u/Important-Dust5614

Hi guys,

I had my mTESE on July 30th, but unfortunately no sperm were found.

I'm 31 with NOA. My FSH is 9.4 IU/L, my testicular volume is around 8 cc, and my karyotype and Y-chromosome microdeletion tests are normal.

I wasn't given any hormonal treatment before my first mTESE. After getting a second opinion, I'm considering Clomid + hCG for several months, followed by another mTESE in about 6 months.

I know there's no guarantee this will work, and my first mTESE was already negative. But with my relatively mildly elevated FSH, I'm hoping there may still be a chance that hormonal treatment could improve the outcome.

This would likely be my last attempt. If anyone has been through a failed mTESE followed by hormonal treatment and a second attempt, I'd really appreciate hearing your experience.

At this point, I'm holding on to whatever hope I have!

Hi everyone. I'm hoping someone here can help me make sense of my situation because I'm honestly not sure what to do next.

I'm 31 and was diagnosed with non-obstructive azoospermia. My wife and I were hoping to do IVF, so I went ahead with micro-TESE recently.

Unfortunately, the embryologist called me afterward and told me zero sperm were found. The tissue was completely processed and searched, and three people checked it. So obviously this was devastating.

What I'm struggling with is that I don't seem to fit the picture I was expecting from reading about NOA.

My main results:

FSH: 9.4 IU/L

LH: 4.9

Testosterone: ~10 nmol/L

Karyotype: normal 46,XY

Y-chromosome microdeletion: negative

Multiple semen analyses: azoospermia

Testicular volume: ~8 cc

No known history of undescended testes, chemotherapy/radiation, anabolic steroids, etc.

I've seen so many people with FSH in the 20s/30s who still had sperm found with micro-TESE, so I was wondering whether my relatively lower FSH meant there might still be some sperm production somewhere.

I recently spoke with my urologist after the surgery. He said the micro-TESE was very extensive, with 29 specimens dissected under 16× magnification, and he does not think another micro-TESE would be worthwhile. He suspects Sertoli-cell-only syndrome, possibly related to previous testicular damage/inflammation.

He said I could try Clomid 25 mg/day for 3–6 months, but he doesn't really expect it to work in my situation.

So now I'm stuck wondering:

Is this really the end of the road for biological children, or is there something I'm missing?

For anyone who has been through NOA:

Has anyone had a completely negative micro-TESE and later found sperm elsewhere or on another attempt?

Has anyone with FSH around 9–10 and suspected Sertoli-cell-only syndrome had a different outcome?

Is hormonal treatment before another attempt ever worthwhile in a situation like this?

Would you seek a second opinion at another high-volume reproductive urology center?

Is there anything else I should be testing or asking for before giving up?

I'm not looking for someone to give me false hope. I'm just trying to figure out whether I should accept the result or whether there's still something reasonable I should investigate.

If you've been through something similar, I'd really appreciate hearing what happened in your case.

Thank you.

Hi everyone,

I'm a 30M diagnosed with non-obstructive azoospermia (NOA).

My workup:

• Multiple semen analyses: Azoospermia

• Karyotype: Normal (46,XY)

• Y microdeletion: Negative

• FSH: 9.4 IU/L

• LH: 4.9 IU/L

• Testosterone: ~10 nmol/L

• No history of chemo, radiation, steroids, undescended testes, or mumps.

I had a micro-TESE a few days ago in Canada. The entire tissue sample was processed, and three embryologists independently searched it. Unfortunately, zero sperm were found.

I'm waiting for the pathology report and follow-up with my urologist.

My questions:

1. Has anyone had a completely negative micro-TESE and later found sperm with a repeat micro-TESE elsewhere?

2. Does my relatively low FSH (9.4) mean there could still be some spermatogenesis, or does the negative micro-TESE outweigh that?

3. Has anyone benefited from hormone therapy (hCG/FSH/clomid, etc.) before a second micro-TESE?

4. Is it worth seeking a second opinion at a high-volume center, or is this generally considered the end of the road?

I'm looking for honest experiences. Thanks in advance.