Ask a doctor on the topic of Urology

Azoospermia???

November 17, 2011 | 30,00 EUR | answered by Dr. med. Ralf Berg

Hello,

my husband and I have had a strong desire to have children for a long time. Previous sperm analysis always showed normozoospermia. After 2 IVF attempts, it was determined that the reason for not being able to conceive lies with me (coagulation) and we were hopeful that we could soon expect a child without artificial insemination.

I did indeed become pregnant soon after with IUI. At that time, the doctor mentioned that the sperm quality was not really good this time. We attributed it to stress.

Unfortunately, we lost this baby in the 11th week. After a few weeks, we were back in treatment. However, it was then discovered that there were no sperm in the ejaculate for the next attempt. We were shocked!

Naturally, my husband was then sent to a urologist. He felt a hardening in the left testicle and immediately sent him to the hospital for further investigation. There, he was operated on the same day with suspicion of testicular cancer. Although testicular cancer could actually be ruled out on the same day, doctors found scar tissue, indicating an original tumor (spontaneous healing - occult seminoma - it seems). However, TINs were found and my husband was advised to undergo radiation therapy. In the meantime, we informed ourselves about what we could do for our desire for children. We were advised to prepare for both ICSI and TESE. Unfortunately, nothing was found during the TESE. The good news: the right testicle is free of TINs, but they only found sperm in the early stage (Sertoli cell - if I understood correctly).

According to the doctors, the previous findings of normozoospermia should be doubted. But we have 8 (!!!) of those!!! Nobody can tell us what happened there. When we asked, the answer was just to focus on his recovery first (he was NEVER really sick!!!)

But now my questions. Is there ever a chance that the testicular tissue might start working again?? How can I understand "sperm in the early stage" - so there was something there and the TESE was done too early after the surgery? (By the way, there were about 6 weeks between the 1st surgery and the TESE) Hormones, according to my husband's statement, are fine. He doesn't want to get checked anymore. Neither blood, nor testicles, nor ejaculate. For him, it's over. Unfortunately, not for me!! :-(

What is your assessment?? Is there hope??

Thank you in advance for your answer!

Kind regards

Dr. med. Ralf Berg

Good evening,

this is truly an extraordinary story. My assessment (unfortunately) is that your husband is probably right to consider the whole thing closed. Just like the female egg cell, male germ cells also need to mature in order to develop into a sperm. This process occurs in the testicle in various stages. If only Sertoli cells are found, it means that there are no sperm (and their precursors) present. Sertoli cells only serve as a kind of binding and supportive tissue in the testicle, and have nothing to do with spermatogenesis. Why nothing is found in the testicle without neoplasia, and why this was apparently not the case 8 times before, is something that no one will likely be able to explain to you. The chances of sperm production starting again here are extremely low, especially since, according to your statement, the hormones are normal, indicating a hormonal stimulation. The time since the operation was sufficient in my opinion. Although spermatogenesis takes about 64 days, there should definitely be precursors (spermatocytes I and II, secondary spermatids) present.

After radiation therapy, the likelihood of sperm being produced again is very unlikely.

I am sorry that I cannot offer you any hope in this matter.
With best regards,
Dr. R. Berg