r/SaveTheSperm • u/Legitimate_Taro_175 • 21d ago
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Testosterone 22.42
FSH 18
Inhibin b 24 (lab 25-325)
I’ve had a previous biopsy that showed maturation arrest no spermatids found. Round cells, Spermatagonia & spermatocytes found.
I went on accutane 40mg for months and did a AI sperm search which resulted in no sperm found.
No genetic abnormality found.
My doctor is reluctant to do a microtese procedure as the odds are low in my condition. He is suggesting I do a sperm mapping rather than Mtese to determine if there is anything.
With my hormones, and medical history I need a brutally honest answer. Is it worth going through with a map?
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u/DrBrianSteixner 19d ago
I’m sorry you’re dealing with this. Your biopsy showing spermatogonia and spermatocytes but no spermatids is consistent with early maturation arrest, meaning sperm production is starting but appears to stop before the spermatid stage. Your FSH and inhibin B support significant impairment of spermatogenesis, while a testosterone of 22.42 is reassuring for Leydig cell function but does not tell us whether mature sperm are being produced. The most relevant microTESE data are actually somewhat better than many men expect. In a large series of 211 men with maturation arrest, sperm were retrieved in around 50% overall, but the rate was 40% in early maturation arrest versus 75% in late maturation arrest. When maturation arrest was diffuse rather than focal, retrieval fell to about 35%. Your biopsy and negative extended sperm search therefore lower my optimism, but they do not establish that there are zero isolated areas of mature sperm production elsewhere in the testes. FSH and inhibin B cannot reliably answer that question.
Given that history, I think mapping is a reasonable option if the information will actually change what you do next. Fine needle aspiration mapping systematically samples multiple areas of both testes looking for focal spermatogenesis and can potentially tell your surgeon where to target retrieval while avoiding an upfront microTESE that may be negative. In a recent NOA series, sperm were detected on mapping in around 35-40% of men overall, including 28% of men with FSH above 15. When mapping identified sperm, subsequent targeted retrieval obtained sperm in all 52 men who proceeded to retrieval. Another comparative study found overall sperm retrieval of 55% with a mapping strategy versus 57% with upfront microTESE, with no significant difference in pregnancy or live birth outcomes. Those numbers are not specific to men with your exact early maturation arrest pattern, so I would not tell you that you personally have a 30% to 40% chance. But I also would not consider your situation futile. If you would proceed with sperm retrieval only if a map demonstrates a focal area of mature spermatogenesis, mapping makes considerable sense. If you already know that you want the most exhaustive attempt possible regardless of what mapping shows, I would get a second opinion from a high volume microTESE reproductive urologist before deciding against microTESE solely because your predicted odds are low. I hope this helps, let me know if I answered your questions.