Where are We with Man Made Sperm?

Stained human testicle
The testicle: mythically complex but beautiful (Courtesy: Gaur et al. Reproduction, 2017)

“Think left and think right and think low and think high. Oh, the thinks you can think up if only you try!” Dr. Seuss
I’ve been asked to report to the fertility community about where we are with man-made sperm.  Although we’re not where we’d like to be, it is certainly not for lack of trying. Around the globe, many research teams are on the quest for this Holy Grail: making sperm from scratch. There’s been some good hard science laid down that I am sure will reap rewards in the future.

How Far We’ve Come

It’s been 7 years since the first reports were published showing that normal, healthy, viable sperm can be made from stem cells in mice. In fact, pretty much any type of stem cell, adult, embryonic or otherwise, can be directed to sperm in the mouse model. And this can be done either within or even outside the testicle. Truly impressive science that is now an unrefutable accomplishment: It’s possible to make sperm from stem cells in mammals like us.

How We’re Different

But we humans, for some reason, are different. And that has made all of the difference in the progress of this science. Two general approaches have been taken to create human sperm from scratch using stem cells as seeds: putting them back into their native environment, an actual testicle of some kind (in vivo), or trying to encourage them down the path of spermatogenesis outside the body, in an recreated, artificial environment (ex vivo). Both have merit and are worth pursuing, but neither has succeeded completely (and believably) in creating a healthy, usable, mature human sperm.

Inside a Testicle

We have had partial success taking skin biopsies from azoospermic (sterile) infertile men with genetic causes and turned these skin cells into adult stem cells in a dish. From there we placed them into mice testicles (in vivo) to see if they might develop further and they have, but not very far. We then took men with genetic infertility, again turning their skin cells into stem cells, and then replaced the missing Y chromosome gene in the stem cells. Yup, actual gene therapy on stem cells. These “fixed” cells were replanted into mouse testicles and we watched them go even further along the precursor path to sperm. We never got sperm but that might simply be because mice are just too different from us for complete success. Regardless, the proof of concept is important here: these little can-do stem cells really want to progress to sperm in the right environment. Like a lawnmower ever so close to firing up when you pull the starter cord.
The University of Pittsburg is doing exciting work that uses the human testis as an incubator (in vivo). They have taken testicular stem cells from boys’ testicles before sterilizing cancer treatment and frozen them. They now plan to reimplant these cells back into the same boys’ testicles after they are cured of their cancers, hoping to grow mature sperm in the same testis that was previously sterilized. This should work, as they previously demonstrated the success of this technique in macaque monkeys. And, it starts with sperm precursor cells that are more committed to becoming sperm than say skin cells or embryonic stem cells which need extra coaxing to become sperm.

Outside a Testicle

There are published claims of mature human sperm being made outside of the testis in a dish (ex vivo) from stem cells. One study was published and then retracted in 2009 and the other sought to restart sperm production in testis tissue that was hormonally “turned off” earlier. Restarting the sperm machinery after it was turned off is not as scientifically challenging as starting from scratch and creating sperm from stem cells. It’s more like baking from a box mix but is important nevertheless.
Finally, we and others, using bioreactors and organoids, have attempted to recreate the testis environment outside the human body with some success. We are now able to get all of the cells needed to make a bionic testicle and have kept it all alive for 6 weeks. And it thrived. Stems cells placed in the bioreactor not only survived but appeared to recognize the testicle-like environment in which they found themselves. But we haven’t gotten them to take the first step and take that walk toward sperm. The human testicle is an organ of mythical complexity and we will need to understand and duplicate the myriad of cell-cell interactions to make sperm.
Honestly, it’s not impossible to make man-made human sperm, it’s just more difficult than we imagined. So easy in mice, so hard in man. It’s a difference that has earned some serious scientific respect in our field. As Walt Disney said: “I only hope that we never lose sight of one thing — that it all started with a mouse.”

125 thoughts on “Where are We with Man Made Sperm?

  1. This is amazing, gives me hope. My husband was recently diagnosed with sertoli cell only syndrome and is 25 years old. We hope and pray every day that medical technology has more advances in this area before it’s too late for us. (I’m 35) Thank you for everything you and everyone does with advancing medical technology.

    1. Dear Jasmine, I have one question: How was your husband’s diagnosis of Sertoli cell only syndrome made? Because if it was made by testis biopsy then there’s a 35-40% chance if you look harder (FNA Mapping or microTESE) that sperm might be present elsewhere. All hope is not lost.

      1. I am so happy to see you responded! I haven’t been back to this page to check, I thought there was no way someone would actually respond. Your response gives me more hope than you can imagine! His diagnosis was made by testis biopsy, after multiple sperm counts and hormone level checks. Thank you so much!

      2. My relative have azoospermia and klinfelter syndrom

        Can you treat it and becom produce sperm normally
        If you can treat it what method
        And where place any country
        And how much cost

        1. Dear Saleem, Azoospermia due to Klinefelter syndrome is the most common genetic cause of having no sperm. About 50-70% of men will have pockets of testis sperm. Typically, natural fertility with sex is not possible, even with aggressive medical treatment, but finding testicular sperm and using IVF-ICSI can work very well. Keep researching or contact us!

  2. Hi Dr Turek I read up on a company Kallistem based in France they claim they are able to grow human sperm in a lab what are you’re thoughts on this. I also reached out to them they said this technology shld be available in 2 to 4 years.

    1. Dear Perry, Kalistem took testis tissue from men who had used hormones to change sex and “turned off” sperm production. They exposed these “turned off” testicles to the right hormones and sperm were made again in a gel metrix in a dish. So not exactly sperm from stem cells or skin..

  3. My husband has kleinfelters we did a m tese with Dr Schlegel and have a beautiful daughter. I read that a lot of clinics are advising men to freeze testicular tissue so in the future they cld use stem cells from the tissue to make sperm shld my husband do this?.

  4. Hello Dr. Turek,
    I underwent bilateral orchiopexy when I was 3. I am now 32. My urologist diagnosed me with severe OATS due to Cryptorchidism. Our attempt to concieve with biopsied sperm(microtese twice – 1st attempt gave 60 sperm and second attempt gave 6 which were frozen after retrieval) with ICSI has failed three times. I got tested for karyotype and ycmd which are both normal. Recently I read about possible treatment with stem cell therapy and PRP. What are your thoughts on such a treatment for my case?
    Thank you.

    1. Dear Vjmun, Severe OAT implies that you have ejaculated sperm. Is there a reason why this sperm was not used for IVF-ICSI? Regarding the failure of IVF-ICSI this can be due to eggs, sperm or the lab. Typically testicular sperm in cases of undescended testicles works JUST FINE and is not the issue for failed IVF-ISI. Have you considered the other two issues (eggs and lab)?

      1. Hi Dr. Turek,
        Thank you for your reply. There were only 2 or 3 sperms available in the ejaculate and they were all non motile. That is why I was asked to take the biopsy route. As for other factors, we did a slew of tests for my wife including some genetic tests to make sure she is healthy. We switched to another clinic in the thought that this could be a lab issue but there was no difference in the outcome. Most embryos made it to the 3rd day and arrest after that. Only one embryo out of 4 IVF attempts made it to 5 day and that dint implant either.
        Thank you.

  5. Dear Dr Turek,
    I did mapping at your office in 2016 and no sperm was found, just early maturation arrest due to Y chromosome deletion B. I’m 33 and my wife 32…time is against us. Can any of these technology ever help couples like us? What are your thoughts on these new discoveries?

    1. Dear JC, I remember. Maturation arrest means that you have testicular stem cells but they don’t progress. Ideally, some day we could do a biopsy on you, shake out the early stem cells, grow them in a dish and replace the missing Y chromosome genes or proteins and replace them back into your testicle or grow them to sperm in a dish. CRISPER technology is incredible which makes the fixing the genome part almost routine. Its the growing of the cells into sperm that’s still stumped us. Consider freezing eggs while you wait.

  6. Dear Dr Turek,
    I was diagnosed with Azoospermia in July 2017. It was a devastated news for both my wife and myself. It’s very hard to see everyone around us same age level have babies and we can’t. we are trying to be calm and follow our Doctor Instructions.
    I am 34 years old, My initial FSH was 14.2 and testosterone was 1.2pg/ml… All remaining measures prolactin and Estrogen were normal.. Did Genetic Test and it was normal. Did scan on Testicles and I was told testicles were smaller than normal size.
    My first doctor recommended me to do a biopsy last Aug and we didn’t find any sperm.
    I visited another doctor and he told me I should have waited until all Hormones levels are normal before doing biposy. My new doctor put me on Vitamin E, Vitamin D, B12 and other medication which lowered my FSH to 9.2 to normal level and Testosterone was 4.6PG/ml.. He asked me to do semens analysis but it came back Zero..
    Not sure what I can do now? Should I wait and do another semens analysis in 6 weeks because I read that it takes 4 month to develop a sperm?
    Do you believe FNA mapping at this stage will be worth doing it? or should I wait?

    1. Dear Fathy, You are experiencing the path that many men take to achieve their fertility goals. Here are the facts:
      1) optimizing men for fertility can make a difference in finding sperm
      2) Despite a lack of ejaculated sperm, there may still be sperm in the testicle.
      3) Despite a biopsy showing no sperm, there may still be sperm in the testicle. With FNA Mapping that rate is about 35-40%. If this number matters to you then you should certainly consider pursuing this further!

  7. As fathy mentioned above even my husband is suffering from azoospermia and his testicular size is also very small and we have also done biopsy (MTESE)by Dr.Rupin shah in India where no sperms were found and there was only jelly kind of fluid was
    found with NIL sperm .It is 26xxy problem.Is MTESE and FNA Mapping same?Also wanted to know when this sperm from skin treatment or IVG treatment will get start?Please reply as I want my husband to become biological father.He is 36 years old and I am 33.My two IVF cycles has also got failed with donor sperm.I m not at all upset as I still have hopes of artificial sperm.
    Please reply.

    1. Dear PKS, micro dissection TESE and FNA Mapping are two approaches to finding sperm in KS patients (47, XXY). Typically KS patients have low testosterone levels and should/need to be on testosterone supplements. For this reason, the fact that FNA mapping may be less invasive and less damaging to testicles than mTESE becomes a mute point, as testosterone replacement is in the picture anyway. They are both excellent ways to find sperm. I am not sure of the value of repeating either procedure if a mTESE procedure fails in KS patients as mTESE is not that complex to do in KS men. We are still several years away from man-made sperm.

  8. Dear Dr. Turek,
    I’m following very interested your blog.
    I’m living in Germany and facing now at the age of 34 years old after a TESE (made by a very good surgeon here) a massive spermatogenesis arrest, so the result of the histology after the biopsy.
    Sertoli Cells as well as primary round cells (the doctor told me, that’s the primary stage of sperm cells) exist, and so there is no need of DNA research regarding any chromosome deletion.
    Also my testosteron, LH, FSH is totally normal, the testes are normally big and hard, I look very man-like (lot of body hair, etc.) and there is no pre-stage of any cancer found in the biopsy.
    Could you tell me, if any of the future developments could help me one day? Especially proceeding the maturation of this round cells?
    My wife is turning 38 soon, should we consider freezing eggs?

    1. Dear Marcus, In the world of testis stem biology, it is my belief that the spermatogonial stem cell is the key cell to making artificial sperm. Patients with maturation arrest histology tend to have these cells and in many cases the problem is environmental in the testis and not genetic to this cell. I often advise patients with early maturation arrest histology and no sperm to consider egg freezing because of the potential of the cells that are present.

    1. Dear Hk Moe, From our published work in 2015-6 using stem cells derived from the skin of men with AZF deletions on the Y chromosome, combined with CRISPR technology, it should be possible to bypass the Y chromosome deletions as a cause of male infertility in the future, probably distant future.

  9. My husband did one tese and found No sperm.
    I would like to know that we can do FNA Mapping on the same day with sperm retrieval or not? Because I would like to do my eggs retrieval on the same day.
    Thank you

    1. Dear S.tee, FNA Mapping is a diagnostic test and therefore no sperm are available for use the same day. In fact, the precision of the technique is due to the fact that the tissue samples are stained to make sperm easier to find than if not stained. However, when you stain them, they are killed and cannot be used. So, with FNA Mapping, you sacrifice usability for high detection. BUT… when the map shows sperm, I typically perform all sperm retrievals LIVE with egg retrieval, because we pretty much KNOW that we will find sperm.

  10. Dear Dt. Paul,
    My husband had gone through two micro tese procedures after a perioud of hormon therapy. The first was performed on the left testicul which resulted in finding 10 sperm but ivf didn’t work out. The second was performed on the right testicul and resulted in finding more, however only 3 sperm were usable as the rest were not normal healthy sperm. The second time ivf worked and we had our baby boy.
    My question is what do you recommend for us if we want to try again ? Is there hopes that stem cell therapy will be available in the coming 2 to 4 years? Is micro tese still an option or three times is very much?
    Thanks alot

    1. Dear Emy, that’s quite a ride you’ve taken to get your family going. My concerns are 1) will another invasive mTESE procedure produce sperm and 2) what does your partners testosterone levels look like right now~! Certainly getting some good advice from your microdissectionist is important going forward.
      In this case, he may be an excellent candidate for FNA Mapping which can detect whether sperm are present in testicles non surgically, before a surgical sperm retrieval is done again. If sperm are found on FNA Mapping, then you can rest assured that sperm will be found on a sperm retrieval. And, you will know which testicle is best and avoid a bilateral procedure and you will do the most you can to ensure that your partner’s testosterone levels and future health are not compromised. Be happy to help build that family using a smarter approach.

  11. My husband was also diagnosed with scos we found out after 3 years of trying and going in the medical proces also he is brca1gen carrier( cancer) and we were talking about the proces of taking that gen out of the embryo but then we had de diagnosis and the world colapses around you we went to belgium ( we are from netherlands) to have an surgery done too see if he had sperm they took biopt from 2 different areas and said no we didnt find any sperm we let it sink in and decided to go with donor and have a beautiful 2 year old boy but it always stays in my mind that we maybe should have tried something more but in the netherlands we dont have many options i read here about fna what is that ? What does it do ? I dont talk about it with my husband anymore because he has to a degree peace with it and well there is always the question about okay if something else does work and he gives me a second child how would he feel about our first one but still i would want to know if i was him your doing great work keep it up

    1. Dear Miranda, The fact of the matter is that a biopsy or two does not tell the whole story of whether or not there are testis sperm present. Even if a micro dissection TESE fails, there is a 29% chance that subsequent FNA Mapping might show sperm. The hard part here is whether this conversation ever comes up in the family again.

  12. My husbant 41y old with azospermia ..testicular biopsy sertoli only syndrom karyotype 46xy…high FSH and normal testosterone ..i am 37ys no any medical disease..any hope by stem cell treatment please reply me with thanks..

  13. My husband 41y old with azospermia ..testicular biopsy sertoli only syndrom karyotype 46xy…high FSH and normal testosterone ..i am 37ys no any medical disease..any hope by stem cell treatment please reply me with thanks..

    1. Dear Noor, the fact of the matter is that even with a testis biopsy showing no sperm there is still the possibility that FNA Mapping or mTESE could show pockets of sperm in the same testicles that were sampled by biopsy. The chance of finding sperm with these more sophisticated techniques could be as high as 35-40%! Forget stem cells for now!

  14. Dear Paul,
    My husband was given a diagnosis of a mixture of primary and secondary testicular failure. He had undescended testes when he was born and then testicular torsion when he was 12/13 years old. We had a normal healthy conception of our 3 year old, it’s only when we started trying for our second child we discovered my husband has non obstructive azoospermia. We had a mTESE done in Dec 17 but only Sertoli cells were found and lots of matted tissue. We have just had the results of FNA mapping performed in the U.K. and unfortunately nothing was found in 36 samples. Please give me hope that there is something else we can try?

    1. Dear Depinder, you have been through a lot. I would need to review the FNA Map study to see if it was well done.

  15. My 24 year old Boyfriend was murder a month ago. His mom still has him umbilical cord from when he was born and she also she has all his genetic markers from a paternity DNA test they did when he was younger is there any way that any of this could be used to recreate sperm.

    1. Dear Courteny, Wow! Thats a question that I have NEVER had before, and its a doozy! I am SOOO sorry to hear of this tragedy. I suspect that cord blood stem cells would be very valuable down the line as a source of stem cells to make sperm in a dish! The question is when!

  16. Hi,
    My husband had testicular cancer (classic seminoma) in 2016 (following a sperm analysis with no sperm) which included removal of the testes and biopsy of the remaining testes to see if there where any sperm. There was no sperm in the biopsy but it did show pre-cancerous cells in the remaining testes, and in the testes removed there was evidence of spermatogenesis. He had one chemotherapy treatment of carboplatin. Before and after treatment he had high fsh & lh levels and low testosterone. He took anastrozole daily for ~6 months and his testosterone increased slightly but not to normal levels. My question is, is there anything else that can be done? Could the technology being developed using stem cells help my husband? Or would fna mapping help?

  17. Hi,
    My husband has azospeemia, which we believe was caused by testicular cancer. He had an orichemtomy to remove the affected testes and also he had a biopsy on the remaining testes to see if there was any sperm. They didn’t find any sperm but did find that he had pre-cancerous cells so he had a one treatment of carboplatin. Before and after the cancer his fsh and lh levels have been high and testosterone has been low. He tried anastrozole for about 6 months and his testosterone increased but not to normal levels and there were no sperm in the semen analysis. One doctor had recommended hgb injections but it is not covered by insurance because they say it’s only for people with low fsh & lh. Is there anything else you could recommend? I feel like we are maybe at the end of the road?

    1. Dear Nicola, I am sorry to hear about the cancer diagnosis in your SO. However, it sounds completely curable. In fact, MOST men with early stage testis cancer, and even those receiving 1 round of cargo chem, will have sperm in their remaining testicle. It might not be produced in sufficient numbers to get into the ejaculate but it could certainly be used for “high tech” (ie. IVF) pregnancies. With FNA Mapping there is at least a 65% chance of sperm in the remaining testicle.

  18. Dear doktor Turek here is Sonja from Serbia, if you remember us…Nemanja and Sonja, we come to you clinic in February 2014 to do FNA-a and again in Avgust 2014 to do microtese and IVF and we did it suceslly all together… we all arange to come again now in September but we have some family problems and we must delay our coming for few month…probably we will see again in Decembar 🙂 I would like to ask you your opinion about “made sperm in a dish”, when will be use in practice, how many years, less or more than 3,4,5 years??? Many people have no time to wait so many years to alive that…. please you are the perfect doctor to help all of us and especially those who wait to alive sperm from dish

    1. Dear Sonja, I hope this finds you well. I can’t wait too see you and the family again. However, please notify the office of your delay. No problem. Man made sperm is 5-10 years away…

  19. I am a 52 Year Old Man and I was Born with Undecended Testicles. 1965 and not Corrected until I was nearly Nine Years Old in1974 by My Parents. I have Normal Sex Characteristics and Puberty but My Testicles have not Grown or Developed at all. I have not had a Normal Upbringing and My Parents did not Both. I have been Married and Lost My Wife in 2016 after nearly 17 Years of Marriage and new Her 3 Years before. ( 20Years). I would like to Meet Somebody else and because I am on My Own and I would of liked to have a Family and I went through My Doctor and had the First Appointment with a Urologist at a Hospital and then for a Second Opinion I went Private. And had Tests for My Testosterone with a Blood Test in the Morning and this is at Normal Levels and had this Twice. I have had My F S H and. L H and other Hormones. The Results where that they are Both Elevated and I have been Informed I Have Testicular Failure. I have had My Semen Tested and there is nothing there. This is very Sad and Devastating to be Told there is nothing that can be done and can’t be Reversed and also My Age and No Fault of My Own. I have all the Medical Information from My Doctor. I have been looking at Stem Cell Treatment for Regeneration of the Damaged Testicles and if this could bring all the Functions I should have and Spermogenisus. I have Asked a Clinic in Baveria, Germany with a Dr Block. I know that Stem Cells are the next Great Medical Breakthrough and I would like to know can anything Help Me or am I being Conned for Money. Regards Richard.

    1. Dear John Richard, First I want to say that I am so sorry about your life partner passing away and that to later learn that you are azoospermic is a huge other blow. Your concerns are real and valid. However, stem cell therapy is NOT ready for prime time, in the US or anywhere else in the world. Buyer beware!!
      Just so you know, there is probably a 60% chance that you have mature sperm in your testicles despite having no ejaculated sperm. FNA mapping, a procedure I invented can tell you more. Microdissection TESE can also tell you more, but your native testosterone levels are much more likely to be even lower after mTESE than FNA mapping. Why not consider trying established therapies first before trying highly experimental ones?

  20. Dear Dr Turek
    I am very happy to know this news.
    I am having azospermia. I got an operation last year (TESSE) to take my sperm..
    But, there was no sperm on both of my testis. I was very sad..
    Is the new founding will help me?
    Thank you

    1. Dear Doly, You may actually not need to go this far yet. Maybe the TESE procedure you had was not as “complete” as is possible. Pockets of sperm can be quite microscopically small in the testis. Consider a call with me!

  21. Thank You Paul Turek for Your Advice from My Letter which I Posted to You. I have been looking at all Options about My Damaged Testicles which was Stem Cells and I do know they will be able to Cue all Peoples Medical Problems Eventually but not at the moment. I am a Electrician from England and I See the Technology moving on every Level from Gene Therapy, Heart, Lung, Eyes, Testicles, Ovaries. I have had all the Test except Biopsy from the Testicles and I can Send You via a Gmail all Medical Information to You in America. It is very Sad for Me and because My Parents did not Bother I am Left Infertile of No Fault of My Own and U would of liked My Own Family to be Honest and Thank You for Your kind Words concerning My Late Wife. Your Advice I would like and I would be a Gina Pig for Trials if necessary. I would Appreciate what You Think can Help Me. Regards John. Send Me an Email back to when You are available please. Thanks

  22. Thank You Paul Turek for Your Advice from My Letter which I Posted to You. I have been looking at all Options about My Damaged Testicles which was Stem Cells and I do know they will be able to Cue all Peoples Medical Problems Eventually but not at the moment. I am a Electrician from England and I See the Technology moving on every Level from Gene Therapy, Heart, Lung, Eyes, Testicles, Ovaries. I can Send You all necessary Information from My Medical Files in the UK. What is Your Advice for Me and can You Help in America. Heartbroken to be Honest because of Failure of My Parents to do something about it and is Preventable if done early. Regards John.

  23. Thank You Paul Turek for Your kind Words for My Late Wife and Your Explanation. I am an Electrician from England and Technology is Moving very Fast now on Everything Including Stem Cells, Gene therapy. I can Send all Relevant Information from My Medical Records about My Condition(Testicle Damage) from the Doctors in the UK. What Advice do You Think I can do now and is it available in America ( US). Regards John

  24. Thank You Paul Turek for Your kind Words for My Late Wife and Your Explanation. I am an Electrician from the UK and Technology in the Stem Cell, Gene therapy is Moving very quickly now. I can Send all Information to You in the U S if required and what Advice would You Suggest now for My Condition. Regards John.

  25. Dear dr. Paul
    I’m a big fan of your work , i’m even still an university student but i got pelvic problem wich triggers erectile dysfunction , i can ejaculate but i don’t know if i’m fertile but if i find i’m not i will must have to come and visit you with my futur wife for micro-tese ivf treatements , but one question is if the prostate is infected by the white blood cells can this be well done & with hope ?
    Thank you .

    1. Dear josef, thank you for the compliment! Regarding the “white blood cells,” where are they? If they are in the urine then an infection is possible and should be evaluated. If in the semen, they may or not really be WBCs as most asymptomatic men have lots of sperm precursor cells (called ’round cells’ before they become sperm) in the semen. This could be the wrong call on the semen analysis. A special stain is needed to see if the round cells in the semen are actually WBCs or not. In men without any symptoms, there is a 70% chance that the rounds cells are NOT WBCs.

  26. My husband diagnosed as azoospermia , did first micro biopsy with no sperm only one maturation arrest then he did 2 micro biopsy with no sperm and even no maturation arrest found , his fsh is 18 , other are normal , what can we do , iam waiting for the stem cell , is there any hope , iam 33 years

    1. Dear Camellia, Please read our most recent publication that showed that even after failed mTESE procedures, FNA mapping was able to find sperm in 29% of men. There may still be hope!

  27. Hi dr turek i have seen you in 2015 did fna mapping show no sperm primary and secondary spermacytes found and you diagnosed me with early maturation arrest on both testicles i have also tested my fsh testosterone karoytype 46 XY no cystic fibrosis also no micro deletion detected. in the next 3 years i have seen dr shlegal in newyork cornell medince Did a thorough ultrasound 45 minutes and found that everything is normal a small cyst on left testicle was found. after that i spoke with you and got a prescription for hcg and fsh puregon and pregynl hormonal injections and i did that for 9 months and went to beirut lebanon seen lebanese french dr elis sneifer and did a testicular biopsy they have found 0 sperm i came back to canada spoke to my fertility clinic here and they told me im left with no options i have been seeing eating healthy i quit smoking and ive been seeing a natropath taking vitamin injections which include b6,12,d,c and some others and oral vitamins to help with any chance of having sperm example selium zinc b6,12 D C carotene coq10 etc my sperm analysis still shows 0
    I was wondering is there anything else i havent covered? Can they use primary or secondary spermocytes with ivf icsi etc…. and is it ideal to do another fna mapping
    Thank you in advance for your help in the past and future we appreciate your help and work !!

    1. Sam. I am sorry that you have been through so much with no luck. Dr Schlegel hasn’t had much luck finding sperm when FNA Maps haven’t shown it. Since maturation arrest patterns can be due to reversible causes as well as genetic ones, I have had patients with this pattern on Mapping undergo treatments and then reMapped them and found sperm. However, just reMAPing without treatment, I have not found sperm. Potentially, your lifestyle changes are significant enough to “push” things through to sperm. Lets talk!

  28. Dear Doctor,
    My husband lost both testicles to cancer as a boy in the 80s. I am 37 and healthy. We are together since 17 years. Do you think we would have a shot with what science is offering today for having our own biological child? What would be your word of advice?

    1. Dear Elin, so sorry to hear about your kid predicament. I would say that currently there is no technology to have fully biological children. But that may change in 5-10 yrs. Considering freezing some eggs so that when the technology comes around, the eggs will be young and ready.

  29. I’m sterile from cancer treatment I received when I was 18 months old. This research gives me some hope that one day it may be possible to be a biological father. I’m keen to take part in any future trials or tests.

  30. Dear Dr. Turek,
    My husband went through a bilateral MicroTese last Friday at thr IVI clinic performed by Dr. Balmori (of of the most recognised urologists for this matter in Spain). Unfortunately no sperm was found although he mentioned they retrieved quite some samples and checked it everywhere.
    We are still waiting for the anatomy results but do you think there is still something we could do? Shall we still have hope somehow? We are deeply devastaded with the news.

  31. Dear Dr. Turek,
    My husband was diagnosed with Sertoli Cell Syndrome Only after a micro TESE surgery which indicated that no sperm was found. The Dr prescribed Femara (Letrozole) to be taken for 4 months along with vitamins. We are scheduled to do the mapping 6 months after the micro tese surgery date.
    Do you think that this medication is beneficial for his case? Is there any hope for sperm production for those suffering from Sertoli cell syndrome?

  32. Dear Dr Turek
    My husband went through a Micro-Tese at IVI center in Madrid performed by Dr Balmori (an expert in Spain). Unfortunately the result was negative although he said the MicroTese was a very complete one. We are devastated are not uet ready to think about any sperm donation. I would like to ask you advice on 2 things: Do you think it is worth repeating biopsy with you on FNA Mapping + Dr Schlegel for Micro Tese? (His hormones/genetics were all normal except for FSH at 18.4).
    2) We are 32 and I have already frozen my eggs. Do you think that science will advance in a way that in 10 years from now there will be solutions for maturation arrest or sertoli only cells?
    Thanks a lot. We are still waiting for the anatomy results of the Micro-Tese. If you think you could give us any hope would be glad t schedule a call with you.

    1. Dear Madrid, Funny that you should ask! I just published a paper showing that when I do FNA Mapping AFTER FAILED mTESE procedures, I can find sperm in 29% of men. And these were men from around the world. From my review of repeat mTESE procedures after failed mTESE the rate of finding sperm is <10%.

      1. Thanks a lot!How could we book an appointment with you?
        Do you recommend FNA mapping in Spain or shall we travel to the US to do this? If so, where? Could we have a phone consult first?

  33. Dear dr Turek.
    My husband went through Micro Tese here in Spain where they have checked for sperm on 21 samples from one testicle and 16 on the other. The result was Sertoli Cell Sindrome. Is there something else we can do? How do you advise us to proceed?

    1. Dear Madrid, There may be hope as stem cells are 5-10 years away. We just published a paper showing that using FNA mapping AFTER failed microTESE, that we found mature sperm in 29% of men. Consider this before giving up!

      1. Dear Dr Turek
        Would you recommend us doing that somewhere in Europe or would we need to travel to the US? Shall we have a phone consult? Please give me some contact so I can start arranging it.

  34. Dr. Turek how could we proceed to do that? Would you recommend anyone in Europe or would we need to travel to the US? Shall we schedule a phone consult? Could you give me an email of your clinic so I can contact to arrange it?

  35. Dear Dr Turek
    Anyone in Europe performing FNA mapping with the same success rate as you that you could recommend?
    Thanks a lot

    1. Dear Claudia, I have trained Dr. Jonathan Ramsey in London recently, although he has no published rates of success to date.

  36. Hiya. Reading all these comments I think I need to book an appointment to see you sir
    So I saw a urologist who confirmed normal testicles said he could feel the vas on both sides but no proper developed epididymis. So referred me me for checks classed it as obstruction.
    The urologist requested a hormone profile,cystic fibrosis gene mutation testing, karyotype,ultrasound vit d, thalassamia screen all tests came back normal.
    Fsh 3.9
    Lh 3.2
    Prolactin 153
    46 xy
    They said scan showed the tail of the epididymis was missing so they said blockage and said they would do biopsy to extract the sperm. But they said they didn’t find any. He was shocked just like me. He was sure was a blockage.
    Now he said let’s do a y delete test but I was confused because he said my hormone profile as a whole was normal. Now he said do that test and has said I have to do micro tese. He did mention sterolli cell syndrome but when I first went to him he said because my fsh lh levels were normal it would not be that. So don’t know where I stand. Please help. I would like to come see you and get things going. In my case with everything I’ve said is micro tese good point.

    1. Dear Shazad, I am sorry that you have had to go through all that! Azoospermia can be due to blockage or not. Missing parts are generally associated with blockages, but we also published that men can have BOTH a blockage and have a sperm production problem! It is extremely rare but possible and may be a source of confusion here. Instead of microTESE, you should also consider FNA Mapping, a kinder and gentler way to find pockets of sperm in your testicles! Would love to help!

      1. I’m currently in the uk. I have been referred the a clinic which will do micro tese. But I’ve been reading a lot of your mapping skills. I did read somewhere that you trained someone in London to do this. I can come for a holiday and also get this test done from you at the same time.
        Couple of questions
        1. You mention pockets of sperm. So if they do tese take biopsy’s that means that they could have missed areas where sperm production is happening ?
        2. Just for future use as I read previous comments 5-10 years so anywhere between there you think this will be out sperm grown in labs ?
        3. Mrs is 25 and has great egg reserve so should we freeze some eggs just in case. Also can I forward you my records so you can review them and we can arrange a appointment.

      2. One other thing doc when they did the testicle biopsy they said they found the starting point when the sperm is round but no developed sperm. They said it’s possible that the biopsy’s didn’t show sperm that is inside the testicle that’s where micro tese comes into play. But what you are saying is that mapping located the areas where sperm is so you don’t have to to do a extensive search ? Even in case of stertolli cell syndrome if I spelt if that’s what he said not sure there’s chance to find sperm ? Doc need to talk soon also arrange an appointment and send you my documents. Like stated earlier I live in England. So can put the micro tese on hold until mapping. I first saw you on tv with a couple who couldn’t conceive then you showed them on show pregnant with twins. So I’m quite impressed. Also I would like to know where your up to with the stem cell research because that’s something that I want to know about because my friend will be coming with me so that will be 2 maps you will be doing.

        1. Dear Shazad, you are correct in what you say. A biopsy showing round spermatids but no sperm is encouraging to me because my experience with non-surgical FNA Mapping is “where there are spermatids, there are usually sperm.” And Yes, FNA Mapping can help you avoid the bigger, badder and blinder procedure of microTESE in about half of cases!

  37. Dear Dr Turek
    You mention stem cell treatment to be available in 5-10 years. How confident are you on this? Do you recommend us to wait for this? I saw in your older posts from 2012, and back then you were expecting it to be available within 5-7 years but nothing happened as we are in almost in 2019 now…

    1. Dear Cmd, This has proven to be quite a difficult task, to make human sperm from stem cells. The prediction has been adjusted thusly.

    1. Dear Shazkhal, at least 5 teams in the world are working on this. My estimate remains 5-10 years until clinical use.

  38. Hi doc
    I will be contacting your office in jan 2019 to book in to have the mapping done.
    All bloods hormone genetics fsh Lh tetestrone is normal but no sperm.
    Biopsy done but no sperm found. Was advised to do micro tese as this is the best option.
    But I think the best option right now is to have this mapping done to confirm sperm before proceeding.
    Question is I spoke to dr Asim surani in the uk who is also working on the sperm in lab who said he has passed the half way point. Also estimated 5-10 years. Is this also your estimate ?
    Also how soon would this be available meaning tested and ready for clinical use?
    I’m just trying to keep options open as if the mapping don’t show anything then the next step is to wait for this stem cell.
    I am 34. Mrs is 25.

    1. Dear AmarK, Great to hear that I might be seeing you soon for FNA mapping so that you have the best chance of keeping your testosterone where it is and also find out whether you can be a biodad. I agree with the 5-10 yr estimate on sperm from stem cells but ALOT has to happen and there is ALOT of politics around this product (including FDA approval).

  39. Thanks Dr Turek for the good work, just wondering can artificial sperm be made from somatic cells or immature germ cells from men like myself with AZF deletion without the use of gene editing if the whole sperm generation process can be recreated in a lab?

  40. Good morning dr paul this aida
    My husband has zero sperm we are new Yorkers
    We went to dr Marc Goldstein and Michael Warner they said the same ,the only solution to have a baby is sperm donor they said that after 3 years treatment and we did mapping with dr Warner but the result is zero
    Now I am hopeless there is any chance to have baby by stem cells
    I contact dr megan your assistance but she said not yet can u reply me please

    1. Dear Aida, Sounds like your husband has azoospermia (?genetic) and has had “mapping” by Dr Werner which showed no sperm. IF not genetically defined, there may be a chance of sperm. Consider a Second Opinion in which you send us the FNA “map” findings and I can judge the quality of the Werner Map. I have found sperm on his maps simply because many of the samples taken during the map are not of sufficient quality to say what’s happening.

  41. Dr. Turek,
    My partner is 29 and non-obstructive azoospermic. He’s had a few SAs with zero sperm.
    His FSH level is in the high 20s. Elevated LH. Normal T level.
    He went through chemo for Hodgkin’s at ages 12 and 13. He was given a less than 20% chance of finding sperm in a microTESE. Do you have any thoughts on whether this probability of finding sperm is accurate in your experience? Or have you had success finding sperm in a patient with a similar background (chemo, around puberty)?
    Thank you so much. I am so desperate.
    Also, any updates you can give on skin to sperm? I know they have recently been able to take blood cells and make human immature eggs?

    1. Dear Shannon, This is a routine case for testicular FNA Mapping. We have published on this in the past. HD cases can have sperm in up to 50-60% of the time, depending on the dose, duration of chemo. 20% seems low for such an invasive procedure (mTESE) that has the potential for lowering his testosterone levels.

      1. Thank you for your reply! So would you say his chances of finding sperm even in a MTESE are better than 20% (around 50-60%)?
        The 20% chance was given by the doctor based on the type of cancer, age chemo was given, and the FSH level. Have you seen success in a similar case at similar ages?

        1. Dear Shannon, I can’t remember the details of the case, but typically in cancer survivors, we can find sperm in 50-60% using FNA Mapping and not mTESE.

  42. Dear Dr Turek
    the usual story, diagnosed with azoospermia, one of the 3 semen analysis showed few immotile spermatozoa, did mtese in Cambridge UK yesterday , unfortunately no sperm were found, and been told probably maturation arrest (all my hormones and genetics are normal) still awaiting biopsy results, also given no hopes which is devastating. do you think thre any possible options ?fna
    i am happy to come to your clinic if any hopes even 10%

    1. Dear Firas, thats unfortunate and frustrating: sperm in the ejaculate but none on invasive exploration of the testicle. Maybe FNA can help. Our published data suggests that 78% of men with a history of cryptozoospermia (few immotile sperm in ejaculate) will have sperm found on FNA Mapping, even with a sperm retrieval in between the cryptozoospermia and the FNA mapping procedure, like you did. Wait six months, repeat the hormones to make sure they are still normal and give us a shout!

  43. Dr Turek, do you know any doctor already using stem cell therapy for infertile men? In china/japan perhaps?

    What is holdin this for so long?

    My husband has NOA and underwent MTese in Spain (Sertoli only syndrome). We visited Dr. Ramsey in London who said he knows thw doctor that performed the MTese very well and trusts his judgement…so he said FNA would give us the same result and we didnt do it. He said the only chance for us would go through donor sperm but this is something we dont really like..

    1. Dear Claudia, You have been through a lot. My trust in micro dissection procedures has gone down since I published that FNA mapping AFTER mTESE procedures can find sperm in 29% of cases. And we have found sperm in cases of failed mTESE by great surgeons! Consider a Second Opinion to start!

  44. Dr Turek,
    I went through FNA mapping in last May and not found sperms in that test, and after the testicular biopsy, the result shows Sertoli cell only syndrome. Is there any treatment for this, and can you please suggest me where it is available and how much will be the cost for the procedures. I read about sterm cell treatment procedure, what is success rate and you suggest any centres in India, since am from there.

    1. Dear Muhyudheen, Depends on who did your “Mapping” procedure (as I have not formally trained anyone in India) there may still be a chance that sperm are present but were missed. Stem cell therapy is a decade away, so maybe considering freezing your partners eggs if that is the plan (to wait).

  45. Hi Dr. Turek,

    My hubby had been diagnosed with non obstructive azoospermia back in 2015. (Chromosomal tests are normal, LH normal, FSH slightly high = 19 and low Testosterone). After the diagnosis we went to Dr. Jarvi at Mount Sinai Hospital, Toronto, He was prescribed HCG before going for Micro TESE(thinking this might help in sperm production). He had procedure done on Dec-2017 after taking HCG for six months.
    I was devastated when the Dr. informed me that he did not find any mature sperms during the procedure, however he did saw some immature sperms possibly elongated spermatids and several rounded spermatids signifying late maturation arrest. Not sure what that means and if these will be useful in ICSI.

    He collected 7 samples the sample was freezed and sent to another lab which deals with sperm maturation as per Dr. request. Currently we shifted the Sperm tissue to TRIO fertility clinic in Toronto Canada. TRIO is the only clinic in Canada that have some success with Spermatids. They asked me to go for a IVF cycle and egg retrieval process and then they will thaw the sample and look for the spermatids. Currently I have started my IVF cycle. My egg retrieval would be next week and the same day sample would be thawed to look for immature sperms. I hope everything goes in favor, have you seen cases with elongated/round spermatids having a successful IVF?
    Please advise.

    1. Dear Sheryy, Wow that’s quite a story! You have been to the best in the Canadian business. Couple of things: Spermatid injection is largely experimental at least in the US. Not sure if I have advice here. Second, some cool microdfluidic cell sorting technology is being developed in the US and elsewhere that may be better than the human eye at finding sperm and spermatids. Probably a couple of years from prime time use though. Lastly, if all else fails, consider FNA Mapping as we published that we could find sperm in the same testicles that failed mTESE in 29% of cases and then retrieved that sperm successfully!

  46. Hi Dr.Turek,

    My husband underwent chemotherapy at ages 11 and 12 for two rounds of lymphoma. His FSH level is 34.1 and LH is 13.1. T level is smack dab in the middle normal.

    I recently read a 2010 case study where you found sperm through FNA mapping in a gentleman who had also undergone chemotherapy for lymphoma at ages 12 and 16 /17 (I believe). However, this man’s FSH level was something like 25.

    My question is, does the FSH level effect the likelihood if finding sperm, in cases of childhood cancer? My fear is that perhaps because he was treated before puberty, that there will be nothing there at all. Does this have an effect as well (when puberty occurred)? Thank you so much.

    1. Dear Jemma, What a great question! We and others have published on the ability of cancer survivors to have sperm for kids after going through hell. My most magnificent cases are men with recurring cancers like leukemias who have been through TBI (total body irradiation) and high dose chemo before receiving bone marrow transplants (BMT). I published on two men in BMT journal and have several more since. To answer your question, the FSH level is a relatively insensitive marker of successful sperm retrieval. Also being treated before puberty may or may not be a risk factor for outcomes. Sperm precursor cells (germ cells) are less active before puberty and so are relatively insensitive to the toxicity effects of chemo, which is protective of fertility. However, we tend to “overtreat” childhood cancers due to the long life expectancy afterwards, which is not good for fertility. It really is a case-by-case situation with cancer. Give us a shout, love to help!

  47. Dr. Turek,

    I ran across this article and it gives so much hope to the future of infertility. My wife and I had been trying for kids for a year and come to find out I have azoospermia. I had two test done with no sperm found. I just got back some extra blood work done and my FSH level is 42.9. My free testosterone level was 4.3. Total testosterone 398. Estradiol was 40. My doctor said that this may suggest Sertoli cell only syndrome or a mutation in the fsh receptor gene. What do you think would be our next step in this situation? We do not want to give up on having our own children.

    1. Dear Wesley, If I were you, I would not be reading about future technology as much as CURRENT technology that can be used to find sperm. You have a 60% chance of having mature sperm in your testicles with FNA Mapping. All in. No question. Don’t give up!

  48. Hello Dr. Turek,
    Good Day!!!
    I am 28 year old now. I was born with one undescended testis and my other testis was removed at the age of 22, since then I have been taking hormone injections 4 ml once every three months. I am married sice the past 1 year and would like to start a family and for this I need your guidance. Is there any chance that the undescended testis still produces sperm? If not then please suggest me any other procedure to become a father. My wife wants me to be the biological father so I would like to know is this possible?
    Thank You.

    1. Dear Syed, Sounds like you have no testicles currently…or you have a single testicle that it is not in the scrotum. IF its the latter, then there may be some hope, but you must be OFF of what sounds like testosterone therapy for 6-12 months. Give us a shout to learn more!

      1. Thank you Dr. Turek for your response! Can you suggest how to determine if the missing testicle is in my body or not. Also incase there are no testicles in my body how can I proceed to have children.

        1. Dear Syed, an MRI or CT scan of the abdomen and pelvis offers the most precise way to locate testicles that are not in the scrotum but present. Currently, without a testicle, there is no way to have biological children.

  49. Hi Dr. Turek,

    I read a study somewhere online that very unfortunately for us, the chances of successfully finding sperm in lymphoma cases are maximum 33%. What do you say the average is?

    1. Dear Jemma, Depends, depends, depends! On type of chemo used to treat lymphoma, length of treatment and doses used. Recurrent lymphomas tend to have less sperm as they require more treatment. 30% chance of sperm seems low. Typically I would put it at 50-60% with FNA Mapping.

  50. Dear Dr. Turek,

    Thanks so much for the response. I know it is specific, but have you found sperm in cases of recurrent lymphoma, around puberty?

    Also, I know that the estimate many in the field give on IVG is 5-10 years, but would this mean that you think this would be available as an option to someone now in their mid twenties?

  51. Hi Dr Turek
    My husband is Azospermic he has y chromosome micro deletion in azf region can you please suggest What should we do further he is 29 year.
    Please reply

  52. Hi Dr. Turek
    My husband is azospermic and is diagnosed with y chromosome micro deletion in azf region he is 29 and I’m 22 what would u suggest further as we don’t want donor sperm is it possible in any technology ?
    Please reply.

    1. Dear Ayesha, Men with Y chromosome deletions can have sperm. Depends on exactly what region (AZF a, b, or c or multiples) is deleted. With AZFc deletions about 60-70% of men have sperm. With AZFa or b region deletions the chance is much lower, probably <5%.

  53. Hi Dr turek
    I have been diagnosed with genetic azzoospermia. With deletions of Azfb and AZFbc on the y chromosome. Results are saying it could be spermatogenic arrest or sertoli cell only syndrome. Karyotype mosaic 46x 45x idic. No further tests are done. What are the chances of finding any germ cells or sperm with in the testes?


    1. Dear Ibrahim, you have a mosaic karyotype with some of your body cells showing male and some female chromosomes. Among the male chromosome cells they may be missing a chunk (B and C) regions. This means that your chance of having sperm in the testicle is >5%.

  54. Good Day Dr. Turek,
    I would like to share my husband’s problem and hope to get feedback from you soon.
    Unfortunately, he have 0 sperms in his semen. All hormones in normal range and had no accident. He had biopsy and resulted no sperms. He took treatment and did mico surgery but no sperms found. In both surgeries resulted first stage of sperm cells in sperm production. ( elementary sperm cells).
    Is there any hope and treatment for his cells to continue in all stages and produce sperms can be used in IVF.?
    Is it possible to come to your clinic and have treatment?
    Appreciate your response

    1. By the way if searching for sperms under microscope is called Mapping . This is waht my husband did in Riyadh, Saudi Arabia
      Is it possible to do this surgery again with another doctor .

      1. Dear Fatimah, Sperm mapping is a very specific technique that I described using a non-surgical fine needle approach. Anything else is not consider true mapping. Sounds like your husband had a micro dissection TESE. In this case, if I were to do Sperm Mapping after that, there is a 29% chance that I will find sperm.

    2. Dear Fatimah, So based on your two posts, it sounds like your hubby indeed had a microTESE. Our published data shows that 29% of men who fail mTESE can actually have sperm detected by Sperm Mapping. In all patients in whom sperm were found, we were able to retrieve it with another procedure too! Be happy to help!

  55. My husband has zero sperm , we did biopsy and he doesn’t have the cells that produce sperms at all , is stem cells something that can creat sperms for him ?

    1. Dear Sal, Even if a testis biopsy shows no sperm, there may still be “pockets” of sperm in other areas of hte testis that were missed. FNA Mapping is great for this. Consider Mapping first as sperm from stem cells is years away from clinical use.

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