From No Sperm, to a Few Sperm, to Twins

This story took place over 10 years ago, but I still hear of the same problem today. A couple came to see me because they were told the only way they could conceive was by using donor sperm. What was that based on? Well in fact, he did have no sperm. So the next step would be to do a testicular biopsy to see if there are any sperm in the testicle that are not making it out when called to duty. And he had the biopsy, which showed no sperm in the testicle.
After listening to the histories of he and his wife, I explained how to go about ordering donor sperm, and how the insemination is performed. But I also said, “let’s have one more person look at your biopsy slides before we do anything”. I had to be careful not to get their hopes up, but I have seen experienced reproductive urologists find sperm on biopsies labeled as “zero sperm”. Sure enough, there were a few sperm seen. They went on to have an in vitro procedure with another testicular biopsy where just enough sperm were retrieved. Pregnancy resulted and she delivered twins. As it turns out she was related to a cop in town, so it was nice for me to feel a little more connected to the community.
I have seen similar cases where the husband was told there is no sperm and a repeat semen analysis with very careful washing in the right lab revealed a few. And there’s a big difference between zero and “a few”.
So the point is when you are given a diagnosis of disaster, find the best provider you can and get a second or third opinion. You may end up with the original bad news, but you may end up with an entirely different picture.

35 responses to “From No Sperm, to a Few Sperm, to Twins”

  1. I think one of the saddest things in medicine is doctors who make mistakes or aren’t aware of all the treatments available. Especially those who tell you “your only option is” when they are wrong. My husband and I were devastated when several Semen analysis’s (over a 4 month period) showed zero sperm. The UR he was seeing told us that our only option was TESE to search for sperm, and that donor sperm might be needed. We had enough money for IVF, but not for the added expenses associated with searching for sperm and fertilizing the eggs. We had to wait almost a year before we could afford to continue. (I was 39 when we met and started trying to conceive so a wasted a year may very well have cost us our chance at ever having children) At that time we decided to see another UR because we just didn’t care for the first one, partly because my husband wasn’t thrilled that the Dr. asked him if he was sure he hadn’t had a vasectomy. The new UR wasn’t convinced of the validity of the previous SA’s (like you said there is a difference between none and very few) however he also determined that no sperm were present. However he was not convinced that TESE was our only option. The both UR’s suspected that the reason for my husbands lack of sperm was due to testosterone replacement therapy. His testosterone level had been very low and his regular doctor had put him supplements, not realizing that it would effect our efforts to conceive. The first UR took him off the supplements for over 3 months and repeated the SA, when there were still no sperm he gave us the “your only option is” speech, and told my DH (who was feeling awful because his testosterone had plummeted) to resume his meds. The new UR took him off the supplements again and added 2 medications. He claimed that one would tell his body to produce testosterone, instead of artificially providing it and the other would tell his body to produce sperm. I was skeptical, but we agreed to give it a try. One month later they found 9 sperm. We were ecstatic. Within 3 months he had over 12 million and we decided to try IUI before moving on to IVF. His highest sperm count was 69 million, about 8 months after starting the treatments. Unfortunately good sperms counts can’t always overcome age related and funding issues. It’s been 5 years since we started ttc and we are still hopeful. I am however still angry with the first UR (who specialized in MF) for the initial delay. I’m glad that there are some Dr’s who care enough to take a second look. Patti

    • Anonymous says:

      Can u tell me what meds they gave him to tell his body to produce? This is my last chance to convince my husband of hope. I may remove my uterus for problems but before I do I have to find something that had possibilities. I have that ounce of hope but it gets shut down a lot. Please help

  2. Anonymous says:

    Dear Dr Licciardi
    i got my husband tested twice on 24th feb & 24th april this yr but no sperm was found in the semen analysis, we are married for 1 1/2 yrs now and are planning a child. the urologist suggested blood tests & urine tests, it showed high prolactin & FSH levels, could you pls suggest as to how to go about the treatment.

  3. Anonymous says:

    Reading your comments, I have realized that my husband and I might have some hope. After seeing two UR’s we were informed that he has no sperm and our only chance of having a baby was via TESE. At this time we’re looking to see a third UR, but its realy difficult finding a doc who is not only a UR but also a male fetility doc. My question to is what meds did your husband take?
    Thank you in advance.

  4. Anonymous says:

    Dear Dr Licciardi:
    I’ve been reading some of your postings, and you sound like a very caring sincere docto, the one every patient can only dare to dream to have. Selecting a good doctor is harder and harder these days. Winning a lottery ticket seems to be easier!! One of the OBGYN I was seeing prescribed clomid without seeing the lab result, while another (in the same group) claimed that I had kidney diseases. Both claims were made without checking or obtaining lab results. I have now moved on to a specialist (RE), who had diagnozed us with sperm motility issue and stellar performance on my end (ovulate on the dot on 28 days cycle). We had 2 IUI performed (one of them was back to back with hcg shot in between), both to no avail though my husband count and motility has gone up since the first IUI (12 million with 50% motility versus 80 million with 70% motility). We’re taking a break at the moment, trying to conceive the natural way and leave the rest in God’s hands. The IUI procedure is truly emotionally draining.

  5. Anonymous says:

    yep !!! here is me.. a poor wasted wife who was prepared for ICSI for about 2 months. i had 21 Great eggs picked. then on the same day TESA was done to my azoospermia husband and they said – ‘sorry. no sperms’. your only option is donor sperm or adoption. i knew there was a God up there. thank you… you give me some hope.

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  7. Anonymous says:


    I was looking for information in regards to the male infertility, when i came across this blog, (never been a fan of the blogs but this one just game hope) because Im trying to conceived since a year ago, so I knew we have to get tested and all that follow so far Im ok but the first analysis on my husband came as no sperm.. This kind of put us a lil’ down, then the doctor subject another analysis, we are waiting for the result.. I was so happy to hear that we still have a chance to have our baby… even when is 50/50… If the result comes back negative.. we will c our other options..

  8. Gerrit says:

    …..The new UR took him off the supplements again and added 2 medications. He claimed that one would tell his body to produce testosterone, instead of artificially providing it and the other would tell his body to produce sperm.

    Dear Patricia, can you please tell me what kind of mediation he recieved, please. Thank you for helping out.


    Gerrit van de Veen, Switserland

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  10. GHANI says:

    dear doctor me from pakistan and i have no sperm i was married before 6 years i am muslim my religion desnot give me permission i took the other men sperm please kindly give tell me is the sperm born in my semen if yes –how can — if not please tell me the way what i do and tell me the some medicion thanks my e mail is

  11. Anonymous says:


    I live in UK but my brother is in Pakistan,who has been married for almost 4yrs and yet they have tried everything to have a child but the test results show that he is has no sperms. I think he smokes but he says he used to but he has stop. Is there any chance of him having a child and if there are can you please suggest any medication as sperm donor is not an option due to religious reasons. He has consulted the best doctors that are available there, however the technology is not very advance there at all. So could you suggest any medication because he really wants to have a child.

  12. mark says:

    my UR said that i have no sperm and there is nothing he could do for me anymore. I had a testicular biopsy and did all my blood work and semen analysis and everything was normal according to the doctor. At the begining i had low testotorone and after taking clomid i raised my level back to normal. I would like your help to see what my options are thank you

  13. mark says:

    I have benn trying to have kids for about 2 years now that there is no hope so far. I went and seen a urologist and he began to do different tests on me to see what the problem was. I had done a sperm count test 3times and all showed zero sperm. Then i did an semen analysis test and that was showing that my testotorone was low. He gave me clomid and that brought my level back up. We then moved on to an ultrasound to see if there is any blockage and of course none. I continued to take the clomid and still on this medicine, but still no sperm. He then decided to to a testicular biopsy on me and my insurance would not cover it, so i decided not to do it. They wanted over 7000 dollars to have it done, and i couldnt afford to do it. So i decided to take another opinion and went to see another doctor. He did a sperm test and detected no sperm, the he began with the blood work to show if my hormone level is normal, and all were fine. So last thing he decided to do testicular biopsy for alot cheaper than the other doctor wanted so i did the test and the results were no sperm. So he calledme up and told me that he can no longer think of anything to do but to to a surgery where they open the testicle and see if there is any sperm inside it, and he wanted over 12000 dollars for that procedure and he said the chances are slim to none. So now im going to see another doctor to get another opinion about what i could do to produce sperm. Please im open to any suggestions that anybody could help me with.

  14. joanne says:

    hi my husand just recieved his sperm count results it says he has no sperm , he has already has an 11 yr old daughter. the doctor told us no more can be done is that true ?

  15. Anonymous says:

    good evening doctor,we r from bangalore and we are married past 3years in that we had a baby girl but after born she was lived for only 7days sudden she experied after long period i did not got pregant so my husband went to test in that he got result of no sperm. so pls, kindly suggest me regarding this problem, thanking you.

  16. Anonymous says:

    Yes, me and my husband just found out his semum alalyis came back with zero count but normal sperm. We are not exactly sure what this means. He is healthy with no surgeries and only 27 years old. Do you have any suggestions for us?

  17. Anonymous says:

    I have been married for a year now… My first semen analysis showed no sperms .. My second one has shown 1 motile sperm and two dea ones
    The UR asked me for blood tests and all results came normal
    We went to another DR who suggested to go for IVF
    I had testicular biopsy where they found few immotile sperms!!
    The doctor then asked me to do another blood test to check something called “microdeletion of Y chromosome”
    I am waiting for the results next week
    However, the doctor asked me to use proxeed to help increasing the health of sperms before I do another semen test
    I don’t know the reason of this “no sperm” case and I hope someone out there could find out why.

  18. Anonymous says:

    Hai sir,

    I am from india i read ur “From No Sperm, to a Few Sperm, to Twins”
    same problem for me also when i take first sperm test it results zero sperm then i do it twice but same happen my doctor advice me to check with urologist the urologist told me that my testicle are small the growth of the testicles not enough he told me growth stage of testicles not enough to produce sperm he told less possibility of biopsy 1% but my doctor advice me to do biopsy some time there may be chance of sperm he told just try it….positively any other way sir ur opinion ?

  19. This is great! Every doc should consult urologist before giving final reply of biopsy.Its really a miracle.

  20. watch says:

    What a great post, I actually found it very thought provoking, thanks
    Hypnosis Education

  21. Anonymous says:

    Dear Doctor,my semen report shows zero sperms.Dr advised me to take harmonal blood test for fsh,lh,and testosterone.these all tests are in normal transrectal ultrasound and testicular ultrasound is also normal.i m planning to have a age is 25 and my wife is 23,what is your ivf only the solution?if there is no sperms can i concieve through donor sperms?

  22. Anonymous says:

    my boyfriend loves kids i have 3 kids that arent his. but he dies to have one but he has a block and no sperms what can he or we do……

  23. Anonymous says:

    my husband’s semen analysis shows zero sperms but his testicular biopsy was positive,we are married for eight years now. i have thyroid too,but the major concern is my husband’s sperm count kindly advise we are in dire need of help as he is already 36yrs and i’m 32yrs old…

  24. Anonymous says:

    Greetings Dr. Licciardi,
    After several weeks of crying and desperate thoughts I did a little research and found this blog. After reading the other testimonies I feel that there is HOPE out there and I need you to please HELP me and my husband. We have been married 21 months and really want to have children, initially I thought it was stress related but after several months I looked into CWRC which is also a infertility clinic and we did the HSG, Semen Analysis, as well as the TESA biopsy.

    These are the results of the following test:

    1. Sperm Physiology report – under comment “no sperm seen before or after spin down” –DEC 2010
    2. Chromosome Blood Test – Indications showed – azoospermia, infertility (cells counted 50, cell analyzed 20 and the CYTOGENETIC RESULT is – 47, XXY- which indicates as the ABNORMAL-Male Klinefelter Syndrome Karyotype.- done in 02/2011
    3. TESA biopsy the results were terrifying because it indicated “no sperm” and the Urologist stated that we only had two options, (adoption or sperm donor)-done 03/2011

    We lost all hope and after reading the comments on the blog, I have a strong feeling regardless of the above results. PLEASE DR. LICCIARDI can you reply this message. I need your HELP!!
    My husband is the most wonderful person, he has a huge heart and this has destroyed him completely. PLEASE HELP US!!!

  25. Anonymous says:

    Dear Dr Licciardi, My husband had 2 SA done between 1-2 months ago. His count was 8 million–not good, but not zero. He was referred to a urologist who examined his prostate, found it was a bit soft and prescribed treatments. He asked my husband to repeat the SA after treatment. My husband did and the SA showed he has 1 sperm! The Dr was baffled and asked my husband to repeat the test, and it came back the same, 1 sperm. Please help us understand what is going on! The urologist is referring him to a male infertility specialist, but we still do not understand how he could go from 8 million to 1 over a few weeks, and why both test came back with just one sperm.

  26. Yamini says:

    Hi Dr.,

    I am from India, chennai and i am married for a year now. Trying to get pregnant for 6 months now. Recently my husband had his semen analysis done and the result showed no sperms. We are going to have it tested again. However, I wanted to know is there a way to increase it naturally or by some medication. Please help me.

    Thank you in advance.

  27. Anonymous says:

    If no testes present in male body and no sperms then what’s the solution for that.

  28. Anonymous says:

    Hello, my name is Karen. My husband and I have been married for 4 years now and really want to have children, but he had cancer when he was one, and when he got tested they found no sperm. He is 30, do you think we should try that again? We recently got licensed to adopt because we want children, but we are still very sad about those findings from 3 years ago.

  29. Anonymous says:

    Me and my husband had been ttc for over a year before we went to see a fertility expert. After many tests the results show that I am perfectly healthy but my husband (after 2 SA) showed zero sperm. The doctor has asked my husband to get an ultrasound and a y chromosome multi deletion done as he thinks it is a genetic matter. Will it ever be possible that we have biological children together

  30. UKJules says:

    My partner and I have been trying to conceive for almost two years with no success. He has literally just arrived home from the doctor’s having had a sperm test – it was confirmed he has ‘no sperm’. He was then told that this could be due to a ‘natural vasectomy’ and other reasons. He has also been referred to a urologist. Needless to say he, and I, are devastated as we are both 39 and have only wanted to have children with each other after years of searching for ‘the right person’.

    After reading some of the comments, it has given me some hope as I will accompany him to his appointment to ask about a testicular biopsy.

    We are both in a daze and feel very strange about our future.

  31. Anonymous says:

    I have been married since 2005 and I have been told that I don’t have any sperm and I wont be able to become a father. I have been though many sperm testing and the results have all come back the same. I am a healthy individual, 31 years of age. I eat healthy and work out as well.
    I have a twin brother who got married a couple of years before i did. He was told the same. I gave up and believed that “it just isnt meant to be”, but my brother was more positive and decided to see many doctors. He met a doctor and got tested again, but this time, the doctor found 1 sperm. my brohter had to get that frozen. He had to provide many samples (once a week). There were times, there was no sperm, but in other times, the doctor was able to find one. They ended up freezing the sperms and after 10 years of marriage, his wife is finally pregnant! Now, i have hope because i know that if he has sperm, i must have some as well.
    I went to see the same doctor and after gettin tested once, he told me that he saw NOTHING. I will be continuing seeing this doctor and hopefully one day, ill become a father!
    For those of you in the same situation, i would recommand you try herbal mediciation. It really does help. Its all nature and could make a huge difference. Take multivitamins and try to keep your mind at ease because whatever your worried or stressed about, it effects the entire body. Most important, be patient! It will take 3-4 months to see results. Don’t expect them right away.
    Even though, I have no sperm YET, I have HOPE.

  32. MJC says:

    I could use some help/advice from a knowledge person in this matter. I have done several semen analysis tests. 2 came in abnormal but there were definitely some sperm in there. The 3rd came in on the low normal side, with 20 million sperm and and something like 63% motility, which I was told is low count but good movement. I had been set up for a urology appointment but we cancelled it because the normal results indicated that it was not needed. My wife, meanwhile, has had her own problems with ovulating ever since we began attempts to conceive 2 years ago. However, she has recently started ovulating and 2 days ago she got a positive response on her ovulation strip, so yesterday we went in for an IUI. I provided my sample but it was a very small sample despite 3.5 days of abstinence and the lab technician said there was no sperm in it. I was shocked beyond belief. I didn’t even know that was possible. She asked if I spilled anything and I said no, I didn’t, I was quite careful. I should note that between the previous sperm analysis tests and yesterday’s sample I developed psychological erectile dysfunction due to the overwhelming anxiety associated with 2 years of infertility and all the pressure to perform and I have been dealing with this for 5 agonizing months. So maybe the ED and stress affected the lack of sperm in the sample, I don’t know. I’ve also been under extreme stress due to the ED. My question is, is it possible that the zero sperm result was simply an anomaly? Could it be a result of the anxiety and ED from trying to producing the sample on the spot? Is it possible I could provide another sample under less stressful conditions and have the lab freeze it for later use in IVF? These are questions I plan to ask my fertility doc and urologist (whom I now plan to see) but any help I can get from a knowledgable person in this matter is extremely appreciated. To all those going through similar problems I have deep sympathy and compassion for you and wish you the best.

  33. Anonymous says:

    I am azoospermic i have done testicular biopsy twice the report says every thing is normal with normal T,LH,FSH but no sperm for IVF or ICSI is there any medication

  34. Anonymous says:

    onstruarDear Dr.

    Me and my wife already married for 5 years and until now no baby. We want to have babies. So we tried many times but nothing happen. We go to hospital but we got bad result zero sperm count. When i ask the doctor what must be the reason why i have zero sperm count he told us some root block the sperm. Is their any solution for this?? please advise me what to do because i felt too much failure. just e-mail me

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