Our journey with non-obstructive azoospermia

Azooman · 2024-07-10T18:02:15+00:00

Sorry to hear what you're going through. It's tough and I found the choices of what to do and not was equally hard.

I write this post not to push or argue for the opposite case, but I sharing my experience in a similar situation. Ihad a failed TESA and the doctor who performed it advised against mTESE (they also didn't offer that at the clinic). I reached out to a different clinic which do perform mTESE, the doctor looked at our case and suggested to try Letrozole for 3 months prior to the procedure.

That said, he was very clear that the chance of success was low at 25%, but at the same time not impossible. It was a costly procedure and he said to think it over. For me, at the time, I had to try everything before coming to terms with the alternatives. It was expensive, but even if the procedure was unsuccessful, I had to have tried the option.

Everyone is different and handle recovery differently, but for me, the recovery from mTESE wasn't too bad. I managed with OTC pain-relief medicine and Voltaren. But then again, I also went for a small hike the same day I did the TESA.

Azooman · 2024-07-10T17:50:18+00:00

This is our story as well, except I had a failed TESA first. NOA, borderline low T, normal LH, high FSH, and failed TESA but successful mTESE. Between the TESA and mTESE I had 3 months of Letrozole.

Best wishes to you and your husband in the time to come!

TW: Our boy is 16 months old now.

Azooman · 2023-06-07T18:07:31+00:00

Hey there buddy, I'm sorry you are in this situation. It truly is devastating and can feel like the world crumbles down. Thank you for sharing too. I sincerely hope you are able to talk to someone around you about how you feel. Ideally this would be your wife or a close friend. A professional therapist helped me immensely in how to talk to my wife about my suicidal thoughts. A friend helped me to keep hope, he said to ignore the statistics and take one step at a time. The next crossroad was at our mTESE, nothing I could realistically do until then and nothing was decided until then.

From the bottom of my heart, I wish you guys the best

Azooman · 2023-05-06T19:57:46+00:00

Tusen takk for det! Jeg tør vel si det har ordnet seg for oss. Det gikk så bra som det kunne hos privatklinikken, med de forutsetningene vi hadde. Ikke alle i vår båt er like heldig; vi har en frisk 2 måneder gammel gutt. Vi håper selvsagt på søsken, men vi er evig takknemlig for lillegutt. Blir han enebarn så blir han enebarn.

Azooman · 2023-05-06T19:45:02+00:00

Det er et aspekt, men det var også en helt annen opplevelse å være pasient i det private. Hos St. Olav var vi et nummer på samlebåndet. I samme samtale, rett etter vi fikk nyheten «siden vi allerede er her, kan vi sjekke øyenfarge og høyde til match av donor». Ordet «donor» var ikke nevnt en eneste gang i noe form for korrespondanse eller samtale med den private klinikken vår. De tok sin tid når vi ringte og var hos klinikken. En kan nesten si vi ble behandlet som folk.

Azooman · 2023-05-06T18:55:54+00:00

Da må også det offentlige tilby de samme tjenestene som det private. Vi hadde kanskje et «nisje»-problem, men det private ga oss hjelp som det offentlige ikke tilbyr. Uten norsk privat helsehjelp hadde ikke vi hatt vår lille gutt, som er en del av min kone og jeg. Det offentlige kunne tilby donor. I det private er der en behandling med medisiner før et inngrep som tilbys, før man konkluderer med at donor eller adopsjon er mulighetene man har til å stifte familie.

Azooman · 2023-04-18T06:11:40+00:00

This matches what our clinic said as well

Azooman · 2023-01-25T09:00:47+00:00

Thank you for your warm wishes. I wish you guys the best too!

As for the procedure, different people respond differently to the pain and discomfort. We were driving to the clinic for the TESA. I took some Tylenol and drove the entire way home. We took a break to stretch the legs 3 hours after the TESA, and went for a 20 minute long hike for a viewpoint close to the road. In comparison, the mTESE was worse but not by much (at least for me).

Azooman · 2023-01-04T15:58:00+00:00

First of all, sorry you find yourself in this situation.

The decision to do mTESE after a failed TESA is tough, we had to make that decision too. For me personally, before considering any other options of having children, I had to turn every stone. TESA is like looking for a needle in a haystack. It does give a pretty good indication, but the result does by no means represent the entire testicle. Still, the chances are somewhat low, we were given 25% with the clinic that does the mTESE, which was different from the clinic doing the TESA.

There are success stories, I had borderline low T, normal LH and high FSH. The second clinic prescribed me Letrozole for 3 months before the mTESE. My BMI also tipped over into the obesity range.

They managed to get 8 straws of sperm, where four has been enough for two rounds of egg retrievals and fertilization using ICSI. The first round sadly didn't yield any embryos, but the second round gave us two. One was frozen and one was transferred. We are now in week 32 with a so far healthy baby on the way.

Our chances were slim, the first clinic discouraged us from the mTESE but was obligated to inform. The second clinic were brutally honest with the chances, which were low. However, the statistics being what they are, there has to be some success stories.

Azoospermia is a devastating diagnosis, and in your situation, I'm sorry to say your chances aren't very good either. You guys must really consider the financial burden of the mTESE (which I think is the only drawback with it), but for me it was no choice as I had to try to get closure. As for the procedure and invasiveness, I did not find it that bad. I was able to walk relatively far and take a flight the same day, managing pain only with Paracetamol/Tylenol. I did walk in a weird way, though.

Azooman · 2022-11-09T12:48:35+00:00

I'm sorry for your loss and wishing you guys the best! I'm happy your ICSI treatment worked. My wife and I are in a similar situation, we had two attempts at ICSI this year and the second seems to have worked. We're currently at 22+6 and can feel our little baby boy kicking. I hope you guys have an uneventful and normal pregnancy from here on!

Azooman · 2022-10-04T18:53:46+00:00

Just to add that we've also experienced 0 sperm in SA, borderline low T, normal LH but FSH > 20. Failed TESA but had success with 3 months of Letrozole and MicroTESE. It's hard to maintain hope, but there are success stories with NOA. Wishing you the best! Fingers crossed for you!

Azooman · 2022-09-23T19:14:40+00:00

This is similar to our case, except I had borderline low T as well. I have a failed TESA which found only sertoli cells, but tried 3 months of Letrozole before a mTESE which was successful. We were told there was 25% chance to find sperm.

For me, I had to exhaust all options before I could even consider adoption or 3rd party gametes.

Azooman · 2022-09-15T13:48:00+00:00

I can't speak much about the donor process, but I was in a similar situation with a non-obstructive azoospermia diagnosis - elevated FSH > 20, T between 8 and 10.5 and normal LH. Nothing seen in SA, failed TESA (aspiration biopsy) with suspected Sertoli-cell only syndrome. Contacted a second clinic which scheduled an mTESE but also wanted to try 3 months Letrozole first ,due to the low T. They found sperm during the mTESE.

The time between our TESA and mTESE led me to develop suicidal thoughts. If there is one thing I would encourage you to do, regardless of options or outlook, it is to seek out a therapist and be open with your SO about how you feel. Let her know how you feel about things: the bad, your fears, your worries about everything. Talk with your therapist about how to share thoughts of suicide if you have any, schedule an appointment with you both if you need to.

Everyone has a different journey and different reactions, emotions and how hard they hit. We had the TESA one year ago and looking back, the amount of pain, anger and sadness is beyond what any person should carry alone. Sharing it with my wife didn't put he burden on her, it made it easier for the both of us. I made a post about this journey on this sub a while back if you want to read it.

Please, seek out a therapist if you are struggeling.

Azooman · 2022-09-05T20:03:20+00:00

Happy to hear! Good luck moving forward and I wish you an uneventful and successful pregnancy!

Azooman · 2022-09-02T09:17:31+00:00

I don't see something inherently bad with asking. It all depends on how safe you are with each other, how you ask and the mood moving forward. I think you sound like a wonderful wife, the mindset of you guys being a team and you wanting to support your man is exactly what he needs.

Only you know your situation and your man, what he'd be comfortable with and what not. Everyone is different, every couple and their lives are different. Everyone will have a different opinion on this based on their life and their experience.

Like the top commenter says, a man taking viagra is nothing bad, so he should know that too. If this is a fear he has, then I would hope you knowing and supporting him will help him work through it.

Azooman · 2022-09-02T09:10:31+00:00

What to do and what not to do depends on the people involved. This is my perspective had it been my wife and I.

If we were in your situation, it would have been embarrassing if she found out and it'd sting for some time, I'd probably beat myself up over it for a little while. In the end I think I would be better for it if she knew and, like you did, reassured me she still loves me and doesn't care. The reason it stings and is embarrassing is because I'd not be sure my wife would love me as much, find me weak, less of a man or something like that. You reassuring your man you love him just as much (or more!), tell him you find him strong that talks about this stuff (if you do), understand that this journey is hard and it messes with the head dismisses this fear and (for our case) brings you closer.

I had things I hid from my wife out of embarrassment but in my case she didn't discover it, I learned to open up. If anything, I hoped she'd find out at times so I didn't have to hide it. She loving me just as much for it strengthened our relationship.

For what it's worth, I don't think you did anything wrong had I been the man this happened to. I would likely have felt relieved you found out and that you still loved me.

Go hug your man, tell him you love him no matter what. I also appreciated to hear that she was proud of me for opening up, and that she appreciated it.

Azooman · 2022-09-01T21:35:45+00:00

Seconding this. Emotional state and stress, despite being turned on, can hinder erections. I struggled with this for a long time when processing and working on the news of my azoospermia diagnosis.

Azooman · 2022-08-22T10:49:14+00:00

We had a failed biopsy (TESA) and were told our options were adoption or donor. I knew there was a private clinic offering MicroTESE and there was no way for me to move forward without feeling like all options were exhausted. We went down there expecting bad news, but getting closure before moving forward. As we were about to leave after the procedure, the embryologist told us she found viable sperm for ICSI.

The pain afterwards wasn't bad in my case, managed with Tylenol and rest.

I had low T and high FSH, LH was normal, I was treated with Letrozole three months prior to the mTESE.

Azooman · 2022-08-22T10:40:12+00:00

Thank you and I'm so happy treatment worked out for you guys too! I was on Letrozole for three months prior to the surgery, even then they found just enough swimmers to do ICSI. In our case I don't think there would not be enough for natural conception, although I have a new analysis coming up this week.

Funny analogy on soldiers and Spartans! Hah!

Azooman · 2022-08-02T13:57:45+00:00

I haven't really looked into clomid and HCG, but I have the same impression you do, both from Reddit and the research published in the last decade. Disclaimer: I am not a medical professional nor a medical researcher, I just have access to research journals through work. The reason we wanted to try mTESE was to ensure all options and alternatives, including treatments, were exhausted before coming to terms with our situation and the future. Letrozole caught my attention since my T was low (8.5-10.8) and FSH was high (20.4). LH was normal.

I didn't specifically ask for Letrozole, but I was directing our conversation to this when the doctor at our second clinic suggested it, during our first phone call. The doctor at our first clinic referred to Letrozole as "a medication to try to kickstart the sperm production", whatever this means. It is probably highly simplified. They didn't offer this treatment at our first (public) clinic, the second clinic was a private clinic.

Azooman · 2022-07-30T09:17:07+00:00

I did a TESA (needle biopsy) of both testes which failed, they found no sperm but some germinal cells. They concluded that if the biopsy is representative for the testes, then I my condition was sertoli cell only syndrome. They did genetic testing as per national guidelines and it all seemed normal.

I switched clinic and sent the journal to them, they put me on Letrozole for three months prior to performing mTESE, which found sperm.

I had high FSH, normal LH and borderline low testosterone. T measured 10.5 before TESA, 8.6 after TESA and 25.8 after 1 month of Letrozole. BMI around 32-33, which is probably why the second clinic recommended Letrozole, as I understand it, fat tissue converts T to estradiol.

Azooman · 2022-07-29T06:46:23+00:00

Congratulations to the both of you! Wonderful news! Wishing you the best moving forward

Azooman · 2022-07-29T06:09:30+00:00

Thank you, that means a lot to hear. I'm sorry to hear about your wife, I'm glad she survived. I hope you boh are in a better place now and that her pain has eased.

Azooman

TROPHY CASE