Isotretinoin might have worked (small win)
Wanted to share a data point for anyone else navigating late maturation arrest, and azoospermia/cryptozoospermia more generally.
Quick timeline:
• Two SAs in early 2025: single-digit immotile sperm both times
• August 2025: TESA — found one amorphous sperm. Histology showed late MA/HS
• September/November 2025: started FSH (Gonal-F 225 IU 3x/week) and hCG (Ovitrelle, three clicks once a week, so very low dose)
• Jan 2026: started isotretinoin 10mg
• Nov, Dec, and April: three consecutive 0-count SAs
• Mid-April 2026: escalated isotretinoin to 20mg
• Today: SA post-centrifugation showed <10 motile sperm — first time motile sperm has shown up at all.
Normogonadotropic baseline, and normal genetic results. Eliminated all alcohol in mid 2025, trying to avoid ultraprocessed foods and eat healthy, and focusing on sleep and managing stress. Also on a range of supplements (COQ10, l-Carnitine, omega 3, multivitamins, zinc, magnesium, ashwagandha, maca root, n-acetylcysteine, arginine, creatine, boron, selenium)
No way of knowing if it was the isotretinoin specifically, or something else, but the timing lines up quite well. Will continue doing SAs to see if this holds, or even improves further. Happy to share more if useful to anyone else here.