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Took Clomid And Clomiphene For Azoospermia. Recent Test Showed Zero Sperm Count. Required Treatment?

Posted on Tue, 16 Apr 2013

Question: My husband is 35 yo. He was diagnosed with Azoospermia 2 yrs ago. On the first yr, there were cysts on the epidimytis, his testosterone is low and prolactin is high but after a year on a healthy diet, exercise, no alcohol, wearing of boxers. His next ultrasound is already good -no more cysts and testosterone is better but prolactin is lower. He had ultrasound with his prostate and it is fine. So we ruled out obstructive azoospermia. Then his genes were checked. it is also fine, 46 pairs XY chromosomes. He was given clomiphene to make his Testosterone regulated. He went to see Endocrine specialist to have his hormones checked for the Prolactin and other related hormones. Endocrine specialist told him his results are fine. He is still continuing taking Clomid. But his recent tests say that sperm count is still zero. Are there other tests that do you think we need to find out the cause and treat it? We want to have a normal pregnancy. Wife is now 34 too. thanks!

Answered by Dr. Dr. P. T. Patil (1 hour later)

Hello,

Thanks for your query.

Based on the facts that you have posted it appears that your husband has Azoospermia.

It is good to know that he has been thoroughly investigated by endocrinologist and have done vasogram to rule out any blockage in transmission of sperms. He also seems to be taking some medications to improve sperm count. However frankly speaking there is no medicine that can stimulate the testicles to produce the sperms.

He may have to do a bilateral testicular biopsy to confirm whether there is production of sperms by the testicles or not. If there is spermatogenesis you can get sperms from his testicles for ICSI. (Intra Cytoplasmic Sperm Insertion) to have baby from your husband’s sperm.

Hope I have answered your query.
Please feel free to ask if you have any more questions I shall be happy to help you.

Regards
Dr.Patil

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. P. T. Patil (6 hours later)

i checked if he did vasogram, he did not. it was just ultrasound of the testes. first result: benign cyst are demonstrated in the head of the epididymis & the pampinoform veins appear to be prominent bilaterlly. then 2nd ultrasound (1yr fr previous): no testicular or epididymal lesion is demonstrated. patient has a left-sided varicocoele.

prostate endorectal ultrasound: coarse calsification appear with the prostate but final result says normal.

do you think we need a vasogram? does the left-side varicocoele mean anything? can he do some tests before he do the bilateral testicular biopsy? is this biopsy outpatient?

Answered by Dr. Dr. P. T. Patil (6 hours later)

Hello,

Thanks for follow up.

First and foremost investigation in a person with Azoospermia is to confirm whether the sperms are produced by Testicles or not by doing Testicular Biopsy.

If there is spermatogenesis then subsequent investigation like Vasogram is carried out to rule out any blockage in the passage of sperms from the testicles to urethra.

You cannot rule out obstruction in passage of sperms by Ultra sound Scanning of prostate.

Testicular Biopsy is a day care surgery for which you have to be hospitalized for few hours.

Thanks and Regards.
Dr.Patil

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. P. T. Patil (48 hours later)

Thank you Doctor. So the next step for him is really Testicular biopsy. Will testicular biopsy represent just a sample of his sperm if there's any? is there a chance that there are sperms but a biopsy will not see? is there another procedure aside from testicular biopsy to check if there is really spermatogenesis?

Answered by Dr. Dr. P. T. Patil (8 hours later)

Hello,
Thanks for follow up.

Testicular biopsy is the only investigation to confirm whether testis is producing sperms or not.

There are 0% chances of the sperms (Spermatogenesis) not being detected on histological examination of a tissue taken during biopsy.

There is no other procedure to detect spermatogenesis.

Thanks and Regards.
Dr.Patil

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Above answer was peer-reviewed by : Dr. Shanthi.E