It’s been 13 years. Certainly a significant amount of time for any recent tech start up, but also impressive for a medical procedure. It’s the 13th anniversary of the invention of fine needle aspiration mapping of the testis for sperm. Nine hundred cases and going strong and many families created along the way.
It all started in 1996. Infertile patients from around the globe asking me if there was anything, absolutely anything, that I could do beyond what was currently available to find sperm so that they could have a child. The in vitro technology was there, if we could just find sperm! Survivors of cancer, war injuries, brutal infections, chronic disease, spinal cord injury, cystic fibrosis and a myriad of other genetic syndromes all had a simple request: the opportunity to be biological fathers. They refused to accept what a simple testicular biopsy was telling them, that there was no sperm being produced in the factory and no chance of having their own sons and daughters.
Its times like these, pushed against the wall, when creativity surges and opportunity frees us from the restraints of the routine. For me, it came as a simple revelation: not all branches of an apple tree have apples. Or, in my field, not all prostate biopsies show cancer and not all testis biopsies show sperm. A single biopsy of a testicle in a man with no sperm in the ejaculate is simply not enough to say that he does not have any sperm and that he cannot become a father. We must look harder. And so out of this revelation, testis fine needle aspiration “mapping” was born, 13 years ago and going strong.
The details of the mapping procedure don’t matter except to say that it’s all a matter of sampling enough to reduce sampling error and, while doing so, being kind to patients. Too many biopsies can destroy a testis, but non-surgical, fine needle sampling is a kinder, gentler, and more informative way to learn more and to find sperm. Think of it as “GPS” for the testis or, as one patient put it, “testicular cartography.” And, once sperm are found, the world becomes our oyster in a reproductive sense.
Telling a leukemia survivor who was too young to bank sperm before he was hit with a wall of chemotherapy, radiation therapy or a bone marrow transplantation to just stay alive that he can now be a father because of some small pocket of sperm still alive in his mapped testis is a profoundly satisfying and motivating experience. Motivating enough for me to be thinking about the next new thing…