What's inside of a coffee mug depends on how you look at it.
Do you think it is possible to have your own children with absolutely no sperm in the ejaculate?
Why yes. It happens on a daily basis in my practice.
Honestly, the word “sterility” has really lost much of its meaning nowadays with advances in reproductive technology.
The Affairs of Sperm
Azoospermia is the word used to describe the lack of any sperm in the ejaculate. It is a devastating thing for men to hear as they try to conceive. It comes in two forms: as a consequence of blockage in the sperm ducts outside the testis in the setting of normal sperm production in the testicle (i.e. vasectomy) or as a result of poorly functioning testicles and normal, open ducts beyond it. We routinely grab sperm from behind vasectomy sites to use with assisted reproduction to conceive. Finding sperm in men with poor sperm production, termed nonobstructive azoospermia, is a more complex matter.
One way to think about sperm production in men with poorly functioning testicles is to compare it to a mug with coffee in it. Say the mug is filled with ¼ cup of coffee. If you hold shake the mug, you may not see any coffee spill over the side. In this case, you might assume that the mug has no coffee inside. But, if you peer into the mug directly, you will see that there is actually coffee in the mug. Similarly, the testicle makes more sperm (coffee) than is found in the ejaculate (spilling over cup). There exists a threshold of sperm production, over which sperm shows up in the ejaculate and below which it will not. So, now you know the secret of making fathers out of “sterile” men with poorly functioning testicles.
Sperm from a Rock
Of course, it’s not quite that simple. There is one more layer of complexity here. Poorly functioning testicles may not make sperm evenly throughout their substance. In many cases, there are “pockets” or “islands” of sperm within a sea of otherwise empty tissue. Clinically, this makes sperm retrieval more difficult and has pushed this technology to a high art.
To find sperm, fertility specialists use several sophisticated approaches in men with nonobstructive azoospermia. The traditional testis biopsy works about 30% of the time to find sperm and, as a consequence, is no longer the de rigueur technique for this problem. Fine needle aspiration “mapping”, which I invented about 15 years ago, is easily twice as good as a biopsy in finding sperm and much less invasive. Lastly, “microdissection” of the testis another alternative and involves an all-out surgical assault on the testicle to find sperm making it the most invasive approach. The elegance and complication rates for these approaches vary widely, but their intent is the same: to find enough sperm to allow biological fatherhood. Importantly, when expertly performed, these techniques will find sperm in the majority of cases. For the remainder, there is hope as even newer “no touch” scanning technologies are on the horizon…
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amy
November 8, 2011
How much does this non-invasive Spectroscopy cost for people paying out of pocket. how can one request this. Is this already available in large hospitals?
Paul Turek, MD
November 8, 2011
Amy, It is currently not available at all. We are working out the kinks. Then we will offer a clinical trial to set the bandwidth. Expect to see something out there in 2-3 years or so.
Javier
December 21, 2011
Good evening Dr. Turek,
I had a biopsy done and it determined azoospermia around six years ago. What is the next step? I thought all hope was lost.
Paul Turek, MD
December 22, 2011
Well Javier, lots of things have happened over the last 6 years! All may not be lost. Be happy to speak with you about this. Call 415-392-3200 and we can chat.
ERNIE
February 3, 2012
DEAR DR. TUREK,
MY SPERM TEST SHOWED A HIGHER FSH LEVEL,AND NO SPERM AT ALL.
I HAD A BIOPSY WHICH RESULT CONCLUDED THAT THERE IS A MATURATION ARREST AT THE PRIMARY LEVEL.
I AM 48 NOW. WHAT CAN I DO TO BECOME A BIOLOGICAL FATHER. REALLY DESPERATE.
ERNIE
Paul Turek, MD
February 4, 2012
Ernie, Sounds like you have nonobstructive azoospermia. Wondering whether your doctors identified any genetic (y chromosome or other chromosome) or non-genetic (variocele, exposures, medications, illness) causes. In our previous research, we have observed that about half of men with this condition and this biopsy pattern have a genetic cause, either definable or not, and the others might not. Interestingly, we have also found that men with early maturation arrest can have sperm if: (a) you look harder than a biopsy does at more places in the testis (see: http://www.theturekclinic.com/testicular-mapping.html), (b) remove insults such as recurrent fevers, illness, certain medication or varicoceles or (c) add FSH injections (expensive) for a period of several months to “push” sperm production past the point of the arrest. The point is that there is hope with this biopsy pattern.
gelle
February 5, 2012
HI DR TERUK I had a biopsy done in 2008 the result was no sperm found and I had FNA mapping at your clinic a 2010 also no sperm was found .DR TERUK is there any hope in my sitaution. thank you DR TERUK.
Paul Turek, MD
February 5, 2012
Gelle, good to hear from you. If you want, I can put you on the list of men who are interested in research protocols ( 2 being developed) that will use either metabolomics or stem cells to increase the odds of finding sperm (http://turekonmenshealth.com/2010/02/07/metobolomics-the-picture-of-fatherhood/) or creating it. Neither is prime time yet. Just let me know.
gelle
February 6, 2012
HI DR TUREK how are you I hope you are doing well DR TUREK I just iwant to thank you again trying to help me. if you asked me if i want to put me the list of men who are interesing in research the answer is YES Iam ready whatever you think will help me. it is depersing sitaution thank you offering me opportunity. goodbye gelle from johannesburg south africa.
Wal
March 5, 2012
Hello Dr Turek
Following on from your post. I have been diagnosed with Azoospermia almost 2 years ago, as well as bilateral varicolcel. I have done the varecocel operation almost a year and a half ago.
i have also done testis biopsy and only setolli cells were found with very few germ cells with complete maturation arrest.
I am not sure if your mapping technique can help in my case and wether the latest advancements in stem cell (Adult or Embrionic) can help.
please let me know if you think I have hope before I make the trip to visit you in SF.
Thanks a lot
Paul Turek, MD
March 5, 2012
Wal, Having a biopsy showing Sertoli cell only with rare maturation arrest and getting a varicocele repair may not commonly lead to ejaculated sperm afterwards, but could lead to some improved sperm production in the testis. This, in turn, could be detected by FNA mapping. Let’s set up a call! 415-392-3200.
Ozcan
March 19, 2012
Dear doktor,
I am Ozcan, I come from Turkey but I live in the Netherlands.
I am 33 years old and my partner is 29 years. We have a problem. I am
patient azospermia, NOA and i am twice operated (TESE and Micro-TESE)
and both operations without result. The pathology results is:
non-obstructive Azoospermia with Maturation Arrest, I have round spermatid, but no sperm.
I want to be father, can I ever be father?
Myles
March 29, 2012
Dear Dr. Turek,
I was diagnosed with Non-Hodgkin Lymphoma about 10+ years ago and I did not utilize a sperm bank at the time because I was so scared with the illness I had to deal with. I wish my Oncologist pushed the issue more about sperm banking… Moving on, I finally got the courage to do a semen analysis about a month ago because my wife and I have had no success with getting pregnant, the result showed no sperm found. I am going to do another semen analysis to find out definitively if that is the case. What do you think my options will be if the results are still the same and is there any hope after undergoing chemo treatment (R-CHOP) Rituximab,Cyclophosphamide, Doxorubicin, Vincristine, Prednisone?
Thank you
Paul Turek, MD
March 30, 2012
Myles, Of course there is hope! We and others have published on our ability to find usable sperm in men just like you. FNA mapping is an excellent technique to find small pockets of testicular sperm that just don’t make it out. See:http://www.theturekclinic.com/male-fertility-preservation.html. I can’t say that it is “routine” to find sperm after your heavy but curative chemotherapy regimen for cancer, but I certainly see men like you weekly. Give us a hoot!
Myles
March 31, 2012
Thank you, I think I will.
Jadi
April 3, 2012
Hi Dr. I am 41 years old married 14 years ago, due to aesospermia unable to become biological father. I did biopsy in 2005 in Saudi Arabia but doctors didn’t find any sperms. Last year I shifted to Toronto, On, Canada. I am going to have have surgey again with Dr. Keith Jarvi working in Mount Sinai Hospital. Do you think it is good idea to spend more money, time and get emotional Trauma instead or should I try my luck?? Does there any treatment for Aesospermia has really discovered yet????
Paul Turek, MD
April 3, 2012
You have done alot and you still sound motivated to learn more. Certainly, there is a chance that you have sperm, despite the findings from a simple biopsy in 2005 that showed no sperm. Remember, sperm production can be “patchy” in men in whom it is low. It really becomes a sampling issue. The harder you look, the more likely you will find sperm. I must agree that there is also an element of luck. Dr. Jarvi is a good friend and excellent doctor. Based on the numbers and statistics that he gives you, you can decide whether it is worth it for you to keep pursuing this strategy.
Javed Tariq
April 4, 2012
Thank you very much D. Turek. I really pray and wish you long life and to all your colleagues doing research and treatment for human infertility. I already requested Dr. Jarvi to add myself in his research study. May be one day your team will reach to the permanant solution of Aesospermia.
Fortune
April 7, 2012
Dear Dr,
Please help me. I have no child due to the fact that my husband is azoospermic. Initially he had ED,and also high FSH,and Low testerone,after much treatment and spending all we have all the hormones has normalised. We have done testicular biophys which says maturation arrest at an early stage.Please find below the details of his last three semen analysis since after the biophys:
1st 19/09/2011.
SEMEN: 1.O ML
VISCOSITY: THICK HYPERVISCID
LIQUEFACTION TIME PROLONGED
TOTAL SPERM COUNT:00
NO SPERM COULD BE SEEN AFTER CENTRIFUGATION BY H.P.F
W.B.CS/H.P.F NIL
R.B.CS/H.P.F NIL
SPERMATOGENIC CELLS NIL.
2ND SEMEN ANALYSIS 26/12/2011
SEMEN: 1.5 ML
VISCOSITY: NORMAL
LIQUEFACTION TIME:VISCID
TOTAL SPERM COUNT:00
NO SPERM COULD BE SEEN AFTER CENTRIFUGATION BY H.P.F
W.B.CS/H.P.F: 2-3
R.B.CS/H.P.F:1-2
SPERMATOGENIC CELLS:0-1
3RD SEMEN ANALYSIS 26/03/2012
SEMEN: 2.0 ML
VISCOSITY: NORMAL
LIQUEFACTION TIME:30 MIN
TOTAL SPERM COUNT:00
NO SPERM COULD BE SEEN AFTER CENTRIFUGATION BY H.P.F
W.B.CS/H.P.F: 2-4
R.B.CS/H.P.F:1-3
SPERMATOGENIC CELLS:3-5
please Dr, advice me do i have any hope of being a mother one day? how do i get in touch with you for am currently based in Gulf country.
Many Thanks.
Fortune
Paul Turek, MD
April 7, 2012
Dear Fortune, It appears that your husband has azoospermia and has had (correct me) a single testis biopsy? If so, think of sperm as apples on an apple tree. Not all branches have apples. One must look harder for apples and this is possible with FNA mapping. It is also possible that some forms of “maturation arrest” look on biopsy can be “pushed” to make sperm by treating correctable conditions such as diabetes, fevers, varicocele etc. Consider a call to talk more at 415-392-3200.
Ratan
May 12, 2012
I am 28 yrs and married 2 yrs back but yet no issue. I got examine by Dr. and seman exam. and Azoosperima came. I fear that I never become Father. I request to kinly help me and advised me further treatment. As i live in India but i can not come to your place due to ecominally condition. pl. help me.
Paul Turek, MD
May 13, 2012
Ratan, I understand your situation. Although it is too big a deal to come see me in San Francisco, you can also consider asking for a “Second Opinion” on the website (http://www.theturekclinic.com/urologist-san-francisco.html). In this way, I can comment on the quality of the care that you are getting, suggest what you may need and help out where I can. Works for many who live far away. And, recently I helped a couple with their first pregnancy and I never actually met them!!