No sperm in first SA - Now what?


#1

Hi all,

I am new to this, and have been reading a ton on this forum… It’s been so helpful! My husband and I have been TTC for over a year and we recently started testing. My tests have all come back good, but my husband just got his semen analysis test back and it came back with no sperm to be analyzed. My gynecologist gave us the results, said it was very rare, and referred us to a urologist. Since we can’t get in for a few weeks, I started researching. I have been reading the Azoospermia threads about our options, but am not sure if I am jumping to a conclusion that I shouldn’t be at this point that my husband has azoospermia. If SA comes back with no sperm, is there a chance that it’s a fluke? Or am I looking in the right place?

I don’t want to put the cart before the horse, but I also don’t want to waste any more time. We are in Chicago, so we have a lot of options for urologists in the area. Any thoughts on meeting with a regular urologist first vs finding a more specialized male fertility urologist right away?

It’s hard to know what to do next, and I think we are about to embark on a very expensive journey, so I also want to be cognizant that we make every visit and test count.

Would appreciate any guidance and advice!


#2

You should definitely go to a urologist that specializes in male infertility. Going to a regular urologist really just wastes time. If a standard semen analysis shows a zero count, the next step would probably would be a semen analysis that has been processed using a centrifuge. Finding even 1 sperm would be a HUGE deal.
I have totally been where you are right now. It’s very scary, but it’s not the end of the world. There are a lot of options. Good luck!!:flower:


#3

Same experience

Hi there,

3 years ago we found out that we have no sperm coming out. We are from Chicago, had TESE with a good urologist, great experience and found sperm to move ahead with ICSI. We worked with Dr. Niederberger and heard good things about Dr. Brennigan, too. Let me know if you have questions, it is not an easy journey but are a lot of success stories on this forum…good luck!


#4

Hi Cubby and Bluehope, thank you for your messages!

I called Dr. Niederberger’s office and left a voicemail, hopefully we can get an appointment with him. My husband isn’t really ready to deal with this yet, or… perhaps he just will deal with it differently than me. He hasn’t done any research or anything yet, so while I understand that we should be going to someone more specialized, I am trying to be sensitive in discussing it with him. I did speak with him last night about it and asked if he minded if I made this appointment for him instead. The urologists where he has the appointment, while they might be fine… I haven’t read anything about them in any discussions around severe male factor like no sperm.

I am going to ask if he can do the more indepth SA and maybe also blood tests before he meets with the doctor… or, I guess I will ask them if they advise/are open to that. Just seems like when he made these other urologist appointments that should have been their first recommendation. The fact it wasn’t is part of what worries me!

Have you heard of anyone having 0 sperm in the first SA and then having sperm in future SA?

My husband isn’t ready to talk about this stuff, and doesn’t want me to talk with any of my friends, so I am feeling really alone and trapped by all this. I am trying to remain calm and act like it’s not upsetting me when we discuss it, because I know he feels terrible already. But it’s been really hard.

Thanks for your help!


#5

It is possible to have no sperm in one SA and then have some in a later one. Also, there are lots of reasons why there might not be sperm. So, for example he might have obstructive azoospermia (something blocking the sperm from coming out) instead of non-obstructive azoospermia. Our dynamic sounds similar to yours. I did all the research, and my husband attended appointments. Not always fun, but we are making it work. Don’t waste any time figuring this out is my advice. My husband was first diagnosed in 2009, and we are still working it out.


#6

Thanks for that… I am praying that it is the case for us and they will find sperm in the next SA. I found out the doctor won’t order another SA or any additional tests until after he meets with the doctor.

I also spoke with my doctor and she agreed that we should go to someone specialized in the area and is going to do some asking around for me as well. I actually called Dr Turek’s office to find out what their standard procedure is for out of towners, but my husband (am I supposed to say DH? I don’t know all the acronyms yet!) said I was over-reacting.

Trying not to obsess about all the what-ifs until we know more… that is HARD for me! I feel like I am on a legit roller coaster the way my emotions are rolling around.


#7

I completely understand what your are going through. It is so hard not to over think everything, especially when you just want to know what is going on and how to fix it. Last June my DH did his first SA and had 0 sperm. That was the worst day of my life. I felt so hopeless, lost and confused. Our world was completely shattered with the one phone call.

I think going to a specialist is a smart move. Meeting with a regular urologist would be a waste of time and money, which I’m sure you will find out, but you will be spending alot of through this whole process! Also, if you meet with a specialist you don’t have to go through the hassel of trying to transfer records from your regular urologist to your specialist.

Good news, my DH’s 2nd SA had 600,000 to 1 million sperm! So you can go from 0 sperm to a low count. You can’t assume is will always be 0 with only 1 SA. However that was the highest his count has ever been. He averages about 10 - 20,000.

I have to say that I’m jealous you live with so many options of specialist. We live in Montana where we have no specialists in the state. Currently, we are working with SRM in Seattle, but our urologist there has proven to be a disappointment. :frowning:

I’ll be following your story and praying your find the answers you need to create your much deserved family!


#8

Same boat!

My heart skipped a beat when I read your post. I have been reading on here for two weeks but didn’t sign up until tonight. I’m in Chicago and am dealing with your exact situation. We did testing at FCI and I came back normal. DH got two SAs with zeros. He doesn’t want me to tell anyone so I’ve been a mess, feeling totally isolated, and not knowing what to do for the last two weeks. FCI and my doctor recommended Dr Neiderberger so we see him in a week and a half. Took five calls to get them to call me back, though! He is dealing with it in his own silent way but I’ve been pretty upset - thinking about all the what ifs and what our future holds. Sending you lots of good vibes. It’s funny that this one Internet post makes me feel a little less alone!


#9

Irishflower: I know what you mean… honestly reading on here was the best thing for me, the only thing to help me with that loneliness. I was scared to write, but so glad I did, and that finding this post makes you feel less alone, too! We have an appt with Dr Neiderberger this week. I think I am going to go with - are you? When were you able to get an appointment? I am glad to hear FCI recommended him. I haven’t gone to FCI or any fertility center yet - just tested with my regular lady doctor.

Tburg: I am sorry to hear you are dealing with this too, and that you don’t have any good urologist options locally. But… he has shown sperm in subsequent SAs - How amazing! I was so happy to hear it went up like that. I know that’s why doctors prefer we don’t read all these blogs, every situation is different, but knowing about YOUR situation helps put some silver lining around my storm cloud. :slight_smile: Even if it hasn’t worked out yet, you have sperm! I will be praying for you too. Can I ask a question, after reading your signature - if there are sperm in his SA why did they have to do the biopsy? Can’t they just get sperm from a sample and do IVF with ICSI using that sperm? I feel like if the next SA has sperm in it, I will want them to FREEZE it right away so we can use for IVF! But I am probably missing something, because it doesn’t sound like that’s standard practice from reading other posts.

My DH and I had a really good conversation about it all last night. We haven’t been talking about it, so I had to force the issue, but he has more than one appointment this week and has to decide which doctor he wants to work with. I figure if he wants to engage a second doctor down the line that might make sense, but we should just choose one to work with at this point. We talked about why I have such a sense of urgency around this (solutions will take TIME and we aren’t getting any younger!) and though he doesn’t want to worry about considering the alternatives until we have to do so - I encouraged him to start thinking about his feelings about DS, adoption, etc now so that if we do need to consider, we have had time to really determine our feelings about it. I absolutely want to be a parent, and I have faith that we will be. Feeling more optimistic (well, at this moment at least!)

I will keep you all posted how things go for us. Please keep me posted on your stories, too!


#10

We have an appointment on April 30th. I’m going along and didn’t really give DH the option, but I think he wants me to go:) I have always been the one in the relationship that sort of organizes things and makes sure everything happens, so it just seemed natural from an organizational standpoint to go. But I know, even though he’s not saying it, that DH wants the emotional support as well.

I am so glad we went to FCI. We only went there because we were at 10 months out from actually trying (May 2012) and at my annual exam, my doctor told me about a cheap program FCI has for $90. You just pay out of pocket for the initial testing. I guess what does 2 months get me in the whole scheme of things, but I am just happy that we discovered it now.

I did way too much online researching last night and now I have a million more ideas in my head about what will (can!) happen from here on out. I firmly believe that being educated about everything is the best way to go, but it’s also hard to shut your brain off about the endless possibilities.

Good luck on your appointment and whomever you choose to go with. I will keep you updated after ours - but I’m guessing there isn’t really big news at these initial appointments. Just referrals for tests and waiting.


#11

Hi Tburg.

TTC since June 2011
July 2012: 1st SA…0 Count
Aug. 2012: 2nd SA…1 mil

How did you increase your sperm count? Treatments? Or just nothing?


#12

Update

Just wanted to give an update. We met with Dr Niederberger and another doctor working with him a couple weeks ago; my husband said they made him as comfortable as he could be in the situation. He had blood tests run last week and a second SA today showed no sperm again. We have our next appointment to see what he recommends next week. Dr Niederberger said his blood tests would help us figure out what to do next. Will keep you posted.


#13

Hi all,

Wanted to share the latest…

We got the blood test results back and my husband was diagnosed NOA. He has high testosterone, as they expected based on his appearance, and also has high FSH at 19.4. We were hoping for obstructive, so we could get it fixed, but were told that with my husbands testis long. axis and testosterone levels, it’s 89% chance that it’s NOA.

We decided to move forward with the mTESE procedure and have it scheduled for next month.

We haven’t yet done additional testing for karotype and y chromosome microdeletions. The doctor didn’t encourage us to do them - I can’t remember if he brought them up or if I did. At any rate, I think we are going to do it before the surgery even though they are expensive… anyone have any opinions on that? Are those tests conclusive, both for whether you have the issue and if you do have it - if there is any chance of sperm? I only see a point to them if we know we shouldn’t bother with the mTESE because there is 0% chance of sperm.

Additionally, my husband is really worried about having a healthy baby and wants to do genetic testing - we were offered Counsyl. Has anyone done this? My opinion is that knowing about the possibility of our baby having an issue won’t help us in this, it would only give us another thing to worry about in a more specific way. Unless the tests could tell us with great certainty that our child wouldn’t be healthy, we still would want to try to have a child together, so why take the test? I haven’t done much research yet so will look to see if there is a thread out there discussing this.

We have an appointment at FCI the week following the mTESE. Since we have no IVF coverage, we are waiting to see if they can find sperm before we go forward with that appointment. We haven’t yet heard what our of mTESE will be covered by insurance.

Irishflower, let me know how things are going for you!

Will try to keep you posted on our journey as well.


#14

Staying Calm,
A good center will not do mTese without IVF at the same time. What are they going to do with the sperm if they find any? Frozen testicular sperm only defrosts and is usable about 30% of the time, and a second mTese may not find additional sperm. Also the Y chromosome deletion tests are standard. There are certain deletions for which they never find sperm. I have not heard of a reputable male factor infertility specialist who would recommend an mTese for NOA with no IVF at the same time. But that was just our experience.


#15

Hey San Diegan,

I think our doctor said he only does frozen… that the results are actually better with frozen than fresh. But now I am researching and finding much more about fresh being better at least on here. I am going to ask my husband what he remembers from the conversation, because I didn’t write this piece down.

Since we are paying out of pocket, and aren’t sure if we’ll do DS if they don’t find sperm, we thought that doing mTESE first and making sure we have sperm before going through IVF made sense for us. We figured it would be less stressful for us to go this route, as I could take care of him, and then him of me, by breaking out the two things. With the added value of not spending all that money and physical stress of IVF if we don’t have sperm.

But on top of that, I swear this is the way the doctor said he always does it, and it wasn’t him responding to our wishes.

Take a look at this: Efficiency of Using Frozen-Thawed Testicular Sperm for Multiple Intracytoplasmic Sperm Injections

Now I am freaking out… our mTESE is next month and I don’t think we can get into FCI before then.

Anybody else done an mTESE without doing IVF at the same time?


#16

Yes, we had TESE before IVF and save 8 vials of sperm for IVF to be used when we want. The frozen sperm worked great, in azoo case I will choose to have more saved frozen vials than going for TESE more than once. Good luck to you!


#17

Staying calm,
I think you should do some research and figure out what makes sense for you given your situation. Also TESE (basically a biopsy under local anesthesia) and mTese (a 2-4 hour surgery under general anesthesia) are different. So maybe your doctor is just doing a biopsy and not mTese? We did something called FNA mapping which is a lot of very small biopsies of the testicle done without any anesthesia, to see if we had sperm before doing our IVF/mTese cycle. We just saw Dr. Schlegel who invented mTese and has done more research on this than anyone. He told us that the pregnancy rate with fresh testicular sperm is about equivalent to normal IVF (so at Cornell about 50%). With frozen testicular sperm it drops to about 20% in his experience. As well, with fresh tissue, even if during the surgery they don’t see a lot of motile sperm, the sperm actually gains motility if left for about 24-48 hours. So in other words, even if they think there are only a few motile sperm when doing mTese, there can actually be many more, which then can be used for fresh IVF at that time. However, once that tissue is frozen, the sperm may not defrost motile (that actually happened to us). In other words, if motile sperm is what you want (and you do) then it is better for the ultimate goal (pregnancy) to use a fresh sample of testicular sperm, at least according to Schlegel. Also Schlegel warned us that testicular sperm only defrosts in a usable format about 30% of the time. You should definitely do your research and ask your urologist questions. It’s better to do this right then rush into it. Also there is a huge profit incentive for doctors because this stuff is out of pocket for almost everyone, so keep that in mind when evaluating your options.


#18

Update

Hi SanDiegan, Thanks for your input!

I have done a ridiculous amount of research. :slight_smile: My DH will be having mTESE, not TESE. We saw the urologist again on Friday to ask more questions as DH had more pop up, and obviously I was still worried about fresh/frozen. Our urologist said that the challenge with all the research on this is that it’s so contingent on the clinic you are at, and what they like to deal with or have experience with. I actually brought in a study from Schlegel on fresh/frozen and although it was an old publication we know that his practice is to use fresh sperm… but that’s not our doctor’s standard practice. He admitted that intuitively, fresh seems like it would be better, and a lot of places will only do it that way. He said his reasoning for using frozen is multiple - the clinic he works with is very experienced with frozen and their success rates with frozen are the same if not better than with fresh, that they try to avoid putting the female body through the rigors of IVF without certainty of sperm, and that although some sperm won’t make it through the thaw, that it is another bit of natural selection to get the strongest or best sperm for ICSI. We felt better after talking to them. DH also did the karotype, y chromosome and Counsyl testing.

I was able to get an appointment with the fertility clinic this Thursday, so hopefully they will validate all that we have been told. If not, we will see what we do!

We were also told that the IVF with ICSI rates published are relevant to us, regardless that we will get sperm from mTESE rather than the old fashioned way.

Will keep you posted.


#19

My husband had a SA in 2008 that yielded no sperm. He had an urologist do a transrectal u/s under anesthesia and couldn’t find his vas deferens. We ended up doing PESA (Percutaneous Epididymus Sperm Aspiration), less evasive and cheaper ($1000) than TESA and they found plenty of usable live sperm. They numb his testicles and insert a needle to extract the sperm. He didn’t have to be put to sleep. Just another option I wanted to put out there. He’s had 3 PESA done over the past few years and no problem getting sperm each time.

GL to you!


#20

Staying calm- Let me tell you my story and give you some hope.

As you can see from my sig., DH and I have been raked through the coals the last year and a half. It is so important to choose a doctor you trust for this process. We used Dr Brannigan for ALL of our Tese procedures. He is by far, the most amazing doctor I have ever met. That being said, the lab at Northwestern (where Brannigan is based out of) almost ruined us when they had a tank malfunction and killed all of my husbands sperm from his first procedure. We loved Brannigan so much we went back to him for another Tese, and opted to do a live fertilization (Tese and egg retrieval on same day), however, my IVF doctor at Northwestern was a complete waste of time. Never answered my questions, and didn’t seem to care much about our case. He kept telling me my eggs were B grade, and he didn’t know why.

We finally opted to switch to Dr Kaplan at FCI for IVF. After my first failed cycle in March with Kaplan, he sat DH and I down and started to talk donor sperm. He said it wasn’t my eggs, and he knew how to make my stim better. He wasn’t very confident in DH’s sperm, which was awful to hear, but it was a relief to have an answer as to why we kept failing. DH was so determined, he insisted on having ANOTHER Tese in an attempt to use fresh sperm for one last shot at our own child. Dr Kaplan tweaked my IVF protocol a little bit and BOOM! Our first :bfp: happened just yesterday!!! Dr Brannigan did perform DH’s 3rd Tese, and then the spermies sat overnight to wait for my egg retrieval the next day, but they were still fresh. And as you can see, my first pregnancy test was convincingly strong!

My point in this long winded message is this…they will tell you that there is no difference between frozen sperm and fresh. I disagree whole heartedly. I realize this thread is a few months old, but if you haven’t had the procedure yet for DH and you plan to, I recommend doing a fresh Tese with your egg retrieval. AND- use Dr Kaplan for your IVF. Trust me, I’ve done the research. He is your man. He does have a urologist that works in his building that can make it so your hubby’s sperm doesn’t have to be transported, which I recommend. But like I said, we love Brannigan so we went about it the way we did. Good luck to you

PS- DH was on clomid for his Tese which really helped get some happy swimming sperm! AND- I made him stop smoking weed for 3 months before his last Tese and that was the one that worked. So, I think making sure DH is in good health is necessary.