A Fighting Chance to Be Fertile

The case of the month is an actual patient from The Turek Clinic.
He arrived exhausted after a flight from Shanghai. We had talked over the phone several times earlier and he decided that he had to try once more before throwing in the towel on becoming a biological Dad.

Here to Help

He was diagnosed with nonobstructive azoospermia and had been through several failed sperm retrieval procedures, included the dreaded microdissection TESE. His testosterone was hanging in there after having these testicular procedures, but just barely. “Doc, another one of those procedures and my testosterone will be in the tank…for good.”
Several hours later, as he was leaving the office after his testicular FNA mapping procedure, he said: “You’re it Doc, I hope you find it.” I called him back 2 weeks later, after our extensive review of the map findings, and said: “You’re on!” We found sperm. One site, right side. Not many, but sperm are there. From across the Pacific Ocean, over 6,100 miles away, I could hear his voice cracking and then, sobbing. “See you in a couple of months,” I said, “And don’t forget to bring your wife (for IVF)!”
His sperm retrieval was this week. Straight forward. One side. 75 minutes. Got all we needed and then some. Done.

Why I Like Testicular Mapping

I developed testis fine needle aspiration mapping in 1996. The inspiration for the idea came from a colleague at UCSF, Dr Britt-Marie Ljung. Back in Sweden, she used to diagnose eye tumors in kids using the technique, a neat alternative to removing the eye to make the diagnosis. Eyes, testicles…same difference really. Both incredibly sensitive and important body parts that people would rather keep rather than lose.
Here is a short list of reasons why I like testis FNA mapping:

  • Quick and noninvasive. Finds sperm without incisions under local anesthesia in an hour or so. Back to work in a day or two.
  • Plans your trip. Having a map helps you get there quicker and use less gas. Sperm retrieval made easy. The best “know before you go” technique out there today.
  • Saves testicles. Just picking the correct side for sperm retrieval alone is a big improvement over any other big, blind surgical approach. No more “Dang, shoulda started on the other side” ever again.
  • Easier sperm retrieval. Not all men need a microdissection TESE to get sperm. In fact, most (75%) don’t. I know this because Mapping can suggest that less invasive methods should work just fine (TESA, TESE). Easy peasy.
  • It’s quantitative. The map provides actual numbers that estimate sperm density at all 18 locations in the testis. “Best to start here,” you might find me saying at sperm retrieval.
  • Sets the bar high. You know that sperm are there with a Map. You have to find them, no excuse. You’re ability to find sperm is actually being measured at sperm retrieval, an intimidating concept for many docs. My view? This kind of feedback standard is great for quality control, improving care, and achieving better outcomes.

In fact, since I began FNA testis mapping, I rarely fail to find sperm at the time of sperm retrieval.  As a consequence, only incredibly rarely do my couples have children that are not fully biologically theirs. And that, my friends, is the ultimate measure of performance.
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