Sperm from Skin? Almost!: Research Provides Looks Hopeful For Azoospermic Men

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Can skin be turned into sperm? The answer is “yes” in mice and “almost

What’s the Buzz?

You know that I am obsessed with helping men who have no sperm become biological fathers. When FNA mapping yields no testicular sperm, I ask men to do what they have to do to keep moving forward… but to stay tuned to the research advance as well. Honestly, I consider our latest published research a significant “moment” in the sperm-from-no-sperm continuum. And, it hinges on the great potential of good ole’ stem cells.
Dr. Turek can help

Where’s the Beef?

In this study, we took tiny skin biopsies from generous patients who were deemed, by the latest and greatest techniques such as sperm mapping, to have no testicular sperm. They also had good reason for their circumstance: each harbored a genetic issue called a Y chromosome microdeletion.
Then, using Nobel Prize proven technology, my collaborators at Stanford University cleverly converted these adult skin cells into stem cells. A cool, and now old-school technique in stem cell science. They then transplanted these adult stem cells into mouse testicles to see what they would do within a relatively natural and ready-made, “live” testicle. You see, stem cells like to “fit in” and typically respond to their environment or “niche” and develop into cells that suits their surroundings. When mouse stem cells are placed into mouse testicles, they develop into germ cells and, eventually, sperm. But, would human sperm develop in the mouse?
Putting human stem cells into mouse testicles, though, presents an unusual challenge. Because of obvious evolutionary divergence between mouse and man, human sperm have never been made in the mouse. So, we did not expect to see human sperm develop in this model. And we didn’t. But what we did find was both exciting and surprising:

  • Skin-derived stem cells from profoundly infertile men gave rise to early germ (sperm precursor) cells in mice, similar to cells from fertile men.
  • The degree to which infertile men made early germ cells in the mouse testicle was 5 to 10 times less efficient than that observed with fertile men.
  • Stem cells that missed the testicular tubules and were found outside of the correct “niche” developed into tumors at high rates. Not [one-third]

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115 thoughts on “Sperm from Skin? Almost!: Research Provides Looks Hopeful For Azoospermic Men

  1. Hi Dr Turek,
    It’s Nas, thought I’d circle back and say what great achievement this is and what great work is being done by some great minds.
    With such efforts and advances being made on this, I assume once all the creases have been ironed out we will be able to actually implant these cells to a infertile male? Are we on the verge of a new horizon Dr Turek, I don’t expect you to be calling me next week and asking me to be on the first flight to CA but I suspect it will happen in the near future?
    Nas

    1. Dear Nas, thanks for circling back and thanks for the encouragement. We are doing it for you and many others like you. You fuel this stuff, in all its glory.

      1. Dear Dr T is their any treatment for testicular atrophy caused by a vericocele? Like any stem cell treatment that regenerates the testicle back to it’s original size?

  2. Dr. Turek, I’m interested to know how far away this is from becoming a reality? Months? Years? And would it work for a man with SCOS?

    1. Dear Jen, Likely years away. We are making progress for sure, but it is slow. Should work fine for a man with SCOS (Sertoli Cell Only Syndrome)

  3. This is incredible. Assuming that this research proceeds down a successful course, what are the chances that it would be an option for family building in the next 10 years?

  4. My wife showed me a article today about the clinical trials for sperm from skin cells. I would like to be on this if at all possible. Ive been told I was azoospermic and had sertoli cell only syndrome. We are having trouble finding the blog with that information in it. Can you help us?

    1. Nick, my patients who (thankfully) donated their skin for the recent Cell paper on making sperm from skin were in a scientific research study, not a clinical trial. The tissue donated and the products made are not suitable for clinical use. We are not offering a clinical trial at this time that would make USABLE sperm from skin. This will take some time, possibly several years.

  5. Dr Turek, I know that it would be a ‘ball park’ guess but when do you envisage this treatment becoming available? I keep seeing “years” but at the age of 25 with a partner 10 years older with SCOS I am keen to know whether this is something that may be able to help us or whether realistically it may just be a little too late.

    1. Jenna, REALLY hard to say as it depends on research progress, funding and even politics. What I can say is that, after a several year hiatus, things are moving along nicely at this point. Stay tuned for more findings to be presented soon.

  6. Dr. Turek, when can we expect this to come life? Your effort means the world to us with new hopes and new life. Mona and surinder

    1. Dear Mona, thanks for the encouragement as it constantly fuels and motivates me. Really hard to say timeline. Each of these important papers is 3-4 years of work.

  7. Hallo Dr Turek,
    My husband is suffering from sertoli cell only syndrome.We are married since 5 yrs.Last yr my husband had a testicular biopsy, which reported SCOS. We are very depressed.Now my husband is taking Homopathy treatment from india from last 9 months.But I dont know wether it will help me out or not.Please tell me if there is any ray if hope for us to have a biological child.Thanks .

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

  8. Husband had a micro tese only one sample on one side. Said nothing was found dx sertoli cell and aplasia sclerosis. Would a FNA be up his
    alley or is it completely hopeless with that dx? Hoping to go through ivf soon they want to do another micro tese but before cutting on him
    Wanted a second opinion.. whats the consult fee? Really dont want to use back up sperm. Having a hard time with that. Dr is willing to freeze part of eggs if we have to go that route. Still young (28) really hoping and praying the skin to sperm will be in our time if no one can find anything in him. Its been a heartbreaking journey.

    1. Dear T, sorry about your negative adventure to date. Why only mTESE on a single side? Why only a single biopsy? These questions are relevant as there may be significant side-to-side variation in sperm findings, at least on mapping. Probably others were worried about testosterone levels, but with mapping you can get similarly good information as a mTESE but without all the invasiveness and trauma. So, I would think an FNA is definitely “up his alley!”

  9. Dear dr Turek, my husband was one of your candidates and actually donated skin for research at stanford due to azoospermia and negative results with fna mapping. If this was something that actually became a procedure, would you be contacting us with the good news?

    1. Giselle, I want to personally thank you and your husband for generously donating your time, energy and skin (!) for this project. We will certainly contact you if we are able to make sperm from skin. Since this was scientific research, any sperm created under research protocols cannot be used clinically for IVF-ICSI. Safety studies are necessary before clinical use.

  10. Dr. Turek, I know you can’t specify times and dates on this research becoming an actual approved ivf procedure, but do you think if skin sperm works it can be a clinical procedure within 5 to 10 years from now? Just wondering…. Thank you

  11. Dear Dr. Turek, DH diagnosed with azoospermia, went directly for ICSI in 2011 but no sperms retrieved during testicular biopsy (TESA). The Gyneac termed it as primary testicular failiure ( without conducting any test).Since then we didn’t go for any further medication or investigations. Currently on thyroxine 25mcg. Kindly suggest the further course of treatment n suggest if there is any hope.WAITING EAGERLY FOR UR RESPONSE.

    1. Sam, A thorough evaluation of azoospermia includes a good history and physical exam, reproductive hormones and even genetic tests. A semen analysis with an “extended search” (pellet analysis) for sperm can also find ejaculated sperm where no one thought it might be. Stable thyroid disease is an unlikely explanation for this condition and a TESA procedure is simply insufficient an examination of the testis for sperm when it is often located in pockets in nonobstructive azoospermia. Consider a visit or a Second Opinion with us.

  12. Dear Dr. Turek, I have anorchia – I’m curious as to whether these techniques coupled with the ‘artificial testicle’ you have developed could potentially be used to aid someone like myself. Thank you for your time.

    1. Dear Tom, YES! They may be ideal for you to be a biological father in the future. You are the reason we are doing this!

  13. Thankyou so much for your reply, means a lot to me. Actually I’m from india n I wish it was posiible for me to come to your clinic. Anyways, desperately praying for ur success.I wish that it happens asap so that the dream of many couples like us comes true. wishing u alll the best.

  14. FYI, I’ve been in discussions with Professor Eisenberg at Stanford University, I thought I’d let you know that in October I plan to visit him and his team to do a skin biopsy.I thought I’d assist you and your team at Stanford. Plus Prof Eisenberg was keen for me to undertake the procedure so I kindly accepted, plus I need a vacation so I thought I’d come to the US once again and no better reason than this I guess. I may say come past your practice and offer my support and say ‘hi’
    Regards,
    Nas
    – See more at: http://theturekclinic.wpengine.com/sperm-skin-stem-cells-male-infertility-azoospermia/#sthash.XVSJ0nwX.dpuf

  15. Dear Dr. Turek. I had testicular cancer in both testicles. I´m on TRT for 7 years now, and still not happy with it. Will the artificial testicle be able to produce testosterone?

    1. Dear Mark, the artificial testicle is a laboratory device that makes sperm outside of the body. We are however, developing cell lines of Leydig cells that may, in the future, be implantable within the body and replace current testosterone therapies.

  16. hi dr turek
    i am liveing in uk i am 46 years of age with non obstructive azoopermia small testicals consultant gynaecologist and andrologist/subspecilist in reproductive medicine and surgery said that i will have 20 0/0 of sperms retrival in about 6to8months

    1. Dear Khan, with NOA you have a 60% chance of having sperm on FNA Mapping. Not sure what “20 0/0” means.

  17. hi Dr. Turek,
    I had prostate cancer about 6 yrs ago and been cancer free since after my prostate removed. Now I’m 68, I had vasectomy done over 35 yrs ago. My current wife and I wants to have a baby since she never have one. Do think there’s chance for us to get pregnant.? What procedure should I go through? I greatly appreciate your reply. Thanks.

    1. Dear JD, Good to hear that that you are cured of prostate cancer and are now considering fatherhood! By having your prostate removed, you essentially underwent a second vasectomy in a different location (the pelvis). One thing that I can say for sure is that after having your prostate removed, a vasectomy reversal would not work to allow for natural pregnancies as you have vasectomies in two places on each side (the one in the pelvis is not reconstructable) and your ejaculate is now altered in character after prostate removal. Having said this, you could very well still be making sperm in the testicles that could be retrieved behind the scrotal vasectomy and used with IVF-ICSI to have a child. You would need some tests to help determine if this is true, including testosterone, FSH and possibly inhibin levels.

  18. Dr Turek, I am tired. Yes tired. I am 54 and still very fit. Just finished my surgery today from St Lukes hospital when Dr Silber told us the truth: Doctors at Cornell Hospital in New York had lied to me all along. Well have just 1 testicle and the only descended one had a benign tumor(never had it easy in life) which was removed in Cornell 3 years back, then did mTESE which Dr Schlegel 2 years ago and found no sperm. The problem is my doctor never informed me that what remained in my scrotum was just scares. Got the the sad news today, but i am still producing testosterone. He wonders how. He said my only option is Stem cell. My wife is so devastated. Please what do you think. Can the artificial testicle work for either of the testicles? because i seriously believe the undescended testicle is still active. Please help.

    1. Dear Oyibo, that is quite a story. I honestly don’t believe that Cornell physicians are “lying,” but simply doing the best that they know how. Certainly the artificial testicle has potential to make sperm for you in the future, but it will take some time! Follow here for details.

  19. Hi Dr. Turek.
    I was diagnosed with non-obstructive azoospermia last year after micro-tese and FNA mapping surgeries. My Doctor was Dr. Smith at UCSF. I live in the Bay Area. Would it be possible to join your studies? I would love to volunteer and help with your research and studies.
    I know Dr. Smith is working on stem cell research related to azoospermia. Are you and him working together? I am part of his study and he is using samples from my surgeries I believe.

    1. Erik, that’s unfortunate. I know Dr. Smith well as I helped to train him in the field. Many centers are doing stem cell research and that’s good for you. Everyone is taking a somewhat different approach. I am inviting men into our research who have been FNA “Mapped” and have no sperm as they have been very thoroughly characterized for our studies.

  20. My son was born with undescended testicles that atrophied after surgery. He produces no testosterone at all and will start testosterone therapy soon. He is 12 years old now. Is this research or current research for infertility something that applies to him?

    1. Maria, Technology to non-invasively image testicles to find sperm might apply to your son. Stem cell based treatment that use stem cell sources outside the testicle may also apply. The timeframe of 10-20 years until your sons wants kids will almost certainly apply!

  21. Dr. Turek,
    Is there enough funding for the stem cell to sperm research, or do you need more? I want to contribute to the study if at all possible. Please let me know.

    1. Sara, So, so kind of you. The US government is finally turning it eye toward funding this type of research. That means that many universities will be vying for money to do this research along with our privately funded venture. This is all good for patients.

  22. I am was diagnosed with testicular cancer and had both testicles removed. I would like to be considered for one of your scientific studies if at all possible. I am getting on TRT but am wondering if human testicles is a requirement for the application of the sperm once developed.

    1. Garland, I stay up late and work hard to help men just like you. We are hoping that testicular cells may not be necessary to make patient-specific sperm.

  23. Hello Dr Turek,
    How are you, I hope you are well. Nas again, just popping my head back through your door to find out how progress was going with the stem cell skin studies that were published earlier this year.
    It seems only yesterday that I was given my diagnosis of sertoli cell only syndrome (doesn’t get any easier excepting this as the years go by). I do remain positive that you and your team’s work will help me and many men. I appreciate it won’t be tomorrow but god willing in the very near future?
    Any update welcome please on the subject?
    Happy holidays to you and your team.
    Regards,
    Nas

  24. Resetting the developmental clock of human stem cells, scientists have been able to create primordial stem cells (PGCs) in the laboratory. This feat, already achieved in mice and rats, is now possible in humans because scientists discovered how to coax human stem cells to assume a more “naïve” state—a more thoroughly epigenetically “reset” state. To induce this state and go on to create human PGCs, the scientists had to recognize how techniques developed for mice and rats were unsuitable for human cells. Ultimately, the techniques the scientists developed succeeded with both human embryonic stem cells and induced pluripotent stem (iPS) cells.
    The creation of human PGCs was accomplished by University of Cambridge researchers led by M. Azim Surani, Ph.D., and Weizmann Institute of Science researchers led by Jacob Hanna., M.D., Ph.D. Together, the researchers compiled their findings and reported them December 24 in the journal Cell, in an article entitled, “SOX17 Is a Critical Specifier of Human Primordial Germ Cell Fate.”
    “We demonstrate specification of hPGC-like cells (hPGCLCs) from germline competent pluripotent stem cells,” wrote the authors. “The characteristics of hPGCLCs are consistent with the embryonic hPGCs and a germline seminoma that share a CD38 cell-surface marker, which collectively defines likely progression of the early human germline.”
    The authors emphasized that the SOX17 gene is critical for “specification,” the process whereby human stem cells are directed to become PGCs. This was a surprise as the mouse equivalent of this gene is not involved in specification, suggesting a key difference between mouse and human development. SOX17 had previously been shown to be involved in directing stem cells to become endodermal cells, which then develop into cells including those for the lung, gut, and pancreas, but this is the first time it has been seen in PGC specification. Another gene, BLIMP1, represses endodermal and other somatic genes during specification of hPGCLCs.
    Unlike mouse embryonic cells, which are easily kept in their stem cell state in the lab, human iPS cells that have been reprogrammed have a strong drive to differentiate. They often retain traces of “priming.” To remove these traces, the researchers created a method for tuning down the genetic pathway for differentiation, effectively creating a new type of iPS cell, which the researchers dubbed “naïve cells.” These naïve cells appeared to rejuvenate iPS cells one step further, closer to the original embryonic state from which they can truly differentiate into any cell type.
    Working with naïve human embryonic stem and iPS cells, and applying the techniques that had been successful in the mouse cell experiments, the researchers managed to produce cells that, in both cases, appeared to be identical to human PGCs. The researchers then further tested and refined the method. By adding a glowing red fluorescent marker to the genes for PGCs, they were able to gauge how many of the cells had been programmed. Their results showed that quite a high rate—up to 40%—had become PGCs; this quantity enables easy analysis.
    Dr. Hanna points out that PGCs are only the first step in creating human sperm and ova. A number of hurdles remain before labs will be able to complete the chain of events that move an adult cell through the cycle of embryonic stem cell and around to sperm or ova. For one, at some point in the process, these cells must learn to perform the neat trick of dividing their DNA in half before they can become viable reproductive cells. Still, he is confident that those hurdles will one day be overcome, raising the possibility, for example, of enabling women who have undergone chemotherapy or premature menopause to conceive.
    “Having the ability to create human PGCs in the petri dish will enable us to investigate the process of differentiation on the molecular level,” explained Dr. Hanna. In addition, as indicated in a press release issued by the Weizmann Institute, further research could provide answers as to the causes of fertility problems, yield insight into the earliest stages of embryonic development, enable the development of new kinds of reproductive technology.
    “Germ cells are ‘immortal’ in the sense that they provide an enduring link between all generations, carrying genetic information from one generation to the next,” added Professor Surani. “The comprehensive erasure of epigenetic information ensures that most, if not all, epigenetic mutations are erased, which promotes ‘rejuvenation’ of the lineage and allows it to give rise to endless generations. These mechanisms are of wider interest toward understanding age-related diseases, which in part might be due to cumulative epigenetic mutations.”

    1. Dear KA, Thanks for posting this. It is nice to see independent confirmation of our stem cell work published in Cell in May 2014 by others. Means that we are getting closer and closer to the truth.

  25. Hi Dr. Turek,
    I wrote in once before and have another question. My son was born with undescended testicles that atrophied after surgery. I was told he produces no testosterone and he will begin testosterone therapy soon. He is 12 now. I noticed that he started having underarm odor. Is this possible without testosterone? All the research I have done on this has confused me further.

    1. Dear Maria, Boys can pass through puberty normally with fairly low testosterone levels. I am not sure how anyone could say that he “produces no testosterone” when this is true of all prepubertal boys. That statement can only be made after puberty or during a failed puberty.

      1. Thank you for responding! After his testicles atrophied he had a blood test that came back showing that he had no testosterone. I didn’t realize that the low levels that are created in places other than the testicles would be enough to kick start puberty.

  26. Hello Dr Turek, i recently read on sciencedaily web site significant advances into recreating primordial gem cells using human embryonic stem cells. is it good news for your artificial testicle? the article subject is : Egg and sperm race: Scientists create precursors to human egg and sperm. happy new year by the way

    1. Dear MT, Yes this is good news. This recently published research from Cambridge University in England essentially reproduced what we should in our research that was published in May 2014. Such an independent confirmation of research findings is good news that the truth is being revealed.

  27. Dr.Sir,Happy New Year !! I am now 54 , with SCOS ! I would like to have my biological child and one of the may patients who are eagerly waiting for your successful clinical trials ! Kindly do let us know when should we approach you for undergoing treatment sorry for poor English !)

    1. Dear Hany, we are in the process of raising 600K from angel investors (and they really are angels) to continue this work. It was a good year last year for stem cells and sperm, a lot of progress was made, but there is still much more to do.

  28. Hello turek sir, after your successful stem cell research completion, will any crypt orchid azoospermic adult man of any age with small testicle have opportunity to make testicle larger & descended in scrotum as normal? Please tell me.

    1. Dear Khalil, Certainly we hope to give patient specific sperm to any cryptorchid azoospermic adult man. However, we have no plans of making an implantable bionic testicle to put back. Currently we treat this with testicular implants.

  29. Hi Dr. Turek,
    I have non obstructive azospermia. All my reproductive hormones are normal. My FSH and Prolactin were elevated slightly but we’re not flagged high. My Karotype and Y chromosome were normal. My testosterone was 600. I went through a TESE microdisection. No Sperm were found. The urologist said it was maturation arrest. Is this the end of the road for having a biological child? Is there any treatments to fix or reverse maturation arrest? Could there be a systemic illness causing this? It’s just a mystery and my wife and I have no answers. We don’t know why there are no sperm and everything is coming out normal.

    1. Replying on behalf of Dr. Turek, the best thing to do is to get in touch with our office and get a Second Opinion. We can set it up easily and he is often able to review everything by phone to give you a real sense of where you’re at. Our number us +1 415-392-3200 or you can email us at [email protected].
      In health,
      The Turek Clinic Team

  30. Hello Dr Turek
    Hope you are well, I was just wondering if there had been any progress with the skin sperm program.
    Are we any closer to getting trials in the near future.
    Thank you
    Nas

  31. I am also hoping for an update with this. any progress?
    for me and my husband to be able to have a full genetic child, with no donor, would be a perfect dream.

  32. hi doctor turek i had undescended testicles which atrophied after the surgery all doctors left me no hope but the stem cell treatment which includes the injection of the stem cells into the testicle how is that different from the artificial testicle and i really need a solution soon. thank you

    1. Dear M-Gamal, Most men with two undescended testicles have “atrophy” or testes that are smaller than normal in size. One measure of whether you may have sperm in the testes is if you are having sufficient testosterone production. So, are you taking testosterone replacement? If so, then making sperm is far less likely. If not, then you might consider FNA Mapping or mTESE to look for sperm. Stem cell technology is at least several years away from prime time.

      1. hi Dr Turek, no im not taking any testosterone replacement but my medical tests that i made earlier this year indicated that my testosterone level was less than its normal range “1.6” and my FSH range was”35″ and most importantly my inhibine-B hormone “2” so due to these result will testosterone replacement will be any how sufficient, and what shall i do at the present time. thank you for your response.

  33. Hi Dr Turek sir..
    I am from a backward area, I had done my bilateral orchidopexy at the age of 28, testis size and scrotum shape size were normal, but having azospermia in biopsy report and several SA reports.
    I have normal satisfaction but my FSH was 17,24 and the last time while taking clomids tablets on my doctor advise FSH was 45 and more,
    Testesteron is normal.
    Now doctor is saying that I have no chance, I had done my surgery one year back.
    What should I do please guide me sir did I have a little chance or stop all my efforts.
    Please sir as I belong to a most far and backward ,poor area so guide me and I will always pray for you.
    Thanks
    Regard

    1. Dear Afgar, Although it is better to have an orchidopexy before puberty than after puberty, nevertheless there is still a possibility that your newly scrotal testicles can harbor pockets of sperm. I would wait at least one year after the fixing procedure that you had and consider FNA mapping to learn more.

  34. Dear Mr Turek
    My Husband has stertoli cell only syndrome. Johnsons score of 2.
    nothing found in 16 biopsies.
    we are now moving foward with a donor.
    is there any hope for the future however?
    is sperm from skin a viable reality?
    i have heard about the Kallistem reasearch, but sadly it seem this wouldnt be able to help us either as not possible for SCO.
    the hope of a biological child one day is what keeps us going,

    1. Dear Emily, sorry to hear about this. 16 biopsies is certainly ALOT and I understand the move to donor sperm. Keep your hopes us as sperm from skin will happen in the future. Bank some eggs while you are young just in case it takes a while to get to market.

  35. Dear Dr T is their any treatment for testicular atrophy caused by a vericocele? Like any stem cell treatment that regenerates the testicle back to it’s original size?

    1. Dear Darren138, When varicoceles are repaired before puberty the testicle can increase in size to match its mate. However, when repaired after puberty, there is usually no “catch up” growth. Currently there is no treatment for atrophy due to varicocele other than varicocele repair. Stem cells may or may not help here.

  36. Hi Dr Turek, I read about the achievement you have done and still trying to do for the universe. I need to ask a question about my case. I was born with both undescended testicles. Is there any hope to father a child?

  37. Thanks sir for your kind reply..
    Sir do you give me a chance..?
    Is sperm maping procedure available any where in clinics..
    Sir my testis are yet not fully in scrotum but my doctor said that we had done what we can..
    May I make another surgery of what..
    Thanks once again,, you are an angel for us..
    Regard

    1. Dear Afgar, Often times, having TOO MANY surgeries on the testicles can permanently injure them so that they do not function well in the future making hormone and sperm. As long as they are in the scrotum (upper or lower) and not the groin, there is the possibility that they are making sperm.

      1. Sir as I already mentioned above that I was with bilateral undecended testtis, done orchidopexy late at 30 year of age.two year I saw nothing in my semen.
        After two year dramatically I saw two live sperm in my SA. After two months taking vitamins my count was 5mil motility 50%.
        Now again after three months I have don my SA now the result is.
        Count:
        20mil/ml
        Active:
        15%
        Imotile
        80%
        Sir what should I do,
        I belong from a far area having no good access to medical proces.
        I am following your kind suggestion.
        Thanks
        Regard

        1. Dear Afgar, GREAT NEWS! Looks like by taking great care of yourself, your sperm count improved! First thing to do now is to try to conceive at home all over again. Remember, a NORMAL semen analysis is not required for fertility. Enough sperm is required and every partner is different in terms of what they need to get the bun in the oven. Try at home for 6 months, and then consider intrauterine insemination, a cheaper option than in vitro fertilization!

  38. Dear Dr Turek,
    My needle test and local biopsy failed to retrieve sperm, although 20 years after a Hodgkin treatment by chemotherapy and radiotherapy in France. My recent blood test indicated: FSH 18 IU/L, testosteron 10.1 nmol/L. Can these values explin my azoospermia problem? What would you suggest as a next step? Is mapping a solution vs. full testicle biopsy (for all sections)? does mapping induce testicle to become dry? Thank you very much and appreciate a lot your answer.

    1. Dear Cata, In cases of prior Hodgkin disease, it is very common that simple (TESA/TESE) sperm retrieval techniques fail to find sperm and more complex ones (FNA mapping/mTESE). Given your low normal T level, the least invasive technique (FNA Mapping) that tells you whether or not you have sperm might be a good choice. FNA mapping does not “induce a testicle to become dry” anywhere nearly as much as mTESE.

  39. Dear Dr Turek , My husband has zero sperm count due to undescended testicle at birth , n now had SCOS . I would like to have an update about the artificial production of sperm cells from skin cells research. Can my husband be a part of the research by giving his skin cells .how long could it take till the artificial sperm production will be possible in future? We r both 31 yrs old at present .

    1. Dear Sara, really, really hard to say. One debate now is where skin-derived stem cells can have an associated cancer rate when transplanted back into a man’s testicles. A two edged sword? This needs some serious research.

    1. Dear Safa, little blips here and there, but no, no real changes. Lots of work being done all over the world though.

  40. Hi Dr Turek.
    I hope you are well? I have been keeping afloat of your blog and the Sperm Cell Research, but I wanted to ask you a question based on this Mapping. With regards to this option I am not sure about this option with you strictly because I went for an operation to attempt sperm retrieval in here in the UK and I have been informed that I have Sertoli Cells only.’ both right and left. My blood tests results showed ring Y chromosome deletion and the molecular analysis has shown absence all AZfa, AZfb and AZFc regions. So in finding out this devastating news, am I trying to understand where Mapping would take me if they are saying I have no Sperm production or Spermatogenesis in the first place? There would be nothing to search for if I am correct? If the results here in the UK came back as Sertoli Cells only, would not waiting on this Sperm Cell research be the best option?

    1. Dear Damien, You got it. A complete deletion of Y chromosome AZF deletions a-c means most of the long arm of the Y chromosome is gone. No one has found sperm in these cases, to my knowledge. The only reason to do FNA Mapping is to figure out whether you may in fact have early germ line stem cells for future stem cell use.

  41. Hi Dr. Turek, my husband had Hodgkins back in “89” & a relapse in “90”. He underwent chemo both times and has been cancer free since. In 2006-2007 we saw a fertilty specialist and had low testosterone and no sperm count so he did a biopsy and still no sperm. Being depressed we choose to stop but i have never given up hope..Would there be any chance that a sperm mapping would be a possibility or any other options to help us have a biological child? Any help in the right direction would be greatly appreciated.

    1. Dear Margaret, YES there is certainly a chance that FNA Mapping would find sperm that a simple biopsy may have missed. Interestingly, regardless of the cause of non obstructive azoospermia (undescended testicles, cancer, genetics, unexplained), the fact is that when sperm production is low, it tends to occur in islands. FNA Mapping is excellent at finding islands of sperm.

  42. Dr. Turek,
    I just in the last week had a microTESE procedure that yielded no sperm. We were attempting to do IVF at the same time with ICSI. We were guided to a donor back up being the only option with no sperm found from the procedure. I don’t have the full details of what was seen in the procedure other than the tubules seen seemed to be uniform and none really “fuller” than others and no sperm found. I know this is limited data, but are we at a dead end here for me being a biological father?

    1. Dear Scott, we are in the process of writing up our series (n=85) of men in whom we did FNA Mapping after failed mTESE procedures. We found sperm in 22%, so there’s your number.

  43. Dear Dr. Turek,
    Our doctor mentioned this study to my husband and I– I found your website/blog to be the best there is out there- thank you for all of your work and dedication towards male infertility.
    This is a very exciting article to read, as my husband and I remain hopeful through our infertility journey. My husband has NOA, had a failed micro-tese on both sides, and has had a varicocele repair. Chromosome tests came back normal, high FSH, everything else is normal.
    How far out is this technology and/or a clinical trial for humans? In the meantime would we be a good candidate for FNA mapping?
    Thank you for all that you do!

    1. Dear May, not clear how far out we are from making sperm from skin, which is likely what your hubby would need. However, several groups in US and abroad are working on this. BTW: we are published our results examining the ability of FNA mapping to find sperm “missed” by mTESE procedures: 22-29%!

  44. Hi, dr Turek. Four years ago i was diagnosed with non obstructive azzoserpmia. Unfortunately I hade unsuccessful MTESE. Please, have you ever seen sperms in ejaculate after such diagnose? Do I still have to do spermiograms? Thanks.

    1. Dear Vermin, Yes I have seen ejaculated sperm after failed mTESE but only in cases of early or late maturation arrest biopsy patterns and after medical treatment with FSH injections +/- varicocele repair. On the other hand, using FNA mapping after failed mTESE, we are now reporting a 25-29% chance of finding sperm that was “missed” on mTESE.

  45. My husband was recently diagnosed with non obstructive azoospermia. We are extremely devastated. And reading this gave me some hope. Are we close to this becoming available to the public? My husband is 30 and I’m 25. Will this technology be available in our child barron years? Should we wait out for it or look into donors and adoption?
    Thank you!

    1. Dear Taryn, Maybe I am missing something but I sense that your husband has no ejaculated sperm and that you are wondering about experimental options. What about looking closer in the testicle for small numbers of sperm can be used with IVF-ICSI to have a biological child? The chance of the (by FNA or Sperm Mapping) is 60%.

  46. Hi Dr. Turek,
    I am curious as to where this research is at now. Do you have any estimates as to when artificial sperm could potentially become an available method of treatment? Do you think that in the next 10-15 years, there could be definite options for a male to conceive biologically in this manner?
    Thank you for all the work that you do!

    1. Dear Melissa, conservative estimates as to when a commercially available technique will developed to help men make sperm from stem cells is 5-10 years.

  47. Hello Dr. Turek;
    Hope you are doing fine. Wanted to check on this, if there’s been any new developments? or updates? –
    Certainly interested;
    Thanks,

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