for you 🙂

    2. Jadi, this is certainly good news and proves the point that you should not give up! However, my expertise ends with the male. A second opinion may be worthwhile however. In the final analysis, despite the numbers and odds, you will choose to do what you need to do. And that will be that.

  16. Sir,My aged 39 years old.I am married.I have no child.But want to a child.Microscopy test:No spermatozoa seen. Doctor comment: Azoospermia.how to increase the spermatozoa.pl treatment to drug me. Thank you sir.

    1. Milon, Sounds like you are azoospermic. Medical treatment for azoospermia may not work, unless you are lacking hormones that can be replaced. Having no sperm is either a blockage or a sperm production problem. Blockage is treated with microsurgical reconstruction. Often, production problems are treated with sperm extraction and IVF-ICSI. Let’s set up a call to talk: http://theturekclinic.wpengine.com/urologist-beverly-hills-los-angeles-san-francisco-california-contact/

  17. Hello Dr Turek,
    thank you for this useful website.. my husband is azoospermic with FHS level of 38 and had biobsy 6 years ago with no success. we are considering mapping but with the level of that FSH, do you think sperms are likely to find? and if you think they are, what are your recommended clinics closed to the UK (e.g Turkey, Germany).
    your help is highly appreciated.

    1. Amina,
      The ability to find sperm with mapping depends more on the extent or number of previous biopsies taken than it does the FSH level. I have men with ejaculated sperm and similar FSH levels. FSH simply doesn’t predict the presence of sperm well. The chance of finding sperm could range from 25-40%!

  18. Hello Dr Turek,
    Thank you for your time.
    My husband (age 34) has a non obstructive azoospermia discovered since 3years. The result of the biopsy done in 2009 was negative, nothing found. All the hormone are normal (FSH, LH and Testosterone). The analysis was described as below:
    Arrest maturation at the spermatocyte stage with hypospermatogenisis.
    Is there any cure or treatment for this kind of azoospermic? Do you think that we should ask for a second biopsy? We try with honey, black seed, chickpea…
    Thank you

  19. Hello Dr Turek,
    Thank you for your time.
    My husband (age 34) has a non obstructive azoospermia discovered since 3years. The result of the biopsy done in 2009 was negative, nothing found. All the hormone are normal (FSH, LH and Testosterone), no chromosome prb… The analysis was described as below:
    Arrest maturation at the spermatocyte stage with hypospermatogenisis.
    Is there any cure or treatment for this kind of azoospermia? Do we should ask for a second biopsy? We trying natural cure as honey with black seed, chickpea… Do you think that it’s efficient?
    Thank you in advance.

    1. Youni, Your husband has an interesting “mixed” testis biopsy pattern that may be a hopeful sign. Having “maturation arrest” on a biopsy has been discussed many times on this blog. If not due to a genetically defined problem (as you have pointed out), then I advise looking harder to see whether pockets of sperm can be found elsewhere, in areas distant from the biopsy, say with FNA mapping /services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count-male-doctors/sperm-mapping-testicular/). Before that, however, I would suggest “medical optimization” of your husband through lifestyle changes (stop hot tubbing, smoking, lose weight, control diabetes better) and fixing varicoceles if present and/or taking FSH injections. This might increase the odds of finding sperm on a “second look.”
      More interesting, however, is the finding of “hypospermatogenesis” on the testis biopsy reading. In our published series using FNA mapping, 100% of men with a biopsy pattern like this were found to have usable sperm in the testicle for IVF-ICSI. So, one thing you could do is to consider sending the actual biopsy slides to me for re-review to confirm that this pattern is actually truly present (see: /services/get-a-second-opinion.

  20. Thank you Dr for your Replay.
    I checked the medical record, and there are only the results of the hormone, chromosome and the biopsie. Two EchoDoppler was done before and after the biopsie. I don’t find any slides… Do you think that I should ask the laboratory? I don’t think that they keep the slides. All the results are in French, do you need a translation for get second opinion?

  21. Hello Dr Turek, you may remember me, i had the FNA mapping done with you in 2011 and no sperm were found. Sertoli only cell was my condition. Has there been any advances in treatment for men with my condition? Are we still 3-5 years away from artifical sperm procedures?
    Im keem to catch up with you and if you can offer any treatment alternatives now or in the near future please let me know.
    Thank you,

    1. Nas, Of course I remember and thanks for circling back. Please see where we are the with artificial human testicle at FertilityPlanit.com. Also, you have inspired me to write a blog about where we are at the moment, to be posted Monday Feb 11, 2013 at http://www.TurekonMensHealth.com.

  22. Hi Dr Turek
    Just a quick question, i have read that lowering testosterone for a period and taking various supplements will hopfully restore sperm production in men. I have sertoli only cell syndrome.
    The website is spermhope.com which offers this treatment? By reducibg testosterone can it help restart the male reproduction system?

    1. Mark, the technique of testosterone withdrawal and replacement is an old and abandoned one that was employed to improve sperm counts in men with ejaculated sperm. I know of no study ever published that shows this technique used successfully in azoospermic men. The key question for you is whether you might have “pockets” of sperm in a testis characterized (based on what technique?) to have only Sertoli cells but no germ cells. The harder you look, the more you find: http://theturekclinic.wpengine.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm-count-male-doctors/sperm-mapping-testicular/

  23. Thanks Dr Turek.
    Sorry to pester you again but I wanted to ask if i had the variocele procedure would this improve my condition? Also is there any meds i can take that will give me a glimer of hope. It would be great if we could set up a call to discuss any options if possible even though they may be a long shot.

    1. Nas, whether or not surgery or medicine can help is a complex discussion. Considering contacting by phone to set up a call: /urologist-beverly-hills-los-angeles-san-francisco-california-contact/

  24. Dr. Turek, I just watched your video on fertilityplanit.com. Amazing stuff. I did have a question. As I understand it, the man made testicle can be fueled with one of three things: (1) embroynic stem cells; (2) testicular stem cells; or (3) adult stem cells.
    My take away from the video, was that there was no way to get embroynic stem cells, and you were skeptical if sperm could be made with adult stem cells. You did say you could probably generate sperm with testicular stem cells, and that you determine if you have testicular stem cells through mapping. I thought mapping tells you if you have sperm in the first place, so then there would be no need to generate sperm that you already have.
    If this is true, the only hope for people with no sperm is to generate sperm through adult stem cells. So, is that the ultimate objective?
    I’m very confused and would like to understand this a little better.

    1. Sara, good read on this! My (and others) beliefs are changing about which of the three human stem cells can be made into sperm in a dish. The biggest issue are adult stem cells, as they are not quite exactly like embryonic cells and they have not been made into human sperm yet by anybody. The jury is still out on this one. Maybe its possible to make human sperm with adult stem cells, but maybe not. This answer will come with time.
      Sorry about the confusion about sperm mapping, I need to explain further. In addition to letting men know if they have mature sperm or not (which can be used now), FNA mapping also creates an “archive” of all the cell types in the testicle, including the earlier cell stages in the process of spermatogenesis (the 13-stage process that a testicular stem cell makes to become a mature sperm). So, in fact, mapping can routinely identify earlier stages testicular germ cells before sperm are made, and many of these cells may be valuable in the future to make sperm in a dish.

  25. Aren’t the recent studies last summer of skin cells turning into sperm precursor cells/spermatids enough to give a good prognosis that a viable, mature sperm can be made in a number of years time,especially sine the new technology has been moving forward quickly in the past few years?

  26. Dr. Turek,
    My husband has been diagnosed with azoospermia (non-obstructive) with an elevated FSH and normal testosterone and LH. A TESE was performed to locate sperm for IVF-ICSI, but no sperm was found. We are wondering what our next course of action should be. We aren’t opposed to donor sperm, but we would like to exhaust the possibility of biological children first. We are Canadians living in South Korea, so communicating our issues is difficult. The clinic we’re going to is great, but like most, they are much better at dealing with women’s fertility issues. I don’t know if he has Sertoli-only syndrome or otherwise because they only looked for sperm (non found). Suggestions? What does it cost for an FNA mapping? Thanks.

    1. Sarah, Depending on the complexity and extent of the prior TESE procedure, there may still be a chance that your husband has pockets of sperm in the testicles. A center that specializes in looking harder for pockets of sperm in testicles is the best way to go. FNA mapping and microdissection TESE are two possible ways to look harder. I do both, but prefer sperm mapping as it is far less invasive and highly informative. I suggest starting with a phone call with us. To arrange, contact us at: /urologist-beverly-hills-los-angeles-san-francisco-california-contact/

  27. Hi Dr Turek, my question is how many times can someone have a microtese procedure? I had been diagnosed with Cryptozoospermia and had a handfull of sperm in every other sample. I had Microtese in December last year with successful sperm retrieval but non-successful ivf with icsi. Medically, could I have another Microtese and if so, how long would I need to wait?

    1. JG, I have safely done mTESE procedures several times in a single patient, but I get more concerned about lowering testosterone levels with each attempt. I have not done many mTESEs in men with small numbers of ejaculated sperm as I prefer using the ejaculated sperm to doing the large surgical procedure. I debated this point with Dr. Schlegel in public last fall at our annual meeting (ASRM). We are presenting our research next month on using smaller numbers of banked and freshly ejaculated sperm for IVF-ICSI and AVOIDING surgical sperm retrieval. This sperm works great! However, it does take some time and energy to 1) get it to be reliably ejaculated and 2) to get enough to bank before going forward with IVF-ICSI. Stay tuned to next week’s blog post!

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

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

  28. Hi Doctor,
    I have filled up your contact form and also posted a conversation message directly to you. Hoping to hear from you.
    My husband was diagonised with Azoospermia. A little elevated FSH and normal LH and Testosterone. Also the Inhibin B levels were low. Our Andro suggested a Micro TESE. No Sperms were retrieved. Also the Centrifuge method was tried with no use. The Tese reports have been sent to the patho lab for further analysis.
    Please suggest us if there is still hope. Would sperm mapping help in this case. We are ready to try ANYTHING and EVERYTHING possible.
    We are from India, so we also would like to know any of the trusted Centers or doctors you consider the best to undergo this procedure.
    Please suggest. Eagerly waiting for your response.

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

      1. Thanks for the reply Doctor. Will get back to you once we have the pathology report.
        I was searching for FNA mapping and found a doctor ‘Karthik Gunasekaran’ who works in Metro Male Clinic. The site claims
        He was trained in Mens Reproductive health and Reproductive microsurgery by none other than world renowned Andrologist and Reproductive microsurgeon, Dr.Paul Turek (www.theturekclinic.wpengine.com) at San Francisco, California.
        Could you please let us know if this is the right information. We just want to know any options we can look out for in India. Please let us know if Doctor Karthik can be approached.

        1. Hi Doctor,
          Please find below the pathological report of my husband. Please suggest our next step after this. PLEASE let us know of any small or big thing we can do for this. We are ready to try all options available.
          Microscopic Description:
          Received multiple tiny bits altogether measuring 0.5*0.5 cm. Entire Tissue Processed
          Sections show seminiferous tubules with only sertoli cells. Few of the tubules are hyalinized. Interstitium shows leydig cells. There is no spermatogenesis seen.
          Right testicular biopsy
          —Shows sertoli cell only syndrome

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

    1. Hari, this is good news! Although I have never seen maturation arrest at the “secondary stage” I have seen it at the late spermatid stage, also termed “late maturation arrest.” And, even better, you are ejaculating motile sperm!
      So, I would encourage maximal medical therapy (fix any varicoceles, normalize FSH, Testosterone and E2, and correct all lifestyle issues [stop hot baths, smoking, alcohol] and see if you can start banking ejaculated sperm (cryptozoospermia). IF not, FNA mapping has a great chance of finding mature sperm in the testis and can guide a testis sperm retrieval if necessary. BEWARE: Microdissection TESE is a much larger procedure that MAY FAIL in this scenario as the seminiferous tubules are big and normal appearing all over the place.

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

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

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

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

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

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

      1. I just finally read your reply, thank you for that. Is it possible that Febrile seizures at a young age could have something to do with his infertility? Doctors I’ve asked have always been unsure. He had a few very high fevers as a child following different vaccinations that sent him to seizure; his mother says he had one grand mal and two petite by the age of 7 and then they stopped vaccinating him. He never had any other after that or any types of illnesses or injuries.
        Since that post my husband did become open to a biopsy and there was no sperm found, he took the clomid up until the procedure (for about 3 mo). The urologist called the method a TESE and took tissue from each testicle. We were disappointed to find out later that this procedure also bore no diagnostic benefit. The office said that they cannot comment on the cause of the NOA because they do not create permanent slides of the tissue to look at afterward. The doc. commented that he is truly perplexed because my husband’s tissues etc. all looked “healthy” whatever that means. We don’t know where to go from here, I think he would have been open to IVF if it had it been an option. We feel like our situation is hopeless and no one out here seems to know much about Azoospermia because we have had to come up with a lot of research and suggestions. Do you think there is anything that we should be asking to be done besides what our doc has done so far? Do couples ever come to see you that live in another state? Here is a little bit of more detailed info : hormone levels a year ago were:T:340,FSH:28.6,LH:6.7,P:6.8
        Thank you so much!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  42. hello doctor turek
    what do u prefer in medical treatment of maturation arrest clomid or HMG and HCG
    inhibin b 150
    and dignosis maturation arres at round spermatid
    in this case
    is there any probability to be y chromosome micro deletion

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

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

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

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

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

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

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


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

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

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

  47. Dr Turek … I am from India , diaognised with Azoospermia 2 years ago , with below observation in biopsy report: Microscopic description of testicular biopsy :
    The biopsy is adequate & incules 25-30 seminiferous tubules.Germinal cells are reduced in number.There is a striking arrest of spermatogenisis at the primary spermatocyte stage with lack of spermatids and sperms across the tubules.Mild sloughing of germ cells is present in the lumen.Thickening of the basement membranes or tubular sclerosis is not seen.The interstiti show few leydig cells.There is no evidence of koch’s seen.
    Harmonal and ultrasound reports are normal. Please suggest.

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

  49. Dear Dr,
    i was diagnosed as azoospermia by several semen analyses. hormonal analysis showed normal levels of testosterone but very high FSH. scrotal scan showed no blockage of any tube and normal epididymis. testicular biopsy showed few germ cells with varying degrees of fibrosis with foci of leydig cells. i have been put of ZEMAN, a fertility drug which is more of a multivitamin rich in L-carnitine.
    Another doctor told me that, nothing can ve done about my situation therefore he did not give me any medication and asked me to just pray.
    Am in Ghana west Africa.
    thank you

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

  50. Hi Dr. My DH was diagnosed with azoospermia 4 months ago. We have been trying for 18 months. Initially was diagnosed with infections staphylococcus. It was treated byt kept reoccurring. He had several SAs with no normal sperm present befire we were given the heavy blow that there was no other option except donor sperm. Which I am not game with. I adore and live my DH so much the thought of not carrying his biological child is killing.
    At the moment we do not know if it is NOA or OA as the hospitals available here did not seem to offer such advanced technical know how. However we were told a cyst was in one of the testis so physically one of the testis appears and feels smaller than the other.
    We want our own biological children what chances do we have?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  66. I am 41 years old, I am azoospermia patient, my recent Testicular Biopsy report showing
    “Section shows seminiferous tubules with sartoli cells only. No germ cells seen” on right testicular biopsy.
    is this report is final that I never become a FATHER…
    or there is some hope ..

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      1. Dear Paul Turek,
        FIrst of all thanks for the reply which could guide me to a solution to my problem. I want to add that in my FNAC, this was found:
        Both Left and Right testes are circular and shows Sertoli cells(80%) amixed with Spermogenic cells(20%) comprising of spermatogenis and primary spermatocyte. No spermatids or sperms found.
        Respected sir, Did you mean that I should not be given Testosterone injections at all?. And will this lead to more maturation arrest and infertility?.
        I am quite shocked that I have been given wrong injections for treatment.
        Highly thankful to you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  87. Dear Paul Turek,
    FIrst of all thanks for the reply which could guide me to a solution to my problem. I want to add that in my FNAC, this was found:
    Both Left and Right testes are circular and shows Sertoli cells(80%) amixed with Spermogenic cells(20%) comprising of spermatogenis and primary spermatocyte. No spermatids or sperms found.
    Respected sir, Did you mean that I should not be given Testosterone injections at all?. And will this lead to more maturation arrest and infertility?.
    I am quite shocked that I have been given wrong injections for treatment.
    Highly thankful to you.

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

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

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

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

  89. Dear Dr. Turek,
    My husband is an Asian and age 34 and was diagnosed azoospermia. His first semen test shows no sperm seen on centrifuged sample, the second shows “ Rare nonmotile sperm present in low concentration.” Fructose shows positive. The urologist then ordered the hormone test and chromosome test for him, that all comes normal.FSH was 8.8, LH 3.5, PROLACTIN 7.1, testosterone 259 (close to lower range though). Since he has no injury or surgery done before, the doctor said it is unlikely to be obstructive azospermia, and it is very possible to be maturation arrest. He didn’t order ultrasound for him since he said the infertility specialist will do that any way.
    Now we’re in the stage of wanting to know the reason for his azoospermia and want to be sure there would be sperm in him before I start my IVF cycle.
    We are still hoping he could be obstructive azospermia (etc.,absence of duct), so that it would be easier to retrieve fresh sperm to be used in IVF+ICSI.
    Dear doctor, based on the info (and I know it is limited), do you think it is possible to be obstructive azospermia?
    And if there is nothing wrong with the later ultrasound result, is testicle biopsy the main option to diagnose if it’s obstructive or non-obs?
    If yes and it turns out to be non-obstructive, then usually how long does people needed to be recovered from the first biopsy to do the FNA mapping and/or eTESE ?

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

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

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

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

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

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

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


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

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

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

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

  95. Hi Doc
    i did testicular biopsy and below is the result
    infertility with azoospermia
    no spematozoa could be detected
    complete late spermatogenic arrest at spermatid level
    no evidence of neoplasia
    Please let me know if there is any chances

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

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

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

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

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

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

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

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

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

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

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

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

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

      1. Thank you for your response and offer to review the information. As it happens I am halfway through my cycle now and my husband will have a synchronised retrieval on the same day as my egg retrieval. ( and use the frozen as possible back up) Considering all this – perhaps it is best if I leave things to fate now – as within the next fortnight we will know something either way… in case you review all the info and the outlook is not good, it is perhaps better for me not to know this now and to just try and stay positive that we will have our miracle. If it is helpful for your research, once everything is done I would be happy to send you the details and the eventual outcome. thank you for your kindness to me and to so many others that I see on this board.

  102. Hello,
    Like everyone else here, my husband was diagnosed with NOA. FSH of 24 and Testosterone of 350 with small testis. We did a TESE and they took multiple tissue samples and found few very immature sperm that did not survive the test thaw. We are planning on going forward with a mTESE but in wondering if it is safe to do so, what our chances are, and if the few sperm we thawed might be usable? Thank you for your time.

  103. Hi Dr Turek
    I did a biopsy. The clinic told I have maturation arrest. The results are testicular parenchyma composed of semiinferous tubules showing decrease spermatagenesis with maturation arrest. occasional tubules are lined only sertoli cells. moderate thickening of basement membrane seen, no leydig cells hyperplasia seen. mild interstitial fibrosis seen.
    I am very devastated. is there any thing I can do to become a biological father. Pls help

    1. Dear Bob, men with maturation can in fact have sperm if someone simply looks harder with FNA Mapping or mTESE. Unfortunately, mTESE is not all that useful here as it is largely a visual technique and maturation arrest tubules look very similar to normal ones. Consider a Second Opinion to learn more.

  104. Dear Doctor
    I really need your advices:
    I underwent a testicular Biopsy in January 2015 and the microscopic showed the following: the section of both right and lefttestes biopsiesshowed hypoplasia of germinal epithelium with maturation arrest at spermatid level in some somniferous tubules or spermatocytes in other. The interstitium showed varyingdegrees of fibrosis, leyding cell hypoplasia was evided blood vessels were not atherosclerotic. The conclusion was: SPERMATOCYTIC ARREST.
    And the blood test taken 3 months before were shown: FSH: 37.3mUI/ml
    LH: 9.69 mUL/ml
    Estradiol: 37.3pg/ml
    Please Doctor, Am I steel have a chance to be a biological Dad?

    1. Dear Emile, Maturation arrest can occur early at the primary spermatocyte stage, and later, at the spermatid stage. The fact that spermatids were mentioned means that in some areas, there is progression to the later stages of spermatogenesis. If this is indeed true, FNA mapping has a reasonably good chance of finding sperm as: “where there are spermatids, there are usually sperm.”

  105. Hi Dr Turek
    I was diagnosed with NOA. I had a testicular biopsy on the right side. Below are the results
    1. Testicular Parenchyma composed of seminferous tubules showing decrease spermatogenesis with Maturation arrest
    2. Occasional tubules are lined only by sertoli cells
    3. Moderate thickening of basement membrane seen.
    4. Mild interstitial fibrosis seen.
    5. No leydig cells cell hyperplasia seen
    My family is so devastated. Pls show some lights. Can i became biological father.

    1. Dear Bob, This signifies non obstructive azoospermia. Genetic testing for Y chromosome deletions or chromosome issues (karyotype) may explain it. Maturation arrest can occur early (primary spermatocyte) or late (spermatid stage). Often times, if you look harder with FNA mapping or mTESE, sperm might be found. Consider a Second Opinion for this one!

  106. Hello Dr turek,
    I had a semen analysis done about 10 months ago and no sperm was found. Then I was on prednisolone 2.5mg daily and dhea supplements due to adissons. I then did a hormone test which showed fsh of 22 IU/l and lh of 11IU/L And testosterone of 0.4 nmol/L. Testicular volume was measured at 16-14 ml on the right and between 12-10 ml on the left. I then abstained From the drugs for about 3 months and did another test. Fsh now at 14.5, LH was 7.5 and testosterone was 15.85. I then did another seamen analysis but still no sperm. I then started on Clomid 2.5 mg per day. After two months did another hormone test with fsh at 46, lh was 28 and testosterone was 37. I have not yet done another semen analysis, but was wondering if you could shed some light on this and what possible tests I should carry out next

  107. Hello Dr,
    I have been trying to conceive with my spouse for over a year. i was not sure of myself as i was on prednisolone (2.5 mg daily/ 4 yrs) and dhea (6-months) (adissons). Did a semen analysis and it showed no sperm. Did a hormone test fsh- 22 IU/L LH – 11 IU/L, Testosterone – 0.4 nmol/l.
    i then abstained form both drugs for three months and repeated the hormone test : FSH : 14.5, LH – 7.5 and testosterone 15.85 nmol/l. i did another semen analysis and it still showed no sperm. i started on clomid, after two months of clomid FSH – 45.9 LH – 28 and Testosterone – 36.77. By the way the normal range at the test centre was FSH – 1.0 – 19 IU/L, LH – 1.0 – 9.0 IU/L, and testosterone – 9.0 – 35.0 nmol/l.
    I am yet to repeat the semen analysis after clomid, but was wondering if there was any diagnosis you could give on this and any tests you would suggest for me.
    Thank you

    1. Dear Smart, Sounds like it was a smart idea to stop the DHEA which is a mild anabolic, kind of like testosterone supplements. This could have suppressed testosterone production. Adding clomid is probably icing on the cake. Now you need to wait 6-9 mos at least to see any ejaculated sperm after 4 years of suppression. Given the high FSH on original meds, it is quite likely that you could have a low or no sperm count though. In this case, I would consider “looking” in the testis for pockets of sperm in case the semen analysis is still 0 after 9 mos.

  108. Hi dr,
    my husband did a biopsy for his testicles and he was diagnosed with markedly decreased numbers of mature spermatocytes. Although markedly decreased numbers of mature hepatocytes are present.
    What does this mean? And can u use this with in vitro or icsi? If not can he has a medication to improve his spermatocytes to mature sperms?

    1. Dear Sadden, I have no idea what “markedly decreased numbers of mature spermatocytes” means. My advice is to consider a Second Opinion with us and send along the actual biopsy slides for our review and we can categorize it in ways that make sense.

  109. Hi Dr,
    In 2012 i was 30 years old and I had sperm. My tests showed 2 million, zero, 1 million, and 600,000. All hormone levels ok. I did use steroids around 18 years old and M1T later in life.
    Fast forward to 2014. We were set to do ivf egg retrieval and suddenly I had zero sperm. Tested two days later zero sperm. Tested again the day of retrieval 20 sperm found. They had terrible morphology. The embryologist searched all day and felt comfortable fertilitlizing 3 eggs. They all fertilized but only 1 embryo made it to freeze. We got 1 embryo. Through the next months I tested once a month looking for soerm to freeze. I guess my clinic might have a protocol on how many soerm are freeze able because they never froze. Anyways I started testing every other weekend sometimes every weekend. They found some sperm and were able to fertilize the last of our eggs. We had 7 left. The embryologist didn’t think they wound fertilize, but they did. The embryos do good until day 3 then they drop off. 2 made it that time. We had them tested and out of the 3 total only one was normal. Transferred it, but we didn’t get pregnant.
    I abused hydrocodone throughout this whole journey. About 3 years. Can this be the problem? I just quit about 2 months ago.
    Why did I have sperm 3 years ago and now none?
    Can we have success without surgery?
    I have tried HCG but haven’t seen any real results in ejaculated sperm….

    1. Dear Lost, first of all, when sperm counts are really low, they vary a lot. So natural variation could account for you not having enough sperm when you needed it. Second, hydrocodone causes low testosterone and low testosterone means less water for the plant (sperm production) to grow. I would check your reproductive hormones and optimize them as best as possible. The real question is why is your original sperm count only 2 million? Do you have a genetic cause of this? A varicocele? Or has this been attributed entirely to past anabolic steroid use?

  110. My name is Tunji. I did a sfa in June and d result reads volume-1.5, ph-7, pull cell -2-4, culture-yielded growth of coli, fructose-positive but nill sperm with Azoospermia result. The dr placed me on some antibiotics and manix and I took d manix for 40 days did another sfa which reads volume-2.0, ph-8, pull cell-2-3, culture-no growth, fructose-negative, nill sperm nd d resulkt is also azoospermia. Pls with these results, it is obstructive or non obstructive and can I continue with the manix. Thanks.

    1. Dear Tunji, Your ejaculate volume is low to normal with a normal pH so this is not likely to be obstruction due to ejaculatory duct obstruction. Not sure that the antibiotics and Manix were helpful as those “pus” cells were likely simply immature germ cells and do not represent an infection. Testicular volume and FSH levels can give better clues regarding whether this is obstruction or NOA. If they are unrevealing, a testis biopsy or FNA mapping can help determine. A testis biopsy is fine for defining obstruction but it may not be sufficient to find sperm if you have non obstructive azoospermia.

  111. Hi Dr. Trek, my husband has obstructive azoospermia with 91 percentage DNA fragmentation. We had two failed ICSI. What is your opinion on us trying again? His hormones were all normal. I am 36 now.

    1. Dear Shoba, Not sure which sperm (ejaculate or testis) has 91% DNA fragmentation but thats HIGH! Certainly consider using TESA/TESE sperm for IVF-ICSI if at all possible. Consider also FIXING the obstruction!

  112. I was diagonise for azospermia with small testicles sir,for two yrars now. Thus, I have procured spermhope. I need your annie sir

    1. Dear Olubusayo, SpermHope is a herbal/hormone supplement and may or may not help. Let us know how it goes if it doesn’t help. We’ve got a lot of tricks up our sleeves.

      1. Dear Dr Turek,
        My husband has azoospermia due to undescended testicles. He had corrective surgery done before he was 7 years old.
        He has small testis and has undergone TESA but no sperms found. Doctor has suggested for adoption or DI. Is there even any hope for us to have biological children?

        1. Dear Joanne, Undescended testicles are a classic cause of non obstructive azoospermia. There is also a very good chance (70% by FNA mapping) that there are pockets of sperm in those testicles. TESA procedures, depending on how extensively performed, may simply not be looking hard enough!

          1. Dear Dr Turek,
            Thanks for the kind response. Appreciate it. Unfortunately we are not local.. would wish to get a consultation with you. May I know what is the estimated cost for consultation and FNA mapping at your clinic?

  113. i am a biotechnologist and an independent researcher. no sperm count in my semen analysis. i am regularly studying a scientific publications every day.
    i found immature spermatozoa in my semen analysis and zero sperm count.
    is there any cure to convert immature sperms to a mature ones….??
    hoping your reply.
    Thank you

    1. Dear Aqib, There is not currently a technology to convert immature to mature sperm…but we are working on it! Before you go down this road in the future, though, you need to know that there could be a 55-60% chance that you have mature sperm in your testicles as we speak!

  114. Hi Dr Turek
    My clinical results says I have maturation arrest and the results are testicular parenchyma composed of semiinferous tubules showing decrease spermatagenesis with maturation arrest. occasional tubules are lined only sertoli cells. moderate thickening of basement membrane seen, no leydig cells hyperplasia seen. mild interstitial fibrosis seen.
    I want to try FNA Mapping. Could you please give me a rough estimate about cost since I am from India.

    1. Dear Krish, Men with both early maturation arrest (primary spermatocyte) and late maturation arrest (spermatid) can have sperm after FNA Mapping. In fact, FNA Mapping may be the better choice for you over mTESE as maturation arrest tubules appear visually identical to normal sperm containing ones, making it similar to shoveling snow in a blizzard. Please contact us for costs, we’d be happy to tell you.

  115. Hi Dr. Turek, my husband has been diagnosed with Obstructive Azoospermia way back in 2008. We were married for 3 years during the said year. IVF were not advised by the doctor due to its expensive procedure. Fast forward to 2013, we decided to ask how much will it cost for the treatment. New urologist performed TESE on my husband. Only 3 sperms were collected and wasn’t scanned if its alive as they immediately froze the specimen. Again, IVF was not recommended because its too risky considering the number of his sperm. We switched to another doctor. 3rd doctor introduced Sperm Hope. He was medicated or 6 months before undergoing for another TESE. Just this year, husband was again diagnosed with azoospermia. Doctors advised us to just adopt. Please help. Your inputs will be greatly appreciated as I am turning 34 this year and time is ticking 🙂

    1. Dear JT, It sounds like from what was done to date that, in fact, there is NOT a blockage present and that NON-obstructive azoospermia is present. I base this on the finding of only 3 sperm collected at TESE. Normally there would be at least hundreds. However the good news in all of this is that SPERM ARE PRESENT. The question is whether or not there are enough frozen to proceed with IVF-ICSI and a thaw. IF not, consider a backup sperm retrieval or a “know before you go” FNA mapping procedure to guide sperm retrieval from the testicle if needed.

  116. Dear Dr.Turek
    My husband was diagnosed with azoospermia in 2014 , hormonal test was done and all is in the normal range,normal testicle size on US, mild variocle on both testis. He went through bilateral open testicular biopsies with magnification and the result was only germ cells/spermatids were found but no mature sperm,we couldnt fully understand what it meant and our doctors comment was till now medicine didnt find a solution to our case!! We didnt do any genetic tests since DH refused to do anythin more because was davistated.just recently he became ready to try and the dr suggested takin tablets for 2 months to increase his testesterone before surgery??? We are kind of lost dr.. i feel we r not given the right advice. Plz advice us.. is there any hope?? Shall we do the y chromosome microdeletion test? And if positive does it mean another surgery is useless??? I would really appreciate your advice
    Thank you

    1. Dear Sarah, Genetic testing can 1) explain what’s going on and 2) OCCASIONALLY predict whether sperm will be present or not in the testicle. So, if either of those matter to you at this point, you should consider genetic testing. It is interesting that you mentioned “germ cells/spermatids” and “mild varicocele” as late maturation arrest (spermatids) can often be converted into sperm by repairing varicoceles. Not enough sperm to conceive naturally, but sperm in the testicle. It would be important to know if this statement (germ cells/spermatids) comes from a histological look at biopsies taken during the procedure or was simply a “guess” by the lab reviewing the fresh tissue specimen because, as I always say, “where there are spermatids, there are usually sperm.”

  117. Hi Dr Turek,
    I m diagnosed with NOA and had failed TESA.
    Underlying reason due to crystordism. Had done surgery at a young age.
    I want to ask if it is worthwhile to proceed with micro TESE or TESE ? Have u had a case which sperms are found in TESE/micro TESE but had a failed TESA?

    1. Dear Augustin, ABSOLUTELY I have had cases of finding sperm in men with one or both testicles undescended at birth and then brought down during childhood. We and others have published that it is best to “drop” the testes into the scrotum with surgery before puberty as testis cancer rates are lower the longer the testis is in the scrotum in life. Probably also true of sperm production. Currently, with FNA Mapping, we find testicular sperm in about 70% of men with a history of undescended testicles. I mention FNA mapping rather than TESE or mTESE as these procedures are more invasive and pose a much higher risk of leading to low testosterone states requiring testosterone replacement.

  118. hi doctor , please help me am very sad
    before two week i did testicular biopsy cause i have azoospermia , and the result was :
    consistent with spermatocytic arrest , and no sperm found of course , the doc gave me ginexin-f and selenium-ace for 3 month
    but i used them before and still no sperm
    so please doctor do i have hope , what should i do next
    sorry English is not my native language

    1. Dear Mohammad, A single (or even two) testis biopsies are simply not sufficient to determine whether sperm are present or not in the testicles, even with maturation arrest on the testis biopsy. FNA mapping (my favorite!) or microTESE may be options for you at this time.

      1. hi doc and thank you very much for ur fast reply .
        i want to explain that the operation i did was with microscope and the doctor told me the he cut the whole testis and search it with the microscope , so is this operation is what you mean by microTESE , if yes , what do suggest ?
        as i already did it what you suggest first .
        thanks and regards

      2. i want to narrow important thing that i did 7 semen analysis and all of them was 0 sperm , but in one of them i found 200000 dead sperm , so is this result sign of something doctor ?
        thanks you very much for reply and am waiting for you please answer me

  119. Dear Dr Turek
    I recently produced a SA which resulted in a count of zero. My partner and I were both very shocked and distraught. As a follow up today I gave blood (awaiting results) and had an ultrasound which detected no blockages or abnormalities. I’ve booked into a specialist (a 1.5month wait) and was trying to remain positive until I started doing my own research.
    At 18 months old I was treated for a rhabdomyosarcoma that was wrapped around my bowel. After many operations I was treated with 1 month of radiation and a high dose of chemotherapy every 3 weeks for approximately 1 year.
    I haven’t been able to pin point exactly what chemotherapy I was treated with but according to my research cyclophosphamide is most common factor in treatment for rhabdomyosarcoma. Unfortunately it is also the most common factor in permanent azoospermia.
    If this true does the trail end here or is there another way and a glimmer of hope to hold onto.
    Thank you for your time in advance

    1. Dear Dan, That’s quite a story! You are a good sleuth and I am pretty sure that a history of having a rhabdomyosarcoma at age 1-2 and the treatment of this condition is the reason for azoospermia as an adult. Rhabdomyosarcoma’s are aggressive cancers and demand aggressive treatment and it is very likely that you had cyclophosphamide chemotherapy. It is also quite possible that you have small pockets of testicular sperm that could be used for IVF-ICSI and pregnancies, despite the lack of ejaculated sperm. Testis biopsy, FNA mapping and microTESE are three very different ways to figure this out. Keep researching and give us a call to talk more when you are ready!

  120. Dr. Turek- I recently underwent a micro-TESE. No sperm was found during the procedure, and the pathology report diagoised me with sertoli-cell only syndrome and also found no sperm. Is this a dead end for me/no hope for finding sperm? Is a second micro-TESE ever recommended?

    1. Dear Sam, I recently put together a series of patients for presentation to Dr. Schlegel at an international meeting. Among n=65 men who had failed to have sperm on mTESE procedures, I found sperm in 29% with subsequent FNA Mapping.

  121. Hi Dr Turek,
    Is there any clinics around the Asia region where they have the technology to find pockets of sperm? like FNA mapping.

    1. Michelle, most of the world seeks to do microTESE as it is easier to learn and is simple extension of a common skill set (the testis biopsy) among urologists. FNA mapping is totally different and has a steep learning curve.

  122. Dear Dr. Turek
    My husband did testicular biopsy and the result was partial maturation arrest at the level of primary spermatocyctes. In doppler it was detected that he has variococel in left testis. His FSH is little high. Other all finding are normal. Seminiferous tubules with partial maturation. Please suggest. I require your help.

  123. Dear Dr. Turk
    My husand did a testicular biopsy which showed partial maturation arrest at the level of primary spermatocytes. He also did doppler studies which mentioned his left testis with varicocele. His seminiferous tubules with partial maturation. His SA showed azoospermia. No sperms on ejaculation. Can you please suggest something. So that my husband can become father. I will visit your clinic soon. I stay in UAE Abu Dhabi.
    Thanks waiting for your reply

    1. Dear Reshma, we have found that some men with maturation arrest and no obvious definable genetic cause (Y deletion or karyotype issue) will start producing testicular or even ejaculated sperm after varicocele repair. Consider this.

  124. Dear Dr. Turkey
    Yesterday i mentioned my problem but I dont know why the website is not accepting my message. I will mention once again my problem my husband did testicular biopsy and the results showed that he had primary spermotocyte maturation arrest. He did SA and found out to be azoospermic. No sperms were found. His doppler report shows that he has variocele in his left testis. I will be grateful if you suggest something. I am waiting for your reply. I will visit your clinic soon.
    Thanks & Regards

    1. Dear Reshma, My sports buddies used to call me “Turkey” when I was a kid. Ah the memories…Your husband should consider further evaluation of his non obstructive azoospermia with FNA Mapping or MTESE procedures as they are quite good at finding sperm when biopsies can’t. Between them though, mTESE is at a bit of a disadvantage here because testis tubules in maturation arrest look VERY similar to normal (sperm containing) tubules and can be very difficult to distinguish by mTESE (visually).

  125. Dear Dr. Turek
    Sorry for misspelling your name. I am happy that you answered to mail so quickly. I will definitely go for sperm mapping. I am pleased that in this busy world people running after materialistic thing you are the person who give hope to couples like us.
    Thanks & Regards

  126. Dear Dr. Turek,
    I forget to mention few things before doctor my husband did peta seta and they found few sperms with no head and tail and so our ivf got failed and that time his FSH was very high. Later after 1 year we did FSH and it came down it is little high. His LH is normal. His testesterone is quite good. When did doppler and found out that my husband has varicocele in left testis and his testis are small. My husband SA showed azoospermic. His biopsy report partial maturation arrest at the level of primary spermatocytes. Testes show thick walled semiferous tubules with partial maturation. Doctor has prescribe 2 talbets to increase sperm count. He is taking carnisure 500 mg and Ubiactive both this tablets twice daily. Please suggest something. I will call you and i will also send you the slide. I will grateful if you tell what exactly we have to do. We are arranging for leave to come to your clinic very soon. I am really disturbed because no child for 14 years. My husband is 42 years old.
    Reshma Ahmad
    Reshma Ahmad

  127. Dear Doctor Turek,
    I am husband was diagnosed with non-obstructive azoospermia back in 2008:
    “the biopsy shows many seminiferous tubules limited by a thin basal .
    The cell population present a maturation of a maximum of the stage of primary spermatocytes. It has not been found secondary spermatocytes or spermatids or spermatozoa. The interstitial tissue is not fibrous, do not contain any inflammatory infiltrate.”
    3 weeks ago l have started an IVF treatment with IVF Michigan hoping to find sperm unfortunately during sperm Aspiration/Biopsy no sperm were found and my cycle was cancelled. I am devastated right and really direction from expert like you. My husband hormone levels are all normal. Is there any hope for us?

    1. Dear Adama, This is classic maturation arrest pattern of testis failure. Visual techniques such as microTESE do not do all that well to find sperm in this scenario as these testis tubules look nearly identical to normal, sperm containing tubules and can “fake you out” in a sense. After 6 mos of rest, you consider FNA Mapping with a 10-20% chance of finding sperm.

  128. Dr turik
    I am from india. My husband harmones test shows that LH 2.5 mlu/mL and FSH 2.0 mlu/mL and testicular biopsy report shows(both the biopsies show seminiferous tubules with mixed picture of maturation arrest with normal spermatogenesis).our doctor suggest us for ivf treatment. Now we seen your website please give us any suggestion which will good for us and is there any chance for become father of my husband.please sir reply me

    1. Dear Poonam, Certainly with a biopsy reading of at least partly normal spermatogenesis, a testis sperm retrieval with IVF-ICSI could work. That could make you a father. However, if the “normal spermatogenesis” reading actually reflects late (spermatid) maturation arrest, then there may not be sperm for IVF-ICSI. A biopsy cannot distinguish these two patterns reliably, but FNA Mapping can.

  129. Dear Dr Turek …
    Good evening.. it has taken me 6 months to find the courage to write you ….
    I have an unusual case …. I am from Nigeria …I am an avid power-lifting athlete as well as a school swimmer in my younger days …. I started lifting weights since I was 14 and has continued ever since …I am now 40 years old. 5 years ago in 2010 I toyed with steroids for athletic enhancement over a course of 2 years stopping in May 2012 …never touched steroids since then. However unknown to me I had varicocele which came to light when I got married last year and began ttc.
    I had started having severe weakness and unexplained fatigue along with a less than convincing lowered libido…. when I did a SA the results came back with nil count and a second test formally confirmed azoospermia. I was immediately recommended for icsi/assisted reproduction …In the confusion though I elected to understudy my problem and recommended a scrotum analysis from my doctor …the test confirmed varicocele grade 3 on the left. A second Doppler ultrasound confirmed grade 3 and 2 on the right and left respectively. My blood work revealed a high FSH of 72 on a 1-19 scale range while my testosterone result was low but normal. My testes have become markedly reduced by about 80%on a scale of 10 even though all other testicular parameters were unremarkable and ok. The prognosis was that the varicocele prevented my recovery from the steroid cycle and then may have escalated the atrophy that resulted from my use of steroids
    In late December I underwent micro-surgical varicocelectomy in India and the effect in the first 6wks were increased libido and wellness …my libido was like when I was 16. I began my normal exercise routine and on the 10th week began to experience lethargy and increased pain in the left testicular region that radiated to my lower left limbs and half of my waist region …my libido dipped and my energy levels were dizzyingly halved .
    I went for blood work to confirm my concerns …the results were mixed …my FSH level dropped 29% from th previous 72nm/l to 53nm/ (range 1-19) while the test levels were at critically low values of 7.85ng/l (range 9-35) from the equivalent of 30 ng/l recorded in India. Lh rose 31% to 31nm/l from 22nm/l. This result whilst encouraging was also at variance with post varicoceletomy results expected after surgery.
    I also underwent ultrasound tests for the scrotum and the results showed varicocele grade 3 and 4.the surgeon dismissed it as not serious and would clear out in 6 months; He recommended doxycycline and levoflacine tabs for the pain. it’s been 9 months since varicocelectomy, all pains have cleared out. Whilst I feel a whole lot better and have been very healthy, strong and stable and my sexual state seemed excellent compared to immediate post-ops period; I am However not confident enough to conduct another test and I have not been able to conceive within this period. I believe that my testicles though firm and normally sensitive 80 % of the time are too small to allow sperm generation, and when they are created cannot withstand heat from pants and long sit-downs from my job. I am also not comfortable with the invasive nature of the procedures available in my environment that may injure my reduced testicles and affect testosterone production irreversibly. At this point I am seemingly short of options than to wait or undergo this invasive sperm extraction procedure which is usually blind.
    Hence I have elected to take the FNA mapping option as I reckon it would have least impact on my testosterone level giving the size of my testes. As I write I had already purchased tickets to San-Francisco during the fall but the currency situation has become so bad I can ill afford your procedure for now as the cost have tripled in my currency terms.I may have to postpone until i can save enough but time is a luxury i do not have!
    As a stop gap until I can afford physical engagement with you I would like to have some questions answered….1. Is there any hope for me …2 if there is hope of finding spermatogenesis would FNA mapping be the optimal approach and what are success rates for men with my history? .and peculiarities. .
    3. if the last option were stem cell therapy or IVG , etc, how close is a breakthrough and will men like me be qualified for treatment 4 Are there other trick/options in the book that will allow me to at least have a child with my very beloved genes and that of my beloved wife whom i really would love to give me a child of her own?
    Thank you for your prompt response and Godbless …

    1. Dear Henshaw, this is an incredibly well written and well considered summary of your story. Nonobstructive azoospermia could certainly be due to the compounded effects of varicoceles and anabolic steroids, varicoceles alone, genetics alone (Y deletion/karyotype) and genetics and varicocele. The chance that a varicocele repair would result in the presence of ejaculated sperm after initial azoospermia is 30-35%. Certainly worth checking at this time. The chance that FNA mapping will show pockets of sperm that are usable for FNA Mapping is 60-65% at this time (assuming ongoing azoospermia). The choice of FNA Mapping vs mTESE is also very well considered as your testosterone levels are borderine low and need protecting in the future. I hope that this addresses the question of whether there is hope for you. In terms of in vitro sperm production, give it a good 5-10 years.

      1. Dear Dr Turek ,
        Please forgive my late reply to your exhilaratingly liberating response to my situation. I have been out as volunteer for a charity. It was like having a little candle in the darkness. I have also read the follow up story below and I am quite positive in terms of outcomes. As i outlined in my initial thread i have two major goals .. find sperm and increase my testes/testosterone levels to improve my quality of life so i can continue to do my sports and raise a family; ” fortunately” you are the clearest route yet to achieve these goals. With this said, notwithstanding the costs I will undergo your procedure as soon as I am able to obtain the funds;
        Although i am not local, however i will be in Dallas next week for only 3 days till 19th. I was wondering if I could pay you a day visit at your clinic for preliminary consultation and familiarization on my case. It will help me psychologically to assess the possible outcomes; I am always with my case history. In addition I also conducted FSH, LH tests lately; FSH remained steadily high at 55 while LH dropped back to pre-surgery levels of 23 n/ml. With my testes shrunk to less than 20% of its original size I am hoping that sperms will still be found? I am also hoping that the volume will increase again.
        Please let me know the possibility of my request and what protocols are make this successful. Thank you for your kindness.

  130. I just had FNA mapping done with Dr.Turek and although I have not gotten the results back yet because it takes about 3 weeks, I am already more hopeful as before, as my diagnosis went from azoospermia to cryptospermia even before the procedure with Dr Turek.
    I found out years ago I was azoospermi in Canada.
    – I had 2 semen analysis done that came back negative.
    – I saw a urologist who performed a testicular biopsy which came back Sertoli cell only.
    ** I asked if there was anything that could be done in the world, was told no **
    – Me and my wife researched and went to a supposedly famous infertility hospital in fukuoka Japan called st mothers and got a mTESE done (surprisingly not that expensive). But that also came back as no germ cells.
    ** Also asked this Dr if there were any other options in the whole world, was told no… ps: the results came verbally, when we requested a copy of the results the next day, it was handwritten on the spot with no details in a single sentence, useful. Also felt like the dr was trying desperately to sound smart by giving the results to me in English and using big words, it had the opposite effect, he should’ve just explained to my wife in Japanese I spoke enough to understand anyways or to probe myself in if required **
    – In dark times I found and read about Dr. Turek through his website and blog, asked if I had hope via FNA mapping despite my previous results through his blog, he said yes with small percentage given the little information provided.
    – booked appointment with his office and went to San Francisco, gave a semen sample (gave 2 shots in one cup for good measure) and although first check came back 0, after spinning the semen from 5ml to 0.1ml then searching for an hour, they found 2 non-motile sperm
    – my world changed from azoospermic to cryptospermia and FNA mapping chances went to ~79%, I had hope!
    Dr. Turek said he had to pressure the semen analysis team for 5 years to get them to search as much as they can, they don’t just take a peek and say no sperm, they search high and low because they know how important it is to us.
    Dr. Turek said that he knows this is so important to us that he doesn’t completely rely on the industry standard of visual queues when doing biopsies mTese or mapping, I’m paraphrasing but I hope I got that right. Him and his team searches high and low for our hope,v they are not only thorough but also super nice and caring!
    Anyways, I came out of my mapping with no pain, barely any bleeding nor swelling. Didn’t need painkillers at all, your mileage may vary on this.
    Only negative thing at all to this would be the price ~10,000 USD for procedure+surgery facilities, the kit caboodle without insurance. But what price do you put on the only hope in the world?
    Would recommend 10/10.
    Thank you Dr Turek!

  131. hello dr turek
    i am poonam from india.My husband is suffering from azzospermia we have done semen analysis test two three time and we got same result nil sperm count then our dr. suggest us for testicular biopsy and fsh and lh test we got reports as”both the biopsies show seminiferous tubules with mixed picture of maturation arrest with normal spermatogenesis” and LH 2.5 mlu/mL and FSH 2.0 mlu/mL.
    Dr. suggest us for IVF/ICSI .
    Give me some advice.Is there any other treatment instead of IVF/ICSI according in your opinion.

  132. What are the chances for sperm to be found during FNA Mapping if I have been diagnosed NOA, got mTESE done and no sperm was found? The hormones lever is normal, except FSH (High) and everyhitng else is normal

    1. Dear Maria. In our latest reported series of failed mTESE procedures, we found sperm in 29% of men on FNA Mapping. The best histology pattern for finding sperm is maturation arrest pathology, as the visual cues that normally guide sperm retrieval during mTESE are virtually absent in this situation.

  133. Dear Dr. Turek,
    My husband has non obstructive azoospermia. 1st TESE was done in 2015 revealed only spermatocytes. Please note that he suffer herpes month before TESE. He consumed himalaya products for 6 months and semen analysis showed occasional spermatozoa seen (well, we are not sure if this is really true). Then he was on HUMOG injection + continue taking himalaya for another 3 months, and TESE 3 months later show very few spermatids. We still proceed with ICSI, and we were able to have 3 embryo ( 7 cell, 5 cell, 4 cell) with <10% fragmentation. We transferred them all, and 3weeks 4 day after the ET, I miscarried.
    What do you think we should do next? Is it helpful if we take another humog injection but this time, take it for 6 months before doing another TESE?
    Thanks a lot Doc.

    1. Dear Ima, thats quite a story! What I see here in all of this is… progression. Primary spermatocytes at surgery and spermatid on repeat surgery after treating with himalayan products and human (hCG). Certainly I would wait at least 6 mos from any prior procedure to have another one. Be nice if you could continue with all treatments during this time. Instead of mTESE, you may consider an FNA Mapping procedure (remember on mapping: if there are spermatids, there are usually sperm) to determine BEFORE the time of sperm retrieval whether there are sperm to retrieve. After more TESE procedures, one wonders what’s happening to your testosterone levels.

      1. Dear Dr Turek,
        Are seminiferous tubules able to heal or regenerate? For example, if only a small part of the seminiferous tubules was damaged or destroyed, would the surrounding tubules regenerate it? By the way, I am not infertile, I just had a general question.

  134. Dear dr. Turek,I am writing to you because you are our only hope. In 2007 my husband was diagnosed with NOA after a sperm analysis and other investigations. In this years he took many natural supplements with no effect because he constantly did sperm analysis including last month when we went at an assisted reproduction center and they put him to make a lot of blood analysis,and he did.Then they send us at an urologist who consulted him and said that everything is ok. After we got the results of blood analysis(who were normal) we schedule the testicular biopsy (TESE) which was on second of December 2016,he still have pains.The result of TESE was negative even if the doctors said that he have chances to be biological father.He is 34 and he started smoking at 30 and drink occasionally. Below I will let the results of blood analysis.Please doctor tell us what to do next,what supplements you recomend to us, and our big question is : do man with negative results after TESE ever had sperm cells again ????? We are from Europe, maybe we can get a second opinion,we still have hope,we won’t give up.
    Thanks a lot doctor!
    LH- 6.40
    FSH- 7.50
    Testosterone- 4.39
    Karyotype in peripheral blood- There was no abnormality numerical or structural observed
    – Chromosomal formula: 46,XY
    PS:Also we wait for the result of cystic fibrosis analysis and the report of testicular biopsy, if you need all blood analysis results let me know and i will send to you.

  135. Dear dr. Turek,I am writing to you because you are our only hope. In 2007 my husband was diagnosed with NOA after a sperm analysis and other investigations. In this years he took many natural supplements with no effect because he constantly did sperm analysis including last month when we went at an assisted reproduction center and they put him to make a lot of blood analysis,and he did.Then they send us at an urologist who consulted him and said that everything is ok. After we got the results of blood analysis(who were normal) we schedule the testicular biopsy (TESE) which was on second of December 2016,he still have pains.The result of TESE was negative even if the doctors said that he have chances to be biological father.He is 34 and he started smoking at 30 and drink occasionally. Below I will let the results of blood analysis.Please doctor tell us what to do next,what supplements you recomend to us, and our big question is : do man with negative results after TESE ever had sperm cells again ????? We are from Europe, maybe we can get a second opinion,we still have hope,we won’t give up.
    Thanks a lot!!!
    LH- 6.40
    FSH- 7.50
    Testosterone- 4.39
    Karyotype in peripheral blood- There was no abnormality numerical or structural observed
    – Chromosomal formula: 46,XY
    PS:Also we wait for the result of cystic fibrosis analysis and the report of testicular biopsy, if you need all blood analysis results let me know and i will send to you.

  136. Dear Dr. Turek,
    Are seminiferous tubules able to heal and regenerate? For example, if only a part of a tubule was destroyed or damaged, would the surrounding tubules regenerate it? I am not infertile, I just had a general question.

    1. Dear Zeshaun, Not sure. I think that stem cells in seminiferous tubules either survive or not. You do not grow “new” tubules after damage has been done. Whatever survives, survives. This is also true of mTESE procedures: once you remove a tubule that “appears” to have sperm, but doesn’t in the lab, the entire spermatogenic pathway in that tubule is now gone. All done. No more. Be nice to just find sperm without removing the “seed” germ cells (spermatogonia) but this is not possible with mTESE procedures.

  137. Hello dr Turek
    I’m azospermia and try many normal TESE without speed found in 2013 in turkey micro TESE(two very small cut in secortum 10 mm length) is that micosessection TESE , but also no sperms and my test is harmenough stop produce tostesron
    Now can stem cell treat my case and where the best clinic to be trusted in Europe
    M Shalakany

    1. Dear Mohamed, Sounds like you have been through so many TESE/mTESE procedures that your testosterone production is now low. I know of no stem cell treatments worldwide for this issue. We are trying to raise several million dollars to make a stem cell based testosterone treatment but this will take 5-10 years.

  138. Dear dr. Turek,I am writing to you because you are our only hope. In 2007 my husband was diagnosed with NOA after a sperm analysis and other investigations. In this years he took many natural supplements with no effect because he constantly did sperm analysis including last month when we went at an assisted reproduction center and they put him to make a lot of blood analysis,and he did.Then they send us at an urologist who consulted him and said that everything is ok. After we got the results of blood analysis(who were normal) we schedule the testicular biopsy (TESE) which was on second of December 2016,he still have pains.The result of TESE was negative even if the doctors said that he have chances to be biological father.He is 34 and he started smoking at 30 and drink occasionally. Below I will let the results of blood analysis.Please doctor tell us what to do next,what supplements you recomend to us, and our big question is : do man with negative results after TESE ever had sperm cells again ????? We are from Europe, maybe we can get a second opinion,we still have hope.
    Thanks a lot!!!
    LH- 6.40
    FSH- 7.50
    Testosterone- 4.39
    Karyotype in peripheral blood- There was no abnormality numerical or structural observed
    – Chromosomal formula: 46,XY
    PS:Also the result of cystic fibrosis analysis is good and now we wait for the report of testicular biopsy, if you need all blood analysis results let me know and i will send to you.

    1. Dear Hope 1. This sounds like a case of non obstructive azoospermia due to genetic causes, whether definable or not. A y chromosome deletion test has a 15% chance of explaining why he has no sperm. There may still be pockets of sperm after a TESE procedure, depending on how extensive the procedure was. FNA mapping can detect pockets of sperm in 29% of men with prior failed mTESE procedures, the most aggressive of all sperm retrieval procedures. Wait 6 mos to allow him to heal and consider FNA mapping.

      1. Thank you a lot doctor,
        Yesterday we just got the report of testicular biopsy .
        My husband has Sertoli Cells Only Syndrome and also in the report is write this : ” In some isolated tubes, there is a maturational stop in primary spermatocytes.” and this: ” Multiple irregular fragments of tissue that grouped measure 2 x 1,5 x 0,5 cm. (All inclusive) ”
        All blood analysis came good and the result of cystic fibrosis analysis is also good ,Chromosomal formula: 46,XY
        Is there anything we can do to became parents, considering this results.
        Please tell me and I will follow your instructions.God bless you!

        1. Dear Hope 1, Testis biopsies can often several patterns of spermatogenesis. In this case, there may be a combination of no germ cells that eventually form sperm (Sertoli cells only) and early maturation arrest, in which germ cells are progressing from stem cells about half way (5/12 stages) to primary spermatocytes, but no sperm. Two possibilities for sperm exist here: 1) with further sampling or more intensive sampling (like using FNA Mapping or microTESE) sperm may be present elsewhere in the testis, 2) improving the testicular environment (i.e improve lifestyle, fix varicocele, consider medications to improve spermatogenesis), sperm might be made in places that they currently don’t exist. So, there still may be options here. Consider a call to talk more.

  139. Dear Dr Turek,
    I am 43 years old, live in Germany. 8 years ago I was diagnosed azoospermia. In 2013 I got microTESE surgery in Germany. Only elongted and round spermatides were found. My hormone level before micro TESE: FSH 34 mlU/ml, LH 13 ml/mlU, Testosteron 380 ng/dl; after microTESE, measured recently: FSH 47 mlU/ml, LH 19 ml/mlU, Testosteron level remains the same as before surgery. So only FSH and LH raised. Is it normal after microTESE surgery and is it something serious? I have additional two questions:
    1. Taking into consideration mentioned above factors, has microTESE had impact on my health? Testosterone level is quite the same, so I understand it didn’t affect it and I don’t need T replacement?
    2. Does it make any sense to have a second microTESE/ FNA in my case or it is better to look for other options i.e. donor, adoption?
    I am looking foraward for you replay and help. I really do not know what to do. Taking another surgery bearing in mind that the chances are low and risking lower Testosterone after that, etc…
    Best wishes

    1. Dear Jack, MicroTESE is a large procedure that can impact on testis health. It appears to have done so, albeit mildly, and you have maintained testosterone levels. This is not anything serious and should not impact your health. However, given that we do not know the long term effects of the microTESE procedure, you can consider checking T levels regularly (e.g. every several years) if you are concerned. As to whether you have usable sperm now, there are two considerations: (1) FNA Mapping usually detects mature sperm when late spermatids are present (and usually does not affect T levels) and (2) late spermatids are now being used like sperm with IVF-ICSI in some center (University of Hawaii). Best of the New Year to you!

  140. Dear Dr. Turek,
    I have Cystic Fibrosis and as a result require IVF, after one of the IVF attempts I went to my GP to ask about reconstructive surgery after doing some research, which suggested possibilities. This was about 3 years ago now and the Doctor I saw at the time said it was possible but put it at a low chance of success. Some background on this, I had tests done, which showed no sperm, I also had other examinations done which showed, to their surprise, that I do indeed have a Vas Deferens on one side (the left I believe) and as a result they summerised that the Vas Deferens must be blocked, hence he said that the procedure is possible.
    I know things have moved forward in the last three years and improved and from research I have carried out into the CF side of it, it does look like it is highly possible now, It’s just finding a clinic that can carry out the procedure. I live in the UK.
    I would be interested to hear your opinion on the matter.
    Best Wishes

    1. Dear Adam, it is extremely rare to have clinical CF and have a vas deferens. That is a good start, as most CF men are missing both vasa. Given this, the likely scenario is that you have either ejaculatory duct obstruction on the side of the vas being present or you are missing the vas in the pelvic region. A transrectal ultrasound (TRUS) is the key study to tell you what’s present, absent or blocked. Blockages in the ejaculatory duct can be fixed but missing tubing cannot.

  141. Dear Dr Turek,
    Thank you so much for replying! I have one general question concerning repeating mTESE/FNA and long term effects on health.
    What is wrong with testosterone replacement? I am rising this question since most of men with hypogonadism (azoospermia) have low testosteron and sooner or later will require T suplementation for better live quality. I heard and red only positive things about T replacement and men over 50 espacialy in US even without hypogonadism go for this therapy. If so I do not worry about future mTESE/FNA procedures in my case.

  142. Dear Dr Turek,
    Does Sertoli cell only syndrome include damage to the sertoli cell as well? Does a sertoli cell have to function fully to make sperm? And I read something from a NCBI paper on “Busulfan induced azoospermia: Stereological evaluation of testes in rat”. What does this mean: “Sertoli cells were compressed between the germinal cells and were not easily seen” (after a single dose injection of busulfan). They said hypospermatogenesis was observed, but does that mean the sertoli cells were damaged if they were “compressed”?
    In double dose of busulfan group, only Sertoli cell and complete germ cell aplasia were present.

    1. Dear Zeshaun, that paper was done by good colleagues of mine. It is their (and my) belief that most damage to sperm production occurs from damage to the essential support cells, Sertoli cells.

  143. Dear Dr. Turek,
    My husband never has more than a 2 million sperm count, and his morphology and motility are always poor. His hormones are all normal, and there is no blockage. He had a small varicocele repaired 1.5 years ago, but it made no difference. We have had 2 failed IVFs with ICSI. I have been doing some research about scrotal temps and the effect on sperm production. My husband sleeps in very warm pyjamas. I asked him to take the temp of his testicles in the morning, and they were 35.92 degrees. Is that hot enough to affect sperm production? Thank you so much for any insight you can provide.

    1. Dear Melinda the scientist, Not sure what to tell you here. The human scrotum has been adapted to regulating testis temperature for several hundred thousand years. My take is that this low sperm count may be genetic. Has he been tested for Y chromosome deletions or karyotype. Even if he had and the results are negative, it could still very well be genetic.

      1. Thank you so much for the response! He did have a normal karyotype. Luckily a repeat semen-analysis that was just done showed a count that had increased to 6 million, with 13% normal forms as opposed to the normal 0%, so hopefully that will increase the odds of a third ICSI working. He has been taking vitamins, so maybe that helped, since he has a terrible diet. Again, thank you so much for your response.

  144. Dear Dr Turek,
    Basically, I would like to understand why FSH, and LH were not changed after “the second part of the study”, or after the second busulfan injection that induced azoospermia. Shouldn’t this make FSH or LH rise significantly?

  145. Dear Dr Turek,
    I would really appreciate if you could reply on my post (January 9, 2017 at 1:17 pm) regarding positive effects of testosterone replacment due to past biopsy procedures like microTESE.

    1. Jack, it saddens me that you need T replacement after a biopsy/MTESE procedure. However, T replacement should do the whole job of replacement much needed testosterone to the body after sperm retrieval procedures.

  146. Dear Dr Turek,
    Basically, I would like to understand why FSH, and LH were not changed after “the second part of the study”, or after the second busulfan injection that induced azoospermia. Shouldn’t this make FSH or LH rise significantly?

  147. Dear Dr Turek,
    Thank you so much. My general question was: Is the any difference (influence on health) between own testosterone and testosterone therapy except cost.
    Kind regards

  148. Dear Dr Turek,
    I would like to understand why FSH, and LH were not changed after “the second part of that study”, or after the second busulfan injection that induced azoospermia. Shouldn’t this make FSH or LH rise significantly? Is it because they were rats in gestation?

  149. Hello Dr Turek,
    My husband has nonobstructive azoospermia. FSH is 12 iu/l. LH was much lower, around 2 iu/l. Testosterone is normal.
    We received the devastating news this week that his biopsy revealed sertoli cells only.
    I have since found an article by Schlegel saying that for some reason sertoli-cell only patients with FSH between 10 and 15 seem to have the worst prognosis (6% chance of finding sperm). This is apparently significantly worse than SCOS patients with FSH both below 10 and above 15.
    Can you tell me if your experience (statistically) has been similar?
    I fear we’ve found ourselves in the absolute worst case scenario of the azoospermic world.
    Best regards,

    1. Dear HJ, With FNA Mapping, I have not seen the correlation that Dr Schlegel describes but I have not applied any “statistics” to this as he has. Having said that, I do not believe that you are the “worst case” scenario” by any means, and FNA Mapping isn’t NEARLY as invasive as an mTESE. Take a smaller step and learn just as much.

  150. Dear Dr. Turek,
    Many thanks for your help. Which Testosterone you use generally in US and your Clinic i.e. gell, injections, etc?

  151. Dear Dr Turek,
    I would like to refer to my post sent in February. Do you think that Testoserone in gell is a good solution in my case? Would it be possible to get back to normal sperm production and FNA procedure after stopping Testoserone gell therapy?

    1. Dear Jack, I do not provide care over the internet and this is most definitely a care question. Typically, testosterone replacement by gel formulations is the most popular of all ways to take it and it works fine. Whether or not sperm production will return after it is stopped is an entirely different and very complex question.

  152. Dear Dr. Turek
    My husband was diagnosed with azoospermia. In 2006 we did SA and found 4 dead sperms. Later in March 2015 we went for IVF and PESA and TESA was unsuccessful. After 1 year we went for testicular Biopsy and which mentioned as primary maturation arrest at the level of primary spermatocytes. Ultrasound of testes revealed small varicocele on left testis. Urologist gave ubiactiv and levicaritinine tablets for 4 months and CQ LC for 3 months. In the meantime 3 SA showed no sperms So doctor prescribed carinisurre hormonal injection. My last FSh is 15.54 miU/ml and prolactin is 9.55 ng/ml and Lh is 3.95 miU/ml testosterone is 472.10 ng/dL. Now recently doctor performed testicular biopsy mentions severe hyperspermatogenesis with focal atropy testis bilateral It also mentioned no mature sperms or spermatids. Only rare tubules show spermatogenic cells.

    1. Dear Dr Nazeer, Got it. You probably have a tiny pocket of sperm in a maturation arrest pattern which is almost impossible to find by either TESE or mTESE. Consider FNA mapping to find that spot (78% chance). Consider a Second Opinion first where I can review all of the biopsy slides and confirm this theory.

  153. Dear Dr Turek
    Yesterday i posted my question i have still not got reply. The questions is also not appearing. Please can you can and let me know.

  154. Hello Dr.Turek,
    Since I got the test results informing me of having azoospermia, I have been reading up on and happened on your website. It’s been thoroughly informing.
    I had some sort of testicular/scrotal swelling as a baby and mumps when I was about 9-12 years old, can’t place the precise age. This was left to heal on its own. I however don’t recollect any scrotal swelling from the mumps save for the cheeks.
    I recently did a blood test for FSH it returned 25IU/L and had a previous testosterone level of 2.8ng/ml, LH level of 5mlU/ml and prolactin of 15.5ng/ml. I am currently discussing with doctors over here if I can undergo Surgical Sperm Collection . With your experience is there any chance of sperm retrieval using TESE or PESE? Mapping is not yet available in my country (Nigeria).
    Thank you.

    1. Dear Julius, your condition could be from either neonatal testis torsion or mumps orchitis or it could be genetic and unrelated, say due to Y chromosome deletions or a chromosomal issue (testable). With an elevated FSH level, it is highly unlikely that sperm will be found in the epididymis (beyond the testis) so PESA, MESA procedures are not worth it. Testis procedures have the highest chance of finding sperm with TESA (needle aspiration) being the lowest and microTESE being the highest. FNA Mapping is also a needle approach but uses many of them to create a “map” of sperm presence that later guides the best sperm retrieval. With testis biopsy procedures, which can affect testosterone hormone production, the more you have taken the higher the chances of finding sperm (from 30-60%). However, too many biopsies poses the highest risk of lowering testosterone levels in your body afterward.

  155. Thank you Dr. Turek. Your reply gave boosted my confidence to go in for the TESE and thankfully sperm was found for the IVF. We finally had 4bb and 4cb 5day embryos transferred.
    However, after the longest two week wait period, we received probably the saddest news of a negative pregnancy test. We were distraught and my wife wept profusely. Is there anything we can do, especially I, since its a male factor case?

  156. Hi there,
    My 27 year old partner has been given the following diagnosis as explanation for no sperm in the ejaculate:
    Genetic testing revealed a Y Deletion – (Gr/Gr)
    Low testosterone of 6.45
    High LH of 16.25
    High FSH of 29.34
    High TSH of 4.84
    Small testes measuring 9.8 and 10.4
    We have been advised against a biopsy due to the risks associated with his health, despite the hormonal issues he is a really fit and healthy guy with no symptoms of his low testosterone. He has a huge beard, good muscle tone and body hair, deep voice, normal sex drive and function – so really its so surprising that he has these results regarding the hormones. The doctors are concerned if we go ahead with a biopsy he may end up quite unwell. We have been told he most likely has a primary testicular failure associated with the Gr/Gr deletion and the likelihood of finding sperm is very very low as its possible he has never made any and never will. We have been advised to consider a sperm donor so i guess we are trying to explore all options before we start going down that path.
    Thanks for your time.

    1. Dear Aussie Pt, Yes this is non obstructive azoospermia. However a Gr/Gr deletion may be associated with sperm. I think your providers are worried that extensive sperm retrieval procedures will lead to low testosterone (hypgonadism), which is a reasonable concern. However, you could also consider FNA Mapping, which is far less invasive and could inform you whether there is mature sperm there with very low to no risk of altering testosterone levels.

  157. Hlw dr Turek . My husband (25) has (Noa). He had his undecended (both) testies operated at the age of 17. Our dr told us to looking for the donor .but it’s not our option we want our own biological child. Pls dr told me is there any hope for us? . we are not doing tesa or m tese yet. Bcz our doctor told us there is no chance at the moment he think.Its very emotional for me because we are not gonna use donor sperm because of the religious nd ethical issues. What should we do now please doctor tell me is their any hope ?

    1. Dear Shanta, Yes there is hope. Fertility is best preserved when undescended testicles are brought down BEFORE puberty. In such cases, FNA Mapping can find sperm in 65-70% of testicles. We have much less experience looking for sperm in testicle brought down after puberty but I suspect there is still a reasonable chance.

      1. Thank you doctor for giving us hope. Please check his report and suggest us what should we do now. Age: 25 , testo :11.1 Fsh :51.97 , LH : 10.58. Should we go for micro tese? PLEASE doctor give some advice.

        1. Dear Shanta, for nonobstructive azoospermia there are two high level strategic procedures that offer the best chance of finding sperm: microTESE and FNA mapping. In the case of low normal testosterone levels and high LH levels (also called compensated hypogonadism) the risk of lowering testosterone levels requiring replacement is much higher with microdissection TESE than with FNA Mapping.

  158. Hi Dr.,
    I did do FNA mapping, and spermatids were found, hence the dr. suggested MicroTESE. But no sperms were found in 18 samples (9 from each side). All my hormones, chromosomes, genetic testing is normal. In your opinion, is it worth to do microTESE again after 6 months?

    1. Dear Drew, I am sorry that no sperm were found after such a large procedure (mTESE). The problem with late maturation arrest (spermatogenesis progressing to stage 11 of 12 but mature sperm are not made) is that the testis tubules with this pattern appear identical in size and shape to mature sperm containing tubules and mTESE is not good at telling these tubules apart. So, I suspect that a repeat mTESE procedure will fail.
      On the other hand, sperm FNA Mapping examines the tubules in an entirely different way (and nonsurgically) and might be a consideration after 6 mos instead of repeat mTESE. As I always say about FNA Mapping: “Where there are spermatids, there are usually sperm nearby.”

  159. Dear Dr. Turek,
    After three years of “trying” naturally, my husband and I recently went through IVF testing and a few procedures. My husband, 36, with no prior issues other than retractable testicles which was taken care of when he was a toddler, tested with a y-chromosome micro-deletion on the AZFc region and low testosterone and high LH and FSH. He quit smoking a year prior to us beginning this all. After three months of clomid prescribed (Aug-Nov 2017), he had a 3 hour microTESE. From the research I did in medical articles, the hopes were high to find sperm. Instead nothing was found. I cannot put my mind at ease and feel that he HAS to have SOMETHING in there. His brother had two children. (He has no other siblings.) Why can’t he?! Is there anything you can recommend? What else can we do? We had donor sperm back-up, but I do not want to pursue anything until we are 100% certain that he truly does not produce sperm. I want to do EVERYTHING POSSIBLE. What questions should I ask the urologist? We basically just got “sorry, we didn’t find anything, maybe it’s “maturation arrest” from our urologist after I was out of the egg retrieval and he was out of the micro-TESE. I will not rest until I can find out more about this! I want to know more!
    Is there any news in the artificial sperm research? How far out do you think this is to humans? I am 32. Should I freeze my eggs and wait for this to be an option to have children with my husband?
    Any information would be truly helpful.
    Thank you.

    1. Dear Rita, I am so sorry about the fact that no sperm were found after such a large testicular procedure. Usually 2/3 of men with Y chromosome deletions (AZFc) will have sperm, but some will not. Consider our most recent research that has shown that in up to 29% of men who have failed microdissection TESE procedures (for whatever the reason or cause) sperm Mapping can find sperm after that. And sperm retrievals after that have been VERY successful.

  160. Dear Doctor Turek,
    Two SA reports showed that I had azoospermia. The urologist observed the testis and said they had normal size and probably had some obstruction and I should for for a trial puncture TESE/PESA as my FSH level too is normal 6.4.
    I undergo a TESE where the doctor made 4 punctures on each testicle. They found no sperm. The doctor said that histopathology will tell us if I have maturation arrest. He said maturation arrest will be a dead end for me.
    However the histopathology report said that they did not find anything in the tissue and the tissue was hyalinized and insufficient for any analysis.
    I will be travelling to California in January and I was wondering if I FNA mapping would be useful here and in your experience what is the probability of finding sperms.
    Also given that TESE was performed on December 1 how long do I need to wait to let the testis heal before I can do FNA mapping.

    1. Dear Akshay, See my last response to your query.Honestly, with “insufficient” tissue for analysis, I am not sure what to tell you. The samples were simply too small. I spend a huge amount of time and energy making sure that every single sample that I take during a sperm FNA mapping procedure is sufficient and good enough to be read by histopathologists. There is definitely a chance that you have sperm on FNA Mapping.

  161. Dear Dr. Turek,
    I have normal FSH(6.5) and normal sized testicles and azoospermia. Doctors performed a TESE and told me that there were no sperms and the tissue was Hyalinized. They punctured each testis 4 times.
    The hysotpathologist said he did not find anything in the tissue samples as the samples were not inadequate. There were no spermatozoa of any kind in whatever little tissue sample that was passed to them.
    Let me know if FNA mapping is advised in such cases. Since I am travelling to California next month I am in position to consult you.

    1. Dear Vinayak, I am sorry about the result that you heard. Although no sperm was found, it is not clear to me what WAS found. What was the seminiferous tubule pattern noted by the histopathologist? Was it maturation arrest? I would think that there is a 30% chance that FNA mapping could find sperm here.

  162. Dear Dr. Turek,
    I was born with an undescended testicle that was never corrected. I had hernia repair on the other side, and a complication during the surgery resulted in my other testicle atrophying. There is effectively nothing down there anymore. I did two semen analyses a year apart and both results said azoospermia. I also did a blood test two years ago and found:
    FSH: 91mIU/ml
    LH: 20.8mIU/ml
    Testosterone: 417.6ng/DL
    I spoke with a two doctors about my condition, the first said there is nothing that can be done and the second recommended an mTESE with a 20% success rate.
    Please advice

    1. Dear Lawal, you will be one of the first calls that I would make if we could generate sperm from skin! Given that you have a relatively normal testosterone level (albeit it is being driven hard by the LH) you must have some testicle somewhere doing that work. Any large operation like a microTESE can risk lowering your testosterone levels to the point that you will need T replacement. That is a major risk. Another fact is that there has not been a reported case of finding sperm in an undescended testicle that is still undescended (i.e. in the groin or abdomen). I have seen a few cases of undescended testicles brought down into the scrotum as adults and there was sperm in them, however. I am working on a testicular “autotransplant” procedure which would harvest undescended testicles and “reimplant” them back into the scrotum, but it is still early on with this. This, my friend, is a tough case!

      1. Hello Dr.,
        In an attempt to check for cancer thanks to my cryptorchid and atrophic testicles, I took a blood test for the three markers with the results below:
        BHCG: 0.3 mIU/mL (normal range is 0-3.0)
        Alpha Fetoprotein: 2.7 IU/mL (normal range is 0-7.3)
        LD-S: 271 IU/L (range is < 248)
        Please what possible conclusions could be drawn from these.

        1. Dear Lawal, No one should give you care by email or blogs. You really need to review these labs with a trained clinician who can also examine you!

  163. Hi Doctor Turek,
    I am NOA azoospermic with small bilateral testis(<normal size around 4CM) and so my urologist suggested to do FNA test. The FNA report result came as hypospermatogenesis with maturation arrest to the stage of late spermatid. Also I had varicocele 2-3 grade with left testicles.
    so after seeing the result of FNA, I got below 2 queries and requesting you to please provide your advice.
    1. If I repair Varicocele, will I ejaculate sperm? or can be find sperm in FNA test?
    Thank you very much!!!

    1. Dear Nihar, Here’s how I think about the results from FNA Mapping: If “hypospermatogenesis” is found, then that typically means that mature sperm are present, just in lower than normal numbers. If “maturation arrest” is present then there are no sperm but the process of making sperm stops at either stage 5 (early, primary spermatocytes) or stage 11 or so (late, spermatids). So, if the FNA map is read correctly, there should be sperm there now for retrieval. Also, varicocele repair either in the setting of hypospermatogenesis or late maturation arrest, should provide a 30-40% chance of having small numbers of ejaculated sperm afterwards. Good to know!

      1. Hi Doctor Turek,
        Thank you very much for answering my doubts.
        I informed same information that you said, to my urologist and he said even if we repair varicocele(2-3 grade for left testis) there will be no use and it’s waste of repairing it because my both testis are very small 4cm and he said small testis will not produce little bit sperm also in ejaculation. Also I have been said, even it will be hard to find sperm in micro surgical TESE.
        TESE is the only option? or should I get repair of varicocele to get little sperm in ejaculate for IVF or ICSI?
        Thank you very much and waiting for your opinion.

        1. Dear Nihar, your urologist knows you the best. I do not know you at all. Your can consider a Second Opinion to learn more about what my recommendations would be for your specific case.

  164. Hi Dr Turek and thanks for giving us a huge opportunity to ask questions.
    I was found to have very severe oligospermia in August 2016 with only one motile sperm seen on my SA. Repeat analysis showed about 25 motile sperm. A further repeat was just similar. I had a testicular biopsy TESE under local anaesthesia last April which unfortunately did not yield any sperm. However the histology on the sample showed evidence of mature spermatozoa in a few of the tubules and commented on evidence of traumatic damage on others. It scored me a johnsen score of 6.
    Following this, i had a more open procedure under GA to collect more samples just this february. Unfortunately also there were no motile sperm seen.
    The clinic here in the UK has told us that the only next step is a sperm donor which is something we do not want to consider at the moment. I wonder if you have any advice for us as to the best way forward from this. Just to let you know i had negative y chromosome deletion and my testosterone which was 9.2 initially has come up to 15 as at last december. The fsh, lh, dhea were all normal.
    Thanks for your advice.

    1. Dear Jac, We have had great success using cryptozoospermic semen samples (i.e. using the small numbers of ejaculated sperm) for IVF and NOT DOING sperm retrieval procedures. We bank sperm until sufficient are there to avoid another back up source. Here are my thoughts. Second, blind sperm retrievals are very difficult in these cases as the sperm typically originates from a single area within one of the testicles. FNA Mapping is superb in localizing and identifying the site. In men like you, FNA Mapping has a 78% chance of finding the sperm pocket that they missed. May not be the time yet for donor!

  165. Sir , 
    I read your articles on Google. We are going through infertility problem. Please give us some suggestions after readout my mail. I hope you will reply. 
     My husband had undescended testis both which operated when he was 17/18 years old. After marriage he can know that he has non obstractive azoospermia. Our doctor told us  that micro tese is only one option for us to get biological parents of our own children. donor is not our option because of ethical and religious reasons. 
    He is sexually very active, and honestly I feel like he is a normal man as  others. But now it is very emotional for me to know that  may be I can’t be mother though I am completely healthy. His 
     Age 26
    Testo : 11.1 
    Fsh     :51.98 
    LH       :10.58 
    please doctor after read his result can you please tell me how much possibility for him to get biological father.  Or is there any better option for successful pregnancy?
     We wanted to do micro tese in in this year. Is there any better option  or any suggestions for us where we will have our own biological child. 
    Please doctor I hope you will reply very soon. 

    1. Dear Linda, You are doing great research on this topic before you dive in. YES, there is an alternative to micro dissection TESE: ITs called FNA MAPPING. In our published work there is a 69% chance of sperm in such cases with FNA Mapping. If sperm are found on mapping, then maybe a LESS AGGRESSIVE surgery than microTESE can be done, or at least limit the surgery to one side or the other. This consideration of testis sparing approach is important as your partner has low normal T levels with high normal LH levels which put him at higher risk of low T after large surgical procedures than if he were normal.

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