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.