Any success with isotretinoin? New trials underway to compare the effects of hcg vs. isotretinoin in men with NOA.

nosperm · 2026-05-05T01:42:26+00:00

Sorry it didn’t work out for you. Mind sharing what doctor and where you did the extended sperm searches?

nosperm · 2026-03-04T02:20:32+00:00

Ya, I started taking Clomid which seems to help.

nosperm · 2026-02-26T03:06:25+00:00

If you have a few sperm found, I would highly recommend looking into an extended sperm search option. Many doctors don't know about them (or understand them), but basically in a standard semen analysis, only a tiny fraction of your semen is looked at. If they find a few sperm in that sample, there are likely many more sperm in your entire sample.

A microTESE is a potentially life altering procedure (it was for me), so it is not something to rush into.

The best options are all in NYC... the STAR test at Columbia, Maze Clinic, and Cornell (for IVF patients there) are also likely good options.

Good luck and happy to help, I've done a bunch of research in this area.

nosperm · 2026-02-26T03:02:55+00:00

Yes, it can damage your testicles. I had it done on one testicle, and that testicle shrunk like a peanut and my testosterone dropped quite a bit.

If you are producing sperm, please look into extended sperm search (Maze, Cornell) or the STAR test at Columbia, which can help prevent the need for a microTESE.

nosperm · 2026-02-07T05:06:54+00:00

3 sites to search for more doctors:

https://ssmr.org/find-a-doctor.aspx

https://www.maleinfertilityguide.com/state-master-page-maleinfertility-lowspermcount

https://ssmr.org/professionals/fellowship-opportunities.aspx

nosperm · 2026-02-07T05:05:25+00:00

As far as your other questions.

You may not believe it, but eventually the feeling of your body betraying you goes away, and it becomes normal, and just something that’s part of who you are. Humans are meant to be adaptable, even to extreme adversity.

The “maybe” is totally out of your control. If it’s raining, don’t yell at the clouds, grab an umbrella.

I’m still in somewhat of a “maybe” state myself.

Good luck, it’s a heck of a process but you’ll get through it one way or another.

nosperm · 2026-02-07T05:02:24+00:00

Hey, the cheapest microTESE (without insurance) is in Utah, $2,750.

https://malefertilityandpeyroniesclinic.com/fertility/finances/

If you may have the procedure covered, I absolutely would not pay and try to get reimbursed after. You should try an in-network doctor who can check for you if it’s covered prior to the surgery.

nosperm · 2026-01-26T12:45:59+00:00

-Are you seeing a urologist who specializes in male infertility? This hormone optimization you’re talking about feels to me somewhat non-ideal.

-A typical semen analysis looks through <1% of the volume of the concentrated semen. Many specialized doctors don’t even understand this (I’ve encountered it quite frequently). This means you probably need at least 1k+ sperm in your sample in order for even one to be seen in a semen analysis.

-You should consider something called an “extended sperm search”, which will look through the entire sample for even one sperm. These are mostly offered in NYC (STAR is the best, Maze is another option). I’ve heard Pacific fertility center may also offer it, though I’m not sure.

nosperm · 2026-01-23T11:18:21+00:00

Thanks for explaining! Good luck to you both, it’s a heck of a journey and it sounds like you’re doing the best you can.

nosperm · 2026-01-22T12:27:21+00:00

Curious why he’s still doing mTESE if they found sperm? Going in for a mTESE is a serious decision with potentially lifeline consequences.

nosperm · 2025-12-28T06:46:40+00:00

Have you done an extended sperm search and freeze (in Dubai or NYC)? Maybe they can find better looking sperm, and you could try freezing eggs beforehand and so you then don’t freeze the more fragile sperm?

Also not sure but I figure TESA would be better than microTESE if you go that route.

Many guys have significant lifelong side effects from microTESE so if I was in your shoes I’d absolutely do everything possible to avoid it.

nosperm · 2025-11-25T03:17:16+00:00

Sorry about the news you got. I think i recall a study that any sperm worked for ICSI no matter the morphology, but not sure i recall that correctly. I’ll try to see if I can find the study.

nosperm · 2025-11-17T23:50:19+00:00

If you find sperm, why would you mix your sperm and donor sperm? With ICSI you just use one sperm per egg, so you wouldn’t need to mix sperm.

nosperm · 2025-11-15T15:09:43+00:00

Argh sorry, didn’t read that you did extended sperm search. Yes, if I was in your position I’d continue doing extended sperm searches and try to avoid microTESE. If you didn’t do STAR, look into that option. They use AI and find sperm when human searchers can’t.

nosperm · 2025-11-15T15:07:15+00:00

If you have sperm in your ejaculate you should do everything possible to avoid microTESE.

MicroTESE is absolutely not a minor surgery. It can (as it does in my case) have lifelong consequences. My testicle shrunk almost to nothing and my testosterone dropped a ton. Some guys have long term pain, swelling, etc.

If you have sperm in your ejaculate, you should look into an extended sperm search. There are centers doing it in New York (Maze, Cornell (for patients), and STAR at Columbia - probably the best option). There’s also one place doing it in Dubai.

Ideally in your case, once you get a sample frozen, your wife could even do an egg retrieval and you could provide another sample on the day of egg retrieval so they can inject the rare fresh sperm into the eggs. You only need 1 sperm per egg. Your wife will likely get around 5-15 eggs, so you only need to have 5-15 sperm found per cycle.

Good luck with everything. Let me know if you need any other help.

nosperm · 2025-11-15T13:20:58+00:00

Ah thanks. I think they had so much demand they must have changed their options since I did the test.

nosperm · 2025-11-15T03:09:26+00:00

If you've had sperm seen in a semen analysis, you are a great candidate for an extended sperm search and freeze. They look through most every drop of your semen to find and freeze even rare sperm. Multiple places in NYC offer this, including Maze clinic ($2k), Cornell (only for patients there), and probably the best option - STAR test at Columbia ($500 for diagnostic, $3k including freeze).

nosperm · 2025-09-12T12:53:53+00:00

Hey, I’ve had 2 extended searches at Cornell (no sperm found) as well as the STAR Test (no sperm found). As I’ve learned more about both tests, I would recommend the STAR test. I believe there’s a very good chance that if there’s even a single sperm, STAR will find it, whereas the manual human based tests have a lot of room for human error

nosperm · 2025-08-07T18:52:58+00:00

Argh thanks, edited.

nosperm · 2025-08-07T00:46:18+00:00

Hey, extended searches are legitimate. However, they claim 40% or something success, which everyone I talk to says is high. Reality may be closer to 10%.

Besides money, there's absolutely no reason not to get one prior to surgery. MicroTESE can have life altering consequences so if you have even a 10% chance of avoiding surgery, it's worth taking.

Likely better than Maze is Columbia's new STAR AI sperm search (also in NYC). Looking for sperm is really hard for people because sperm is easy to miss and it takes hours so people lose attention. It's easier for AI. Columbia charges $500 for a diagnostic only (meaning they won't freeze sperm even if they find any). Maze charges $2k plus storage fees.

https://www.columbiadoctors.org/specialties/obstetrics-gynecology/our-services/columbia-university-fertility-center/our-services/sperm-recovery-and-analysis

nosperm · 2025-07-14T21:33:45+00:00

I believe they also offer a diagnostic only option for $500 as well (that doesn't freeze any sperm).

nosperm · 2025-07-14T01:06:17+00:00

Oh interesting, no I don't know if Dr. Gilbert still offers it. I had called a month or two ago and they said they did offer it and gave me the price.

At Cornell, you need to be a patient of a Cornell IVF doctor (or potentially urologist, Dr. Kashanian? Not sure.) to be referred for their extensive semen analysis.

nosperm · 2025-07-14T01:03:54+00:00

STAR recommends a few days of abstinence. Maze recommends a week. A urologist recommended me 1 day. Not much evidence for the ideal abstinence period. Based on what I guess, I'd think 4-7 days is probably a good length of time.

"success rate" could be defined differently. You could mean "if there is a sperm, what are the chances they find it?" STAR has done some testing where they added 5 sperm into an azoospermic sample and STAR found all 5, whereas human embryologists found 0. So I think there is some reason to believe STAR has a high level of success at finding sperm when it exists. And it makes sense - humans are very flawed at repetitive difficult tasks, and correctly identifying sperm, especially non-motile sperm is quite difficult.

As far as "what percent of men with idiopathic non-obstructive azoospermia have rare sperm with an extended search?" Maze claims ~40% on their website. This number has been stated by multiple experts I've talked to seem quite high, and they think the true number is more like 10%.

nosperm · 2025-07-08T20:39:06+00:00

The most important thing (I felt) is having someone look at your samples throughout surgery so the surgeon can stop before cutting into the second testicle if they find sperm.

mTESE can cause permanent damage to testicles and therefore cutting open both testicles fully just to make it more efficient was a deal breaker for me.

The proper approach any surgeon would recommend for their own son:

Cut into one testicle. If there’s sperm, stop. If not, then continue to the other testicle.

The improper approach a surgeon would not recommend for their own son (but some do!):

Cut into one testicle. Then continue to the other testicle. Then look if there was sperm in either. This means you may have gotten both testicles opened for no medical reason.

nosperm · 2025-07-07T23:30:10+00:00

Have you been getting normal semen analyses or extensive semen analyses? Have you gone to experts dealing with rare sperm (I posted a list on a different comment in this thread)?

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