Hi everyone,

I (Male, 39) recently dug up my old medical reports from 2021 and am finally tackling this topic again after a 6-year break. I am planning to see an andrologist soon for follow-up tests and am considering undergoing a TESE (Testicular Sperm Extraction).

Back then, my findings were as follows:

*Diagnosis: Azoospermia.

* Hormones: FSH elevated at 15.21 U/I, Testosterone at the lower limit with 2.85 ng/ml.

* Testicular volume: Approx. 6 ml on both sides.

* Genetics: Chromosome analysis (46,XY) and AZF microdeletions completely normal.

Previous plan: I was prescribed Anastrozole (1 mg) back then, but I never really followed through with it consistently.

Now I am wondering how I should proceed and what my chances look like:

- What do you estimate my chances are? With an FSH of 15.21 and a testicular volume of 6 ml each, is a TESE still worth a shot after all these years? Are there any success stories with similar values?

- Direct TESE or medication first? Should I go straight for a TESE or try to optimize hormone levels first (e.g., using Anastrozole for a few months) to improve the chances of finding sperm in the testes?

- Lifestyle & Supplements: Do weight loss, exercise, or specific supplements (like CoQ10, Zinc, Selenium, etc.) actually help in a case like this, or is that more of a drop in the ocean given the underlying primary testicular insufficiency?

Looking forward to your input and experiences!

Hi everyone,
I recently had a semen analysis and I’m particularly concerned about the morphology result. I also want to mention our pregnancy history, because we have experienced several very early pregnancy losses, and I’m wondering whether there could be any connection with my semen analysis.
RESULTS
Volume
3.6 mL ≥ 1.4 mL
pH
7.2 ≥ 7.2
Days of abstinence
3 days - 2–5 days
Liquefaction
20 min -20–30 min
Appearance
Homogeneous -Homogeneous
Viscosity
Normal -Normal
Agglutination
Absent - Absent
Sperm concentration (sperm/mL)
56 million/mL ≥ 16 million/mL
Total sperm count (sperm/ejaculate)
201.6 million ≥ 39 million
Motility assessment possible
Yes -Yes
Progressive motility (PR)
43% ≥ 30%
Non-progressive motility (NP)
4%
—
Total motility (PR + NP)
47% ≥ 42%
Immotile (IM)
53%
—
Normal forms
1% ≥ 4% normal sperm forms
Abnormal forms
99%
—
Head defects
99%
—
Midpiece (neck) defects
0%
—
Tail defects
0%
—
Leukocytes
1.6 million/mL < 1 million/mL
Round cells
0 million/mL
—
Germ cells
0 million/mL
—

Regarding our pregnancy history:
● July last year: pregnancy loss at around 5 weeks.
● July this year: pregnancy loss at around 4 weeks.
● August this year: pregnancy loss at around 4 weeks.
So we have had three very early pregnancy losses.

And most importantly, do you think we still have a good chance of having a healthy pregnancy naturally despite the 1% morphology and our history of very early pregnancy losses?

Estradiol (E2): 24.3 pg/mL Reference range: 24.2–62.1 pg/mL

FSH (Follicle Stimulating Hormone): 30.4 mIU/mL Reference range: 1.5–12.4 mIU/mL

FT4 (Free Thyroxine): 1.23 ng/dL Reference range: 0.9–1.75 ng/dL

FT3 (Free Tri-Iodothyronine): 2.4 pg/mL Reference range: 2.0–4.2 pg/mL

LH (Luteinizing Hormone): 16.5 mIU/mL Reference range: 0.5–12.4 mIU/mL

Progesterone: 0.68 ng/mL Reference range: 0.21–2.1 ng/mL

Prolactin: 30.8 ng/mL Reference range: 2.52–13.23 ng/mL

Total Testosterone: 681 ng/dL Reference range: 171–789 ng/dL Status: Normal

Im seeing a urologist tomorrow, i just want to understand what the concerning markers are indictive of?

Context: Workout heavy lifting 4-5 times a week, sleep is a little disruptive prior to the blood test, work and life factors slightly underlying and stressful

No active symptoms i.e. low libido, fatigue, nipple discharge or anything

No active injuries or previous history of steroids

Any advice, suggestions or anything else would be much appreciated

Hey Guys, I wanted to introduce myself. Ive been reading your stories and questions for a few months and Ive even responded to some. I spend a lot of my professional life talking to men about fertility as a urologist.  But this is one area of medicine where I’ve also had the experience of sitting on the other side of the table. My wife and I went through IVF twice to have our children, so when I talk to men going through this process, I’m not speaking only as their doctor. I’m also speaking as a husband and father who remembers exactly what it felt like to be in it. I remember the injections, appointments, procedures, and waiting. I remember wondering how many eggs we would get, how many would fertilize, etc, etc.  I remember watching my wife carry most of the physical burden and doing my best to maximize my SA. I also really remember the failure we had and the loss of cycles. Believe me, being a urologist didn't somehow make IVF easy. Knowing the medicine didn't take away all the anxiety, disappointment or feelings. Ive been there with you.

That experience is a big part of why I’m here. I’m a urologist, but I’m also a member of this club of men who have gone through IVF, and it's a club most of us never expected or wanted to join. Male infertility and IVF can be incredibly isolating because so much of the process understandably revolves around what our wives and partners physically endure. As men, we often respond by trying to become the steady one, the person who stays positive, goes to work, tells everyone we're fine and keeps moving forward. Meanwhile, we also may be worried or have emotions.  I’ve felt some of those things too. So I'm here to answer questions when my experience as a urologist can help, but I'm equally here simply to support the guys going through it.  So, just saying hello and hope I can help a little on this journey. All the best guys, stay positive!!

My wife and I have been struggling with infertility issues for over 3 years now. After some testing, it turns out that I was the problem, low testosterone and low sperm count. I’m not even in my 30s yet. I never thought I would have issues like this, or that it would impact my life the way it has. Everyone of our siblings has children, almost all of our friends have children, all the social media we get is about being parents, even the bible groups at church for our ages are usually just new parents talking about being parents. The emotional toll it has taken on my wife and I cannot be understated. Over 36 months of hopeful waiting only to see another negative. We’ve taken to going out of town on Mother’s Day and Father’s Day the last 2 years, it’s just too hard. Don’t get me wrong, I love my nieces and nephews and I’m in no way upset at anyone for our struggles, it just is a bit too much to handle. On top of this I do not have a great support on my side of the family (they just don’t contact me other than once a month or so to say they miss us), and we’ve been living with her parents for the last 2.5 years as we are trying to save for a home. I feel like less than a man. I feel like a failure. Everyday. No matter what I’ve been doing. More than once a week I have to hold my wife as she cries and it has shattered my heart into pieces. I wasn’t very religious before I met my wife, but she made me a believer in Christ Jesus. I strive to remain positive and grateful for all that we do have and not dwell on what we haven’t gotten yet, but some days are worse than others. Like today.

Sorry for the rant, but I really don’t have anyone else to vent to. Have a good day.

I'm 30M and my wife is 28F. We've been trying to conceive since October 2025 and started fertility treatment in February 2026.

I've had 3 semen analyses this year, and I'm concerned because some of my parameters seem to be getting worse over time.

Semen Analysis #1 — February 2, 2026

Volume: 1.0 mL

Concentration: 120 million/mL

Total sperm: ~120 million

Active motility: 70%

Sluggish motility: 10%

Dead: 20%

Total motility: ~80%

Morphology: 20% abnormal → ~80% normal

Viscosity: Normal

Liquefaction: 25 minutes

Pus cells: 1–2

RBC: Nil

Bacteria: Nil

Immature germ cells: Nil

At this point my lifestyle was actually pretty bad. I was heavily using cannabis, eating a lot of junk food, drinking soft drinks and eating a lot of sweets. I wasn't exercising.

Semen Analysis #2 — August 2, 2026

After making major lifestyle changes starting June 3:

Quit cannabis and other smoking

Started going to the gym 5x/week

Started eating much better

Eating chicken/eggs regularly

Drinking much more water

Taking creatine + whey protein

The results were:

Volume: 1.0 mL

Concentration: 70 million/mL

Total sperm: ~70 million

Active forms: 25%

Sluggish forms: 35%

Inactive forms: 40%

Total motility: ~60%

Morphology: 70% normal / 30% abnormal

Viscosity: Viscous

Liquefaction: Prolonged — took >1 hour

Pus cells: 1–2

RBC: Nil

Epithelial cells: Nil

Spermatogenic cells: Present

pH: 7.5

This is where I became concerned because concentration dropped from 120 → 70 million/mL and motility from ~80% → ~60%, despite my lifestyle being significantly healthier.

The semen was also noticeably much thicker and took over an hour to liquefy.

IUI sample — August 31, 2026

I had an IUI performed.

Before sperm preparation:

Abstinence: 3 days

Volume: 1.0 mL

Concentration: 55 million/mL

Total sperm: ~55 million

Total motility: 30%

Progressive: 5%

Non-progressive: 25%

Morphology: 2%

Agglutination: Grade II

Aggregation: Grade II

Pus cells: 4–6

After density-gradient preparation:

Volume: 0.7 mL

Count: 30 million

Motility: 95%

Progressive: 85%

Non-progressive: 10%

Morphology: 2%

Agglutination: Nil

Aggregation: Nil

Pus cells: Nil

The huge improvement after washing is confusing to me. Raw progressive motility was only 5%, but after preparation it was 85%.

I'm 30 and honestly pretty worried that my fertility is deteriorating. I'd really appreciate input from anyone.

I was having pain in my testicles...so i went to the urologist he suggested i should get a USG done..and also do a semen analysis I did that and usg shows varicocele grade 1 to 2 ....i showed that to my urologist he said it's not an issue...but my semen report is not good..he gave me medicine for that...the question that i am trying to ask is that does anyone here has this issue..? .and is surgery necessary for every varicocele? And will it affect my marriage in the future? Or it get ok on its own

It wasn't until a few years after we got married that I was given a diagnosis of having a low sperm count and poor motility. Ever since then I've had a go at various medications and supplements, made some changes to my lifestyle and undergone several rounds of treatment, but the outcomes have been inconsistent.

The real difficulty, to be honest, hasn't merely come from the treatments, it's the continual questions from family and friends as to when we're having a baby. Since we've been married for five years, there's always this pressure at every family get-together....

Although people generally have good intentions, they don't know what it's like to receive those questions while you're already having difficulties all on your own.

How did you cope with the social pressure when dealing with male infertility and avoid feeling as if you were failing in your role as a husband?

Hi everyone,

I (Male, 39) recently dug up my old medical reports from 2021 and am finally tackling this topic again after a 6-year break. I am planning to see an andrologist soon for follow-up tests and am considering undergoing a TESE (Testicular Sperm Extraction).

Back then, my findings were as follows:

* Diagnosis: Azoospermia.

* Hormones: FSH elevated at 15.21 U/I, Testosterone at the lower limit with 2.85 ng/ml.

* Testicular volume: Approx. 6 ml on both sides.

* Genetics: Chromosome analysis (46,XY) and AZF microdeletions completely normal.

Previous plan: I was prescribed Anastrozole (1 mg) back then, but I never really followed through with it consistently.

Now I am wondering how I should proceed and what my chances look like:

- What do you estimate my chances are? With an FSH of 15.21 and a testicular volume of 6 ml each, is a TESE still worth a shot after all these years? Are there any success stories with similar values?

- Direct TESE or medication first? Should I go straight for a TESE or try to optimize hormone levels first (e.g., using Anastrozole for a few months) to improve the chances of finding sperm in the testes?

- Lifestyle & Supplements: Do weight loss, exercise, or specific supplements (like CoQ10, Zinc, Selenium, etc.) actually help in a case like this, or is that more of a drop in the ocean given the underlying primary testicular insufficiency?

Looking forward to your input and experiences!

Hi everyone,

Getting married in the coming months and going to want to conceive. I’ve been on TRT for years, I’m 34.

I started HCG a few months ago. I did my first SA out of curiosity and it came back with 2.5 M/ml. Obviously far below ideal ranges. I also had virtually no motility.

I’ve heard some people say they’ve been able to conceive on TRT and HCG - I’m guessing that likely won’t be for me.

Anyone ever come off and switch to enclomiphene for better results? Did this to myself so while discouraged, only myself to blame here.

My wife (36F) and I (37M) have been trying for ~6 months. Her fertility tests (AMH, FSH, LH, etc.) are okay.

My testosterone/LH/FSH were poor in June, but after Clomid, CoQ10, L-carnitine, etc., my repeat bloodwork on Aug 25 showed significant improvement.

My June semen analysis at FlowLabs was also not great:

- Volume: 1.44 mL

- Concentration: 14.44M/mL

- Total sperm: 20.79M

- Progressive: 32.05%, Non progressive: 10.36, Immotile: 57.59, Total motile: 42.41

I'm already scheduled for a repeat semen analysis at FlowLabs on Sept 14.

Today, Trio recommended their semen analysis with DNA fragmentation testing for $350 out of pocket. They don't have my previous results yet.

From what I've read, ASRM doesn't recommend sperm DNA fragmentation testing as part of the initial infertility evaluation.

Would you pay the $350 now, or wait for my repeat standard semen analysis and decide based on those results? Is DNA fragmentation actually useful/necessary in my situation?

Would especially appreciate experiences from anyone who has dealt with Trio or DFI testing in Canada.

34 year old male healthy male looking for advice. Wife and I have been trying to get pregnant for 1.5 years now. I’ve had a grade 3 left Varicocele for as long as I can remember. No pain, maybe a slight ache here and there. Went to see a urologist, gotten all the tests necessary. Urologist told us I have azoospermia and having birth naturally is not possible. I addressed the Varicocele since I expected surgery. He states, that’s probably not the main cause of the azoospermia. He suggested getting microsurgery and a microTESE to begin the process of IVF. I really wanted the microsurgery or embo to see if the Varicocele can bring sperm back before even IVF. I was really optimistic on having natural birth but it seems like that might not be a possibility with my Semen analysis results being that terrible. If anyone has any experience about this please let me know. Would love an expert opinion. Should I get both surgeries? Or should I risk just getting the microsurgery to repair the varicocele and see what happens after?

Semen Analysis: volume - 5.3 Total count 0.53 Total concentration 0.1 %Motile - 0
FSH - 7.5
LH - 3.5
Prolactin - 10.2
Testosterone - 568
Karyotype - normal

Before marriage with masturbating it was fine. I tend to get erection and few drops of fluid don't know if it is ejaculate or pre ejaculate fluid followed by a sense of pleasure.

Once I got married I still get erection but it just ends here, I can't ejaculate nor reach orgasm, either by sexual intercourse or even masturbating. I tried to get semen analysis 3 times at lab and failed all of them. My wife got frustrated and left the home. I feel like my life is getting ruined and I don't know how to solve this. She said she won't return to home until I manage to perform a semen analysis which I keep failing.

My hormonal assay , pelvi abdominal and scrotal us came out fine. All hormonal assay is normal, scrotal us showed only bilateral varicocele which doctors said they have no role in this.

How to solve this issue ?

Hi everyone, I'm 29M and currently undergoing fertility evaluation. My wife has ADPKD, and because there is a risk of passing it to our child, we decided to go with IVF/ICSI + PGT-M.

Before moving forward with IVF, I had a semen analysis.

Semen analysis Volume: 2 mL Abstinence: 3 days Sperm concentration: 7.7 million/mL Motility: 0% Vitality: Not tested

A second manual examination reportedly found very few sperm, including occasional motile and non-motile sperm, but I'm not sure how reliable that examination was.

Hormone tests FSH: 2.7 mIU/mL LH: 5.39 mIU/mL Total testosterone: 521.5 ng/dL Prolactin: 11 ng/mL TSH: 2.03 µIU/mL

My Vitamin D was also 16 ng/mL.

Scrotal ultrasound with Doppler Right testicle: 4.5 × 2.8 × 2.1 cm Left testicle: 4.2 × 2.8 × 1.6 cm Normal testicular appearance Normal blood flow No varicocele Small 6 × 3 mm left epididymal cyst Minimal right hydrocele Spermatic cords reported as normal No obstruction reported

The radiologist also told me during the scan that there was nothing concerning and no obvious obstruction.

However, my doctor suspects an obstruction and has suggested TESA.

The radiologist told me there was nothing concerning and there is no obstruction and this case However, my gynec doctor suspects obstruction and has suggested TESA.

Would it be reasonable to repeat the semen analysis with vitality before doing TESA, and get a second opinion from an andrologist/ male-infertility specialist?

I'd appreciate experiences from anyone who has dealt with 0% motility, low sperm count, suspected obstruction or TESA.

Update: I have updated all units in reports

Hi All, I’m 34M trying for our 1st kid from past 8 months. Today I have my sample for semen analysis and the reports have come. Can anyone tell me if there is any problem in the report and any suggestions on fixing the problems.

34M | Semen Analysis | TTC

Abstinence: 4 days

SEMEN PARAMETERS
-------------------------
Volume: 4.5 mL
Liquefaction time: 20 minutes
Viscosity: Normal
Appearance: Grey opalescent
pH: 7.4
Epithelial cells: Present
Cell debris: Present
Leukocytes: 1–2/HPF

SPERM PARAMETERS
-------------------------
Sperm concentration: 9 million/mL
Total sperm count: 41 million
Total motility: 46%
Total progressive: 36%
Rapid progressive: 0%
Slow progressive: 36%
Non-progressive: 10%
Non-motile: 54%

MORPHOLOGY
-------------------------
Normal forms: 2%
Abnormal forms: 98%
Head defects: 52%
Neck & midpiece defects: 28%
Tail defects: 18%

Lab impression: Oligoteratozoospermia

I’m currently taking 40 mg of testosterone and 120 mg of Clomid per week. My wife and I are trying for a baby, and I asked my doctor for a semen analysis, but he doesn’t think I need one.

Has anyone been able to conceive while on a similar protocol? Should I push for the semen analysis anyway?

This is the place for partner's perspectives today.

Hey people, any expierence with DR Johnathan Ramsay from London. I go to visit him for FNA testicular mapping. Any good review from Lister hospital or general? Thanks.

Hello everyone, sorry that we’re all here. I just need support right now. My wife (28) and I (29) have been on the infertility struggle bus for 5 years. A bit of history, when I was 3, I was diagnosed with Ewing’s sarcoma. Underwent chemo and surgery and, thankfully, I made it to the other side without a single remission, though there have been a couple of scares (turns out a side effect of chemo is increased risk of leukemia later. Ain’t that swell?) I asked my doctor about what effect chemo may have had, and he told me that it was a 50/50 shot because of how young I was at the time. He told me he’s treated men and women for Ewing’s with various stages of fertility after the fact. I also have a diagnosis of sarcoidosis that I medicate for and seem to have it under control. My wife has PMOS (PCOS, historically.) She also recently had a fallopian tube removed due to excess free fluid, which could have increased her risk of ectopic pregnancy. I had my levels checked a couple years ago where my sperm count was only 5 at its highest after a month of FertileAid. My urologist recommended IVF for getting pregnant. But, like other stories here, we ain’t got that kinda money and I don’t want to put my wife through that.

We decided to start the process of adoption after both of us felt a religious calling to that. All of that happened back in April and we’re still waiting for a possible call. I am a paramedic and my wife is a public school teacher, so, anecdotally, we should seem like rockstars. Because of my experience as a paramedic, I was able to mark off the drugs I was ok with the birth mother having taken while pregnant. Spoiler: it’s not a whole lot of them.

Early this month, my wife had a late period. We tried like hell not to get our hopes up, but the timing of our possible conception seemed quite favorable. She took two tests, both negative, but I still foolishly held out hope. That was, until her period started. We were both crushed. This month has been hard and after having a talk with my wife tonight, we both just let the other spiral in our lamenting.

It’s unfair. I had something stolen from me before I was old enough to even understand it. I have maintained a decent weight and I take decent care of my overall health. I quit nicotine after seeing that it can cause lower sperm counts. My wife has been taking medicine to manage her conditions and has been optimizing her overall health. Yet, we still can’t get pregnant. I’m so fucking angry that people around me, who have circumstances so stupidly self-inflicted upon themselves, can stick their dick in whatever has the right receptacle and can become a father to another child. People who don’t have nearly the level of emotional intelligence, wherewithal, survival instincts, or anything like that, as I do, can just have kids with such ease. In my career, and my wife’s, we’ve both met some real pieces of work. They have no issue at all with conception, but somehow, two upstanding members of society can’t fucking do it.

I feel like I failed my wife. I can’t do the one thing every man ought to be able to do, and it kills me. Every period, every negative test, every single time one of our friends gets pregnant, I begin to feel the same way again. I feel so alone in it, too. Every man I know that has struggled with infertility eventually was able to conceive. Yet, I can’t. I feel like so much less of a man and that’s the ultimate kick. To feel like I’ve failed as a man and husband kills me inside. I can’t be the only one who’s had these thoughts and feelings, am I?

This is the place for partner's perspectives today.

Hey everyone. I’m 30 years old, and my significant other and I have been trying to have a baby but have unfortunately been having some trouble conceiving.

I ended up having a semen analysis done, and both my sperm count and motility came back low. We also had my testosterone checked back in March, and it was extremely low at around 150 ng/dL.

We eventually went to a fertility clinic, and the doctor prescribed me 25mg of Clomid (clomiphene) daily to try to raise my testosterone while hopefully improving my sperm production as well.

I’ve now been taking it for close to two months, and I have an upcoming appointment where they’re going to recheck my testosterone levels and do another semen analysis to see if anything has improved.

I’m definitely anxious but also really curious to see what the results are.

For any guys here who have taken Clomid for similar reasons:

How low was your testosterone before starting, and how much did it increase?

Did your sperm count or motility improve?

How long were you taking Clomid before you noticed a significant difference?

Most importantly, did you and your partner eventually conceive naturally while you were taking it?

I know everybody responds differently and I'm not looking for medical advice. I’d just really like to hear some real experiences from other men who have been in a similar situation.

Thanks!

I’m 35 and developed severe male infertility after chemotherapy for a PNET/Ewing tumor in 2015 (Ewing 99 protocol).

My FSH is elevated and my testicles are somewhat small, but my testosterone is still being produced. Ultrasound showed normal-looking testicles with only mild bilateral varicocele.

Sperm have been found in my ejaculate more than once, but in extremely low numbers. My latest sample had only 10 spermatozoa in 20 µL, mostly immotile, so nothing could be frozen.

My urologist is now considering TESE/micro-TESE during IVF to search directly in the testicles for viable sperm for ICSI.

Has anyone had a similar situation after chemotherapy and successfully had sperm retrieved through TESE/micro-TESE and eventually had a biological child?

A few months ago I posted here feeling completely lost. My numbers were varying, but all critically low (concentration 2–14 M/mL, motility 5%, ~0.82 million total motile. All sperm results posted at the end of this post),

And the doctor basically just shrugged and said he doesn't know why, and the only advice we got was that we need IVF. A lot of you told me to push for a real workup with a reproductive urologist before committing to IVF. You were right.

I did all the usual tests... all my hormones look good. Unremarkable scrotal Doppler ultrasound. No varicocele or structural issues. But while I was getting my ultrasound the tech said there was another test ordered... and before I knew I was in the MRI machine wondering "wtf"

We met with our doctor and he said "yeah i'm not sure why they did that, I don't recall ordering it"

BUT LOW AND BEHOLD: MRI showed a cyst in my prostate. It then took almost a month of my wife and the doctor hounding the hospital just to get the actual images transferred (advocate for yourselves, people!). Once he finally reviewed the images, the verdict: a large midline cyst. He said I've probably had it my whole life, and it *may* explain my semen analysis numbers. The only thing is my semen volume is normal, so it's not a textbook blockage scenario, but he says the cyst is large, and right in a spot where it could cause issues.

What's next: he's reccomending a TURED (or a similar procedure) to open things up and let more sperm through. We're waiting on surgery scheduling now and hoping to get it done in the next few weeks.

I know this doesn't guarantee anything the cyst may not be the whole story, and we're still waiting on some of the other test results. But after months of being told the only path was IVF, having an actual explanation and a treatment to try first feels like a huge shift.

Question for the group: has anyone here had TURED (or another procedure) for a midline/prostatic cyst or ejaculatory duct obstruction? Did you see your numbers improve and on what timeline?

I wanted to share all this because this group has been so helpful and I hope someday this post may help someone else.

More sperm background:

Sperm tests timeline January → March → May

Volume :
7 mL (High) → 3.1 mL → 5.5 mL

Sperm Concentration:
2 (Low) → 14 (Low) → 3 (Low)

Total Sperm Count:
14M → 43.4M → 16.5M

Total Motility:
38% (Low) → 12% (Low) → 5% (Low)

Progressive Motility:
NA → NA → <2% (Very low)

Morphology (% normal forms):
20% → 18% → 5%

Viability (% viable spermatozoa):
44% (Low) → 14% (Low) → (Not reported; inferred very low from 0.82 million total motile sperm)