My husband had a sperm count done and it showed not even one sperm. He then had an LH and an FSH drawn. Both were somewhat elevated. His urologist told him that he shouldn't bother to do any further testing. Is this true? Or are there any other tests or procedures that can be done to see if he is able to produce sperm?

M.

What you were told is NOT true. There are many conditions that might result in an absence of sperm in the ejaculate. We divide these conditions into three main classifications.

The first possibility is failure to stimulate sperm production by the testicles. Sperm production depends on appropriate release of the hormones FSH and LH from the pituitary gland -- no LH/FSH, no sperm production. In your husband's case, the FSH and LH are slightly elevated, so let's cross this problem off our list.

The next possible culprit is "outflow obstruction." The sperm are produced in the testicles and mature in a nearby structure called the epididymis. Then the sperm pass through the vas deferens and ejaculatory ducts, through the prostate and penis and out of the body. If any of these passages are absent or blocked, sperm cannot reach the ejaculate. Clues can be obtained by noting the volume of ejaculate. If ejaculate volume and hormone levels are all normal, the problem might be a blockage close to the testicle, which might be caused by infection. If volume is low, there may be a neurological abnormality that allows the sperm to be diverted into the bladder, rather than taking the correct path down the urethra to escape the male genital tract. Or there may be a blockage in the prostate gland that can keep the sperm volume low. If this is suspected, the urologist will check the bladder for sperm after ejaculation or perform a prostate ultrasound. While obstruction may be repaired with microsurgery, the most cost-effective option is to surgically retrieve and cryopreserve (freeze) sperm for later use in IVF and ICSI, procedures in which eggs are retrieved and a single sperm is injected into each egg.

The final possible culprit is the testicle. Is it doing its job? The physical exam may provide clues. Is one of the testicles small & firm? Is there a dilation of veins (varicocele) surrounding the testicle? These findings may suggest testicular failure. Other tests may indicate that the testicle does a great job when it comes to making the male hormone testosterone, but fails to make sperm. The elevated FSH is a clue to this condition. This diagnosis is made by taking a small biopsy from the testicle, a simple outpatient procedure. If no sperm-producing cells are seen, a condition called Sertoli-cell-only syndrome is diagnosed. But the results can be misleading. It is best to do this in a fertility laboratory, because often live sperm cells can be missed after processing. If an embryologist is present at the time of biopsy, any live sperm can be cryopreserved for later use in an IVF cycle. If the initial specimen is inadequate, additional biopsies or a biopsy from the other side may provide adequate sperm for cryopreservation.