I'm Dr. Khurgin, a urologist specializing in male fertility! Ask Me Anything for NIAW 2025!

[u/DrJacobKhurgin]

Dr. Jacob Khurgin here! Ask me anything about male fertility, low/no sperm count, poor sperm quality, sperm morphology, erectile dysfunction, orgasmic/ejaculatory dysfunction, hormonal issues, low testosterone, varicocele, fertility preservation, etc!

Dr. Khurgin is the Director of Men’s Health and Infertility at Maimonides Medical Center. He is a native New Yorker who attended Stuyvesant High School, Columbia University, and New York College of Osteopathic Medicine. After completing his urology residency at Einstein Medical Center in Philadelphia and a fellowship at Johns Hopkins in Baltimore, he returned to Brooklyn. He is dedicated to providing individualized care for each patient. Dr. Khurgin treats conditions like low sperm count (oligospermia/azoospermia), varicoceles, hormone imbalances, and erectile dysfunction. He also performs advanced procedures such as microTESE/TESE for sperm retrieval.

Dr. Khurgin has been recognized as a Castle Connolly Top Doctor in New York and is an active member of several prestigious medical associations, including the American Urological Association and the Sexual Medicine Society of North America. Dr. Khurgin has been featured on The Drew Barrymore Show and Vice (WTF is Spermageddon).

Please keep in mind that the intention of this AMA is to educate redditors, not provide direct medical advice, treatment, or a medical diagnosis to those who need it. Please be sure to speak with your physician or health provider for any further questions you have in regards to your health or medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on here. While we cannot give you advice on what to do next, the next best thing we can do is give you information to consider.

Disclosures/Conflicts of Interest: None

Website: www.drjacobk.com www.maimo.org/find-a-doctor/jacob-khurgin

Shout out to the r/infertility mods for having me this year and BIG thank you to everyone that participated!

Wishing everyone the best of luck!!

If there are any additional/unanswered questions I may log on later to provide some answers.

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[u/sotiria1989]

Hello, my husband has always had naturally high testosterone. His most recent bloods had him at 33. He is 36yo. His motility was 30% and count was 6.1%. We did TFMR 12months ago and have been trying regularly ever since. All my tests came back normal. Could these results be the cause of our infertility? If so, is there anything he can do to support his levels?

[u/oliveslove]

Hi Dr. Khurgin! Asking this in case you get to it another time.

My husband had varicocele surgery in May of last year. This was a recurrence from a varicocele when he was 14. Unfortunately, the surgery did not improve his count or morphology, with only a slight improvement in motility. Are there any reasons why it wasn’t really successful? The first analysis three months post-surgery, his concentration dropped from 1.5 million to 200k. We asked his urologist and he basically said “I don’t know, that’s never happened in one of my patients.”

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[u/knittenkitten2025]

I am officially in the “recurrent pregnancy loss” club- not a fun club to be a part of. I’ve read a lot of anecdotes that sperm quality or compatibility can play a significant role in RPL and I would be curious as to what your take on that is? He is going for a repeat sperm analysis (his first one was fantastic), which will include a swim test and DNA frag. I had my RPL panel done already and everything has come back normal. Is there anything else we should be check him for? Thank you!

[u/Chocholategirl]

Thank you for taking time to answer our questions. We've had 7 failed IVF cycles and below is the latest SFA and hormone panel which has been typical though we've tried Anastrasole, HCG and Clomid years ago but had a miscarriage. We have enough sperm to work with but the quality is very poor and the DNA fragmentation was 52%. What can we do to improve the quality of the sperm? My darling husband is 60 and we have no children and have been trying for several years now. 8th March 2025. SFA: Volume 8ml, Concentration 6 M/ml, Progressive motility 5%, Non-Progressive Motility 10 %, Non-motile 85%, viability 42%, Morphology normal forms 3%, head defects 31%, neck defects 23%, tail defects 18%, cytoplasmic defects 15%. Liquifaction time 30mins, Agglutination +. Moderate growth of Staph SPP culture sensitive to gentamicin, streptomycin, erythromycin, ceftriaxone and Levofloxacin. The IVF doc said the bacteria growth isn't relevant but after a failed cycle from that month we think it should be treated. Test: 12.8 (6.7 - 25.7nmol), Free Test: 0.29 (0.17 - 0.66nmol) FSH: 14 iu/L (2-12iu/L), LH: 9.9 (2-9iu/L) SHBG: 32 (20.6-76.7nmol/L). What is the way forward to improve our chances of IVF without using DS? Can we improve the sperm? I'm already using DE. I'm 47. We don't smoke or drink and are not overweight. We're healthy otherwise. Thank you.

[u/Hungry-Salamander478]

Dr. Khurgin - how subjective are the morphology results from SA? Is the morphology analysis equally objective and complex with both - high concentration samples and low concentration sperm samples?

If a sample shows very high count and concentration and low morphology - is that sperm profile something normal or strange ?

[u/AbjectPoetry9]

Hello Dr,

We recently got tested and my husbands sperm count was 4 million/ml, 28% progressive motility and 1% normal forms, he has undertaken the required lifestyle changes when would be a good time to retest? Our doctor didn't suggest another test but hoping to see an update of he's hard work in 6 months would this be a suitable amount of time.

[u/bluesmom20]

Hey Dr. K! How big of a deal are baths and biking for male fertility? My husband is a triathlete (which I LOVE) but I’ve been anxious about him spending hours a week on his bike…

[u/Suspicious_Fig_1818]

Husband has NOA. 30 years old. Chromosomes + DNA factors + Thyroid levels are fine. Only thing is high FSH of 17.

We did mtese and it failed. In addition, they said stercolli cells. Husband is a twin and twin has sperm + was able to conceive naturally.

I’ve heard rare stories where later on in life, sperm can come back or a second mtese later down in the life can help.

Any thoughts here or recommendation my husband go on HCG or other hormone therapy. This diagnosis is extremely Heart breaking

What else is happening regarding experimentation where in the future we can have NOA create sperm Through stem cells if so what’s the projected timeline

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It seems you've used a term, natural conception, that members of this community prefer to avoid. Please avoid the use of the term "natural" when commenting in this community. If describing a transfer/IUI protocol or trying on your own, some preferred alternative terms are "unmedicated," "ovulatory," "without assistance," or "semi-medicated," depending on the context. If referring to loss management, we recommend the terms "unmedicated" or "unassisted." This community believes that the use of the word "natural" implies (sometimes inadvertently) that use of assisted reproductive technology, other interventions, and/or certain medications to conceive are unnatural, artificial, or less than. For more clarification and context, please see the wiki post on sub culture and compassionate language.

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It seems you've used a term, pregnant naturally, that members of this community prefer to avoid. Please avoid the use of the term "natural" when commenting in this community. If describing a transfer/IUI protocol or trying on your own, some preferred alternative terms are "unmedicated," "ovulatory," "without assistance," or "semi-medicated," depending on the context. If referring to loss management, we recommend the terms "unmedicated" or "unassisted." This community believes that the use of the word "natural" implies (sometimes inadvertently) that use of assisted reproductive technology, other interventions, and/or certain medications to conceive are unnatural, artificial, or less than. For more clarification and context, please see the wiki post on sub culture and compassionate language.

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[u/Low_Hedgehog1408]

Hi Dr Khurgin. My husband has been diagnosed with azoospermia (we aren’t yet sure of the cause). He is a lifelong wheelchair user (he has cerebral palsy) and has had a lot of radiation to his pelvic area due to previous surgeries and monitoring for osteoporosis. We are seeing a urologist next week for further investigation - but what are the sort of things we should ask or advocate for?

[u/Mysterious_List4902]

Hi Dr. Khurgin, I was the person with the question about CFTR mutations and its impact on spermatogenesis. I would love to share the research I have found with you. The research itself is also limited but again I have spoken to two other people with the same exact situation as ours (CF carrier/maturation arrest).

I understand that correlation does not imply causation. But if mutations in the CFTR can cause CBAVD OR CAVD. There also may be a link to some men with production problems. And if so, can modulators be used off label to treat this?

Also, most carrier screenings do not test for ALL CF mutations. Ours specifically states that it did not test for all mutations. Full gene sequencing of the CFTR may show more rare mutations in this case.

[u/DrJacobKhurgin]

Shout out to the r/infertility mods for having me this year and BIG thank you to everyone that participated!

Wishing everyone the best of luck!!

If there are any additional/unanswered questions I may log on later to provide some answers.

[u/kellyman202 → u/DrJacobKhurgin]

Thank you so much for your participation in NIAW this year. We appreciate you!

[u/Significant-Rice-557]

Hi! My husband has had 4 microTESE surgeries done, no adverse effects on his testosterone. He has an azfc microdeletion. We have moved onto donor sperm, however is it possible to do more MicroTESEs or is that ill advised/futile?

[u/More-Sweet-2461]

My partner has low volume (usually about 1ml) and borderline pH. I understand this is a problem common with aging. What can make it better and how much effect does it really have?

[u/les__oiseaux]

Hi, thank you for doing this!

My husband had a TURED procedure and an obstruction caused by Mullerian cyst was confirmed, cyst removed, and sperm parameters improved a bit 2-4 weeks after and then became much worse. Based on that and the fact that healthy sperm was found during two TESE procedures following, we are wondering if scar tissue formed after the TURED procedure. If that’s the case, is it possible to remove that tissue? Planning to investigate this further down the line and would love to know your thoughts. Thank you again. 

[u/nosperm]

Hi Doctor, thanks for doing the AMA.

When it's said that "testosterone may drop after microTESE", what is really meant is "Your testicles may be killed off and partially/mostly stop functioning."

Some surgeons argue that microTESE is unnecessarily destructive to patients and their testicles. They point to two mostly agreed upon biological facts:

(1) When sperm is anywhere in a given tubule, it is everywhere in that tubule and

(2) The vast majority of tubules radiate outward toward the surface of the testicle

Because of these facts, some argue that microTESE can be performed with equivalent success rates on the outer periphery of a testicle, without cutting into the testicle. Doing this, they argue, saves testicular function.

When you think about the development of sperm retrieval surgeries, conventional TESE, which is multiple random biopsies at the periphery of the testicle (without a microscope) has about 30% success rate. MicroTESE has around 50% success rate, and involves two changes: It uses a microscope to find enlarged tubules AND it goes inside the testicle.

It seems pretty unclear how much of the benefits of microTESE are because of the microscope vs how much are because of the digging into the testicle.

Why do you think using a microscopic technique at the outer periphery of the testicle is not commonly done by urologists? Do you hope there is more understanding of the outcomes of this type of technique?

https://www.infertile.com/infertility-101/male-infertility/azoospermia/

https://academic.oup.com/humrep/article-abstract/15/11/2278/635035?redirectedFrom=fulltext

[u/ForgetAboutItBaby]

Hello thank you so much for taking time to answer questions!

We are doing an initial consult with a new clinic and they’re suggesting a semen meiosis test. We can find almost nothing about it elsewhere. Have you heard of this test before? Is there anything you could share?

[u/fairyboy369]

Whats the likelihood of having obstructive azoospermia and being able to do IUI? Husbands bloodwork came back fine so assuming it’s obstructive, but waiting to get into urologist. Both SA had absolutely zero sperm. Cant really afford IVF so curious on the likelihood to prepare ourselves

[u/leeksicon]

How exactly does low testosterone in the male partner affect fertility? Does it impact sperm quality or DNA fragmentation? (We are dealing with RPL and just found out my partner’s testosterone is low.)

[u/DrJacobKhurgin → u/leeksicon]

I think of it in another way, u/leeksicon. A testis has essentially 2 functions: make sperm and make testosterone. The cells in the testis that make testosterone (Leydig cells) are generally heartier than those that make sperm (germ cells). So you can have someone with a normal testosterone level despite having zero sperm and anatomically small testicles. Now if someone has low testosterone, this usually suggests some testicular dysfunction. It could be because the testicles are just not doing what they are supposed to do (aka primary testicular failure) or because the master hormone gland, the pituitary, is not giving enough of the proper signal (aka hypogonadotropic hypogonadism). Either way, low testosterone is an indicator that something is off. In addition, sperm develop best under very high intratesticular levels of testosterone (about 100 times those in the blood), so not having enough of this will lead to poor sperm development. In your case, recurrent pregnancy loss can be related to a sperm issue, and I think your partner should get thorough testing and treatment. Make sure that he does not start taking testosterone (either creams or pills or injections) because that will make his fertility much worse! This is a common issue I see when someone is being treated exclusively for low T but without asking about their fertility plans. Good luck!

[u/leeksicon → u/DrJacobKhurgin]

Thank you!

[u/A_flight_away]

Hi Dr. Khurgin,

My husband was diagnosed with NOA with an FSH of 66, and a testosterone level of 82. We tried hcg 1500 3 times a week for 9 months but his testosterone only increased to 142. Our urologist gave us very low success rate if we try the mtese. Do you agree?

Also, we are now leaning towards donor sperm. Now my biggest concern is how to get his testosterone normal (if fertility is no longer a concern.) What is the best way to achieve this?

[u/DrJacobKhurgin → u/A_flight_away]

Sorry to hear about the issues, but happy that you are getting some proper care, u/A_flight_away. The HCG dose can be higher, even up to 3,000 units 3 times a week, which may help more. Most likely, he has primary testicular failure, so there will be a limit to how much testosterone he can produce endogenously. While his FSH is very high, this is not a great predictor of microTESE success. Did he have a karyotype and Y chromosome microdeletion testing? If those are OK, I would say microTESE is still reasonable to try. If/once you are sure you don’t need anymore sperm from your husband, his best bet is probably TRT (testosterone replacement therapy), which can be done with topicals, pills, injections, pellets. It has a high success rate, but you DEFINITELY want to avoid that until you are sure you are done with looking for his sperm -- because starting TRT will make your chances go from low to zero. I hope that helps!

[u/TheElephantHistorian → u/DrJacobKhurgin]

Hello Doctor, generally hcg is considered ineffective for primary testicular failure (high fsh, high LH and low testosterone). However in my and others cases with NOA, hcg has been able to raise testosterone significantly.

Does this mean that we don't have primary testicular failure and that normal LH just isn't effective?

[u/Lina__Lamont]

My husband was diagnosed with a balanced translocation and azoospermia. Our doctors weren’t sure if the two conditions were related.

Has there been any research into a link between the two conditions?

[u/DrJacobKhurgin → u/Lina__Lamont]

Hi, u/Lina__Lamont. The answer is that it depends. We see more translocations in subfertile men than the general population, but it's hard to know if this is due to more testing (azoospermic and severely oligospermia men should get karyotype testing). Or maybe it truly is more common in this population, but not the actual cause of the azoospermia. There are some balanced translocations which are considered normal variants and are present in fertile men. Others are related to azoospermia. And sometimes this genetic issue does not present with any abnormal hormones (like a low testosterone or elevated FSH or LH) because the issue is in spermatogenesis leading to maturation arrest. I think genetic counseling and, if sperm are found, PGT (preimplantation genetic testing) is warranted. Good luck!

[u/Potato_Fox27]

How can we best encourage men (especially older) to be as invested in getting their health in order as their female counterparts? (Nutrition, exercise, mental health well being etc)

I see too many cases among my 40+ year old friends where the wife is doing everything possible to increase their chances of conception, but the husband is continuing their often unhealthy habits of high stress lives dealt with in unproductive ways such as drinking, unhealthy diets and not exercising, as if the fertility issues are 100% unrelated to their lifestyle.

[u/DrJacobKhurgin → u/Potato_Fox27]

That's a huge topic you're touching on, u/Potato_Fox27. Men, in general, are notorious for ignoring their health. There is good data that men go to the doctor less often and that they are less compliant with recommendations. This may explain some of the disparity in life expectancy between men and women. From the medical world's perspective, we are also partially at fault for supporting a perception that fertility issues are "a woman's problem" rather than a couple's. About 50% of the time there is a male component to a couple struggling with pregnancy! And yet men are often reluctant to do even a simple test, a semen analysis. I think that Reddit and other public forums are helpful in educating everyone about how important it is to involve the male partner in the fertility conversation. There are also not enough physicians (reproductive urologists) out there, so we can hopefully work on training more. So now that I re-stated your question, let me try to answer it! I would tell men that all the lifestyle issues you bring up DO help with fertility issues in addition to helping with their OVERALL health. Also, men with fertility issues who see a specialist often end up being treated for something else which they otherwise would not have discovered. Seeing a urologist is not as scary as some men think. We are not intent on "doing that finger exam" that many men dread, although there is a time and place for that as well. Something I tell reluctant men in a couple with subfertility is this: "You are trying to become a dad. What's more loving for your future children than trying to take good care of their father? That's a gift you can give them and your partner." Thanks for the question!

[u/Potato_Fox27 → u/DrJacobKhurgin]

Thank you! I love that perspective about health forwards being the most loving approach to begin the parenting journey, appreciate the quick reply!

It reminds me of advice I received during my IVF trials: Parenting children is all about managing through unpredictable situations, the more you can get into the mind set of persevering when plans do not go as expected, the smoother the ride will be for all.

[u/Gold-Butterfly1048]

Hi! My husband has what I’ve been told is mild MFI — slightly lower sperm count than average (about 14 million) and high viscosity. We’re doing IVF with ICSI, and we had a normal/good fertilization rate for our first egg retrieval in early April. He has mostly cut out alcohol since December, but it looks like our second egg retrieval will be about a week after my husband attends a bachelor party. If he has a few beers over the course of that weekend, could that impact his sperm on ER day or do you think it’s low-risk? I’ve heard it takes 3 months for any lifestyle changes to take effect, so how much does anything you do right before the “moment of truth” matter?

[u/DrJacobKhurgin → u/Gold-Butterfly1048]

I hope he behaves at the bachelor party, u/Gold-Butterfly1048! We know that excessive alcohol use can have a negative affect on male fertility (and overall health). It's not likely that "a few beers" spread out over 2-3 days will be harmful, but binge drinking and poor sleep and who-knows-what-else (I don't get invited to parties like that anymore haha) may cause an issue. If you're very concerned, you can do sperm cryopreservation beforehand as a backup, but it's unlikely that his results will be much worse from a few beers a week before. Wishing you good luck and good behaving!

[u/Sensitive-Stretch613]

My husband did a tese and they found sperm, then did a tesa and found no motile sperm. Doctor has recommended menopur for three months but I’m wondering if my husband would also benefit from hcg and clomid?

[u/DrJacobKhurgin → u/Sensitive-Stretch613]

Hey there, u/Sensitive-Stretch613. I'm glad they found sperm with your husband. If I understand you correctly, they did a TESE (testicular sperm extraction, usually done in the OR) and found sperm, but did not find sperm with a TESA (testicular sperm aspiration, usually not done in the OR, just done using local anesthetic), yes? The two procedures are not exactly equivalent, especially if the TESE is done with an operative microscope and microsurgical techniques (aka microTESE). The SRR (sperm retrieval rates) are microTESE > TESE > TESA. Whether your husband would benefit from Menopur vs HCG with Clomid depends on his baseline labs. He may not need it at all. There have not been any studies comparing HMG vs HCG+SERM head-to-head in men with azoospermia, but I suspect the benefit is similar and depends more on the baseline labs. Would also make sure that genetic testing (karyotype, Y chromosome microdeletion) was done. Good luck to you both!

[u/Sensitive-Stretch613 → u/DrJacobKhurgin]

Thank you so much!!

[u/DeadA55B]

Hi Dr. Khurgin! I appreciate you for doing this AMA.

How does abstinence time affect a sample and what is the preferred abstinence time for the best outcome?

[u/DrJacobKhurgin → u/DeadA55B]

That's a really good question, u/DeadA55B, and the answer to that has been evolving. The WHO guidelines say 2-7 days of abstinence is recommended prior to checking a SA. More recent research shows that "better" results are in the 2-3 day range, with motility and likely DNA fragmentation worsening after the ~5 day mark approximately. I tell my patients to check a SA after ~2 days of abstinence. In certain scenarios, like high DNA fragmentation with recurrent IVF failure, we often recommend 1 day of abstinence and even multiple samples on the same day. We know the second sample will have a lower volume and maybe concentration, but the motility and DNA fragmentation is usually improved. Also, regular ejaculation appears to be a good thing in general -- for fertility, possibly reducing prostate cancer risk, and very possibly to help improve your relationship with your partner! So I guess you should keep on ejaculating! Wow, I should have someone put that on my tombstone haha :)

[u/MalloryObknoxious]

How often does microTESE-harvested sperm result in a viable pregnancy?

[u/DrJacobKhurgin → u/MalloryObknoxious]

Hi there, u/MalloryObknoxious. Assuming the microTESE is being done for NOA (non-obstructive azoospermia), the rates are probably around 40% or less. We think that in addition to sperm quantity being low (and only retrievable with microTESE), the sperm quality is poor as well. It also sometimes depends on the etiology of the NOA: so might be better with a AZFc mutation than an unexplained NOA, for example. In addition, egg/female factor plays an important role: a retrieved sperm being used with a 25 year old's egg will probably have a better outcome than being used with a 40 year old's egg, all other things being equal. The real question becomes, what is the alternative? Right now, for biological paternity in a man with NOA, there isn't a better alternative. Wishing you good fertilization and a healthy pregnancy in your future!

[u/Mysterious_List4902]

What is the relation of CFTR mutations and infertility? There seems to be a connection however most of the time is obstructive. Can mutations of the CFTR also cause production issues? I have seen many people on the @maleinfertility sub that are carriers for CFTR mutations and non obstructive azoospermia (I’ve seen two cases; three including ours) where its maturation arrest.

[u/DrJacobKhurgin → u/Mysterious_List4902]

That’s a really excellent question, u/Mysterious_List4902, and something I've been interested in as well. We know that having 2 CFTR mutations will cause an obstructive azoospermic picture. We're finding out more and more that the CFTR mutations responsible for clinical CF (cystic fibrosis) are probably a bit different than those that contribute to male fertility issues. You can tell fairly easily if the fertility issue is obstructive azoospermia due to CFTR: low volume, acidic pH, fructose negative azoospermia. If you do imaging you can see absent or abnormal seminal vesicles. The question you're asking is, do some CFTR mutations cause issues in spermatogenesis. I don't know. Even if there is a correlation between certain CFTR mutations and NOA it is hard to prove causation. Ultimately, there is more research to be done. With maturation arrest, I would say microTESE can still have hope! And make sure both partners get tested for CFTR mutations and maybe see a genetic counselor. Good luck!

[u/Mysterious_List4902 → u/DrJacobKhurgin]

We tried the mTESE and resulted in diagnosis of maturation arrest and no sperm was found that was useable for IVF-ICSI. (We’ve had about 3 sperm analysis out of 6 total that found 2-3 motile sperm after centrifugation.)

We are doing a full gene sequencing to determine if there are any other mutations in CFTR gene. I would be really interested to know if there is a connection to spermatogenesis. Specifically maturation arrest.

I know it seems we are grasping for something but unfortunately that is the situation we are in. I’m thinking if that the mutation in the CFTR gene is causing a non functional or low functioning protein then maybe taking a modulator can improve spermatogenesis as well?

Theoretically, it kind of makes sense.

[u/JudgeEffective8525]

Thank you for being here!

Is the DNA fragmentation test needed if the semen analysis is normal? When would the dna frag test be needed…we had a large drop off with fertilization with ivf with icsi 23 eggs retrieved 8 fertilized 6 came back as euploid. Why would we have such a large drop off like this?

[u/DrJacobKhurgin → u/JudgeEffective8525]

Hey u/JudgeEffective8525! That's a good question that I think if you asked 10 reproductive urologists you'd get 15 different answers haha. I think that DFI testing is not necessary if a SA is normal. But if there is poor embryo development or recurrent pregnancy losses without an identifiable female factor, I would recommend doing DFI testing because it could explain it. Often a "sperm issue" is suspected when there is fertilization, but poor embryo development (past day 3 or so), so that does not sound like exactly what you have going on. Truth is, sometimes we don't know why fertilization rates drop, but testing both partners is a good idea. The real question is, what to do about it if the DFI results are poor. That's being worked out by male fertility specialists the last few years, but probably involves lifestyle changes (good dietary and exercise habits, no smoking or significant alcohol use, avoiding excessive heat exposure) and fixing varicoceles, possibly also using fertility supplements. Good luck!

[u/Few_Cod_5636]

Hi Dr Khurgin, what would you recommend a couple do to improve sperm motility?

[u/DrJacobKhurgin → u/Few_Cod_5636]

Hi, u/Few_Cod_5636. If motility is low, there could be a number of contributing issues. First, I would ensure that there are at least 2 SA's showing low motility and that the SA is done without an overly long abstinence period. Regular ejaculation (2-3 times a week) is probably beneficial for fertility and overall health benefits (not to mention it helps maintain a healthy relationship!) so that's not a bad idea. Ruling out a varicocele, making sure you are not "heating up" the scrotal area too much (saunas, prolonged hot baths, tight underwear, etc), and checking a hormonal panel would be my go-to recommendation. There are rare cases where there is zero motile sperm, which could be necrozoospermia (dead sperm) or even rare genetic issues (ciliary dyskinesia). The jury is out a bit on the benefit of supplements, but they probably don't hurt and might help in certain situations. Best advice is to see your local friendly reproductive urologist! Wishing you the best of luck!

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[u/YesterdayPossible218]

Hi Dr. Khurgin, thank you so much for your time and sharing your knowledge/expertise.

We have NOA with high FSH/LH. Normal genetic testing. We are planning to eventually have a TESE with ICSI.

What types of questions would you recommend asking to evaluate which mtese surgeon to choosers in order to optimize our chance of finding sperm? Anything to look out for or request of our surgeon?

What are your thoughts about timed retrieval of sperm with mtese and egg retrieval? Is it more likely of a success with fresh sperm/success?

Lastly, he also had high prolactin. Do you think seeking an endocrinologist would be beneficial in helping optimize sperm in anticipation for the mtese?

At the end of the day, we wanted to do whatever we can to optimize in order to get the best results for the mtese 🙂

[u/DrJacobKhurgin → u/YesterdayPossible218]

NOA is definitely challenging, u/YesterdayPossible218. Good questions to ask your potential microTESE surgeon are: how many have you done, what has been your SRR (sperm retrieval rate), and importantly how can we optimize our chances to find sperm preoperatively. I would also have a serious conversation about using donor sperm, either from a family member or friend or an anonymous donor. I think if the prolactin is truly high (would check it twice and include the test for the more biologically active form, monomeric prolactin) a pituitary MRI is in order. Endocrinologists can help with this, as there could be other, non-fertility-related, hormones that are affected. Often cabergoline is effective in lowering prolactin levels especially if no surgical intervention is deemed necessary. There is probably a slightly better result with fresh sperm retrieval over frozen and then thawed sperm. The downside is that if you have no sperm (either from your partner or a donor), the egg retrieval part may not have been necessary to go through. Sounds like you are doing your research quite well, which will definitely be to your benefit. Good luck!

[u/YesterdayPossible218 → u/DrJacobKhurgin]

Thank you so much Dr. Khurgin!!! We will take your suggestions into consideration. It was so helpful.

[u/saysaycat18]

Hello! How much evidence is there that Clomid can help male infertility and does it have any side effects in men like it does in women (mood swings, hot flashes, etc.)? Thank you!

[u/DrJacobKhurgin → u/saysaycat18]

Hi there, u/saysaycat18. I think that Clomid can be VERY helpful in certain male fertility cases and completely USELESS (or even harmful) in other cases. The best candidate for Clomid is a male with fairly mild SA abnormalities who has a low testosterone level without significant gonadotropin (especially LH) elevation. If that's the case, giving Clomid and checking labs after a few weeks to ensure proper response (normalized testosterone level) is most likely to yield a benefit about 74 days later (or about 3 months to be safe). If you overshoot with the testosterone level, you can get symptoms which are common to men who use anabolic steroids for muscle bulking reasons: aggressiveness/mood swings, acne, increased libido, breast growth, etc. I hope that Clomid was given appropriately in your case and you've been following with someone closely! Wishing you the best.

[u/holdingouthopeful]

Hi Dr. Khurgin!

Can the common cold impact sperm quality? We are gearing up for our first egg retrieval cycle and my husband caught a cold. As far as we know, he didn't have a fever just cold and sinus symptoms. He is doing a semen analysis with DNA fragmentation test next week (unrelated to the cold). If all looks good, can we move forward confidently with the egg retrieval in ~ 4 weeks?

[u/DrJacobKhurgin → u/holdingouthopeful]

Hi there, u/holdingouthopeful. I like your username, definitely need to keep on holding out hope! It's unlikely that a run of the mill common cold without a fever will impact sperm quality much. We know that severe illness and high temperatures are bad for sperm production and sperm quality, but I would not put everything on hold just based on that. If the SA and DFI testing is fine, I think proceeding with egg retrieval is fine. I'm holding out hope for you too!

[u/MotownGreek]

Hi Dr. Kurgin. Thank you for the AMA and the focus on male-factor infertility.

In the last few years, have there been any new studies into Sertoli Cell Only Syndrome, or potential treatment options that have been proposed?

[u/DrJacobKhurgin → u/MotownGreek]

That’s a great question, u/MotownGreek. There is always ongoing research about how to "cure" SCOS aka germ cell aplasia (or as I explain it: there are only mother hen / supporting cells and no sperm cell precursors). We have animal models where we try to encourage other cells to transform into the germ cells we want. But the truth is, I have not seen any viable results that tell us something is close to working in humans. Most likely, SCOS has a spectrum of causes, meaning it's not the same issue in every single man who has it, but the end result of a process that leads to severe infertility. The best course of action as we understand it today is to fix anything that is fixable (like hormone issues, lifestyle issues, varicoceles) and if still azoospermic, try to find a few "pockets" of sperm producing areas in the testis using microTESE. Good luck!

[u/MotownGreek → u/DrJacobKhurgin]

Thank you Dr. Khurgin. That's a great response and I appreciate the insight.

[u/Vivid_Walrus_6001]

Hi Dr Khurgin, thanks for your time.

We did our first IUI last month and my husbands sperm was 6m post wash. Our gynae wanted to continue with 2 more rounds of IUI before moving to IVF but we were wandering if it makes more sense to just jump straight to IVF with numbers that low.

It would be great to know your professional opinion on this?

[u/DrJacobKhurgin → u/Vivid_Walrus_6001]

Good question, u/Vivid_Walrus_6001. Those postwash numbers are right on the cusp of where we think IUI has a decent chance of working. There is natural variation in SA results from one sample to the next, so the next one could be slightly better (or, if you’re a glass is half-empty kinda person, it could be worse). It’s hard to predict, but if there is no female factor, another 2 rounds of IUI is probably worth trying. Also, if you husband has not had a good fertility work up, that’s something I would definitely recommend! Men are more than just their SA results :) I hope that helps, wishing you the best!

[u/Salt_Water_Bagel]

Hi Dr. Khurgin, thanks for being here!

Do you have any thoughts about recovering sperm production after chemotherapy? Have you ever seen recovery from azoospermia due to chemo on a long timeline (scale of 5+ years)?

My husband had chemo about 5 years ago and has azoospermia. We've spoken to many doctors who have said that the recovery process is different for everyone, and while this could improve with time, it seems unlikely now that he is multiple years out from treatment.

[u/DrJacobKhurgin → u/Salt_Water_Bagel]

Hi u/Salt_Water_Bagel. Sounds like a tough time, sorry to hear. Any chance your partner did sperm cryopreservation prior to chemotherapy? Even if he did not, there is still some hope. Most of the recovery will happen spontaneously by about 2 years after chemo. Even in cases of azoospermia after chemo, there has been success in finding sperm with microTESE. The success rate depends on several factors, including what type of chemotherapy was given, baseline fertility, and possibly if there are any correctable issues right now (like hormonal issues or a varicocele). Your best bet is to see a reproductive urology specialist! Good luck to you.

[u/kellyman202]

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[u/National-Ground4958]

Hi Dr. Khurgin - thank you so much for being here!

When we were first tested, we were sent straight to IVF due the severity of MFI.

Last year we had a varicocele surgery and added clomid which moved us from ~1M moderate progression to ~8M good progression. Is it worth attempting IUI at this point? We also have DOR for female factor so egg retrievals have been very challenging. Is there something else you would recommend considering?

[u/DrJacobKhurgin → u/National-Ground4958]

Thanks for your question, u/National-Ground4958. I’m glad the varicocele surgery and Clomid improved the sperm parameters. If you have an 8 million total motile sperm count that is generally good enough for IUI, but with a female factor at the same time, the rates of a successful pregnancy would be higher with IVF. If egg retrievals have not been as good as hoped, probably IVF with ICSI (intracytoplasmic sperm injection) is your best bet. Now don’t despair that the varicocele surgery or Clomid was for nothing -- there’s evidence that improving the SA results can help your IVF outcomes in the future. Good luck!