Ever open up the back and look inside a wristwatch? Pretty simple looking from the front, but a whole lot going on inside. And remember the cool mechanicals under the skin of the Terminator (1984) when he operates on his own injured arm? There is sophistication in simplicity.
Behind the Curtain
This concept is top of mind as I prepare for an invited lecture on Sperm Mapping for providers of fertility care at our national meeting this week, the American Society of Reproductive Medicine (ASRM). So tell us, how is Sperm Mapping, performed in men with azoospermia to find sperm, like a wristwatch? Well, FNA Mapping is a straightforward, simple procedure that takes about an hour under local anesthesia. No cuts, no muss, no fuss. It is GPS for finding sperm in men with testicular failure. That’s the front end. On the back end, what’s done behind the scenes to get the final result is a whole other story. Let’s take a peek behind the curtain.
How Things Work
In fact, most of the labor and effort that goes into Sperm Mapping occurs after the mapping is done. Individual microscope slides, representing individual sites in the testis, are hand smeared, fixed and PAP stained, just like cervical smears for cervical cancer. Then, a group of cytologists, including technicians and doctors called pathologists, pour over the slides for days under microscopes. The first thing they do is to judge the overall quality of each specimen that was taken. Are there adequate cell numbers present to make an accurate determination of sperm presence or absence? If not, the slide is deemed “inadequate” and considered no further. Let me tell you, this review directly reflects on the quality of my mapping technique, which definitely keeps me on my toes.
The next step in the slide review is to identify mature sperm with tails, the final stage in the process called spermatogenesis. And by God, these cytology peeps are good! They can spot a single sperm among millions of other cells like nobody’s business. They can also detect whether earlier germ cells are present in the testis, such as spermatogonia, primary spermatocytes and spermatids. Abnormal cells, characteristic of cancer or inflammation, are also duly noted.
Back at You
Then, the slide racks are sent to me and I personally review every case. Then, and only then, I examine the cytology report. If my review agrees with that of the cytologists, then we’re done. If not, we do it all over again. This redundancy in the review process ensures quality and consistency in our ability to find mature sperm.
So if things seem simple, then either they really are or the intricate is well honed. In the world of Sperm Mapping, getting it right matters enormously, since finding just one sperm can make all the difference in the world.