The Case of the Month is an actual patient of The Turek Clinics.
In my life and work, I have always believed in the mantra of the modernist architect Mies van der Rohe that “less is more”. However, as a card-carrying member of the real world, my mantra is really “less can be more.” Especially when it comes to surgery on a man’s nether regions. And this what I will speak about next week at the Japanese Society of Assisted Reproduction.
Running on One
My patient was a testis cancer survivor. After living through surgery and chemotherapy, he now enjoys and savors every breath he takes. The reason he was in front of me was that he wanted children but was found to have no ejaculated sperm. Azoospermia, a sobering consequence of cancer or its treatment.
He was seen back East by several infertility specialists and they all recommended the same procedure: Microdissection testicular sperm extraction (Micro-TESE) in conjunction with IVF and single sperm injection. But the patient said to me: “Doc, I gotta protect this little guy as it’s the only one that I have left. This ‘big dig’ for sperm just doesn’t sit right with me.”
I offered him a more user-friendly alternative: Sperm Mapping. An office procedure done with fine needles in an hour or so, Sperm Mapping is also well established and can find testicular sperm in small places. The essential difference between Mapping and micro-TESE is that Mapping is a far less invasive way to figure out if there are sperm in the testicles, as no large incisions are made in somewhat sensitive places. This he found attractive. But after I explained some other advantages of Mapping, it sealed the deal for this judicious guardian of his jewels:
- If Sperm Mapping shows no sperm, then sperm retrievals of any type or extent are highly unlikely to yield sperm. And this saves testicles.
- If FNA Mapping shows sperm, then about half of the time a micro-TESE is not needed for sperm retrieval, since less invasive procedures (TESA, TESE) can do just fine. And this saves testicles.
- Even after a micro-TESE fails to find sperm, Sperm Mapping may be able to find missed pockets of sperm and lead to successful sperm retrieval. And this builds families.
Ended up that his Map showed sperm in his lone rider. Several months later, only a simple needle aspiration was needed to retrieve sperm. No cuts. No muss, no fuss. All good.
More recently, another patient who went through a similar testis-sparing approach fertility wrote me a thank you note: “Never have a man’s testicles had a better friend and champion.” Now, how much “more” can “less” get!