Diagnosed with early maturation arrest: I can't make sperm. Any ideas?

[tastyfood]

I had my testicles biopsied in 36 different regions (Fine Needle Aspiration), and the pathology results showed early maturation arrest in all sites. The process stops at the primary spermatocyte stage for me.

I had a varicocele repair 8 months ago, but it hasn't helped yet.

I have normal levels of testosterone and DHT (not super high, but enough to make sperm). They gravitate around 450 most of the times, and after taking some exemestane they even went up to 750.

The cause of the early maturation arrest is idiopathic. Doctor says it could be "genes", but what am I supposed to do about that?

I have a small thyroid carcinoma left untreated (less than 1cm), and I'm starting to wonder if the cancer cells are doing damage all the way down there.

Any ideas? I have tried everything under the sun: suppressed TSH, anti prolactin substances, exemestane to obliterate aromatase....everything!

I am trying to become a biological father so obviously these are the worst news.

I do all the Peaty stuff so rest assured I get my calcium, my sunlight, and everything else we typically discuss in this forum.

Any ideas or experiences from others in this regard would be really helpful. My body is clearly saying "NO" to reproduction. All the building blocks are there in the testicle, but it's just not happening.

Thank you!

 

[alephx]

What does your diet look like? Please be extensive
Did you get the shot?

 

[tastyfood]

No I didn't, and will never do.

Diet is 2g+ calcium a day from milk or cheese. Beef liver 8oz once a week. Close to 400mg of magnesium from various sources including hot cocoa, well boiled russet potatoes. Plenty of sugar and carbs, always aiming for 250+, respecting the 1:2 protein to carbs ratio at least.

I get oysters regularly. Have started using oat bran in the morning which has been helpful for bowel movements. I eat eggs, squash, white button mushrooms, zucchinis, well boiled collard greens for the vitamin K, magnesium and calcium.

2 cups of coffee per day with milk and sugar.

Those are my staples.

 

[haidut]

I had my testicles biopsied in 36 different regions (Fine Needle Aspiration), and the pathology results showed early maturation arrest in all sites. The process stops at the primary spermatocyte stage for me.

I had a varicocele repair 8 months ago, but it hasn't helped yet.

I have normal levels of testosterone and DHT (not super high, but enough to make sperm). They gravitate around 450 most of the times, and after taking some exemestane they even went up to 750.

The cause of the early maturation arrest is idiopathic. Doctor says it could be "genes", but what am I supposed to do about that?

I have a small thyroid carcinoma left untreated (less than 1cm, they), and I'm starting to wonder if the cancer cells are doing damage all the way down there.

Any ideas? I have tried everything under the sun: suppressed TSH, anti prolactin substances, exemestane to obliterate aromatase....everything!

I am trying to become a biological father so obviously these are the worst news.

I do all the Peaty stuff so rest assured I get my calcium, my sunlight, and everything else we typically discuss in this forum.

Any ideas or experiences from others in this regard would be really helpful. My body is clearly saying "NO" to reproduction. All the building blocks are there in the testicle, but it's just not happening.

Thank you!

I have a relative with the exact same diagnosis, who was told the issue is genetic and nothing can be done about it. After a month on 10mg exemestane, he and his wife now have twins
The fertility doctor got livid and threw them out of his office for using "unapproved methods" to get pregnant...instead of celebrating a natural conception that he said would be "impossible".
I would advise against having other biopsies as they can cause long term damage and an actual sterility. Since it takes ~90 days for sperm production to fully reflect the changed hormonal environment as a result of taking the AI, I'd keep taking the exemestane (no more than 10mg daily) and then do a sperm (but NOT biopsy) test for motility, morphology, numbers, etc after another month or two.

 

[tastyfood]

I have a relative with the exact same diagnosis, who was told the issue is genetic and nothing can be done about it. After a month on 10mg exemestane, he and his wife now have twins
The fertility doctor got livid and threw them out of his office for using "unapproved methods" to get pregnant...instead of celebrating a natural conception that he said would be "impossible".
I would advise against having other biopsies as they can cause long term damage and an actual sterility. Since it takes ~90 days for sperm production to fully reflect the changed hormonal environment as a result of taking the AI, I'd keep taking the exemestane (no more than 10mg daily) and then do a sperm (but NOT biopsy) test for motility, morphology, numbers, etc after another month or two.

When you say the exact same diagnosis, do you mean early maturation arrest? I am not making any sperm, not just in the ejaculate, but also not in the testicle. They sampled 36 different sites between the two testes. No sperm being formed anywhere in the testes. There are many diagnoses for male infertility, so I want to make sure we are talking about the same thing.

My testicles seem fine, all the germ cells are there and all the sites look exactly the same, however, spermatogenesis stops at the primary spermatocyte stage. They wouldn't be able to even surgically extract one sperm from my testes at the moment.

I tried exemestane on June 2021. I took 7 to 8 mg for a month with a fatty meal. My testosterone clearly increased as a result. It went from 390 to 750 in just a month. It didn't make a difference in the semen analysis though. No sperm found in the ejaculate even with such high testosterone numbers.

Since sperm takes 90 days to form (more or less), do you think a month of exemestane could have been not enough?

Exemestane also shot up my LH and FSH, as well as prolactin, which worried me a bit. My LH and FSH have stayed higher since then.

Would you be concerned about the increase in pituitary hormones long term from taking the exemestane?

Thanks for the comments.