How to Be a BioDad: The Essential Checklist
You have been told that you’re sterile. Absolutely no sperm in the ejaculate. You turn to the Internet for help, to learn what options you have and to avoid thinking about any deeper meaning of this horrific news. As you do this, you keep feeling that you really want your own genetic child. Yes, you want to be a BioDad.
Here’s a checklist of a dozen things to know to ensure that every possible stone is unturned in your quest to be a BioDad.
- Don’t believe the first result. Repeat the semen analysis, as even men with normal semen quality can be zero on occasion. It’s a well-recognized fact.
- Get a better semen analysis. If the semen sample shows no sperm at first, it should immediately be “spun down” so that all the cells in the sample are pooled together in a “pellet” and then the pellet of cells is examined by an experienced lab person for sperm. The chance of finding sperm in a pelleted semen sample is 10-20% after the basic semen analysis misses it.
- See a reproductive urologist. Azoospermia can have both acquired and genetic causes. Some acquired causes include regular use of hot baths, testosterone replacement, chronic fevers, past infection or traums and even a bad flu. A thorough history can reveal these things. Also, an expert physical exam can suggest natural and acquired causes of blockage such as scarring after surgery or trauma or missing pieces of the reproductive tract.
- Get your hormones checked. Testosterone, FSH, LH and prolactin levels are instrumental in trying to figure this out and can often distinguish between blockages and testis failure. Some cases of testis failure are due to missing hormones (Kallman Syndrome) which can be reversed and natural fertility restored by simply replacing the missing hormones.
- Ask if you are blocked. Men with blockages can often be “rebuilt” and natural fertility restored especially in cases of ejaculatory duct or epididymal obstruction. A testis biopsy or sperm FNA mapping are two excellent ways to make this diagnosis.
- Ask if you have testis failure. Even if the engine or testicle is not running normally (i.e. is blocked downstream), it could still be running. The fact is that a majority men with testis failure can still have sperm in the testicle despite not having it in the semen.
- Find out why. Remember the goal of all of this is to have a healthy child. Genetic causes of azoospermia (cystic fibrosis, chromosomal abnormalities) can have implications for the health of offspring. And luckily, if there is risk to offspring, embryo biopsy can done along with IVF to substantially reduce the risk of having unhealthy children.
- Know before you go. With testis failure, testicular sperm may not be found everywhere in the testicle, but instead are often found in “patches” or “pockets” scattered throughout the organ. That complicates finding them easily. There are several strategies commonly used to locate sperm pockets, including Sperm Mapping and microdissection testicular sperm extraction (mTESE). Some, like Mapping, are performed in advance of and to help guide, successful sperm retrieval. MTESE is a large operating room procedure that is performed blindly without knowing whether pockets of sperm are actually present which means it fails more often than Sperm Map guided sperm retrieval. Consider all options.
- Ask about your testosterone balance. Sperm retrieval procedures (TESA, TESE, mTESE) differ in their levels of invasiveness and the more invasive they are, the higher the risk of lowering testosterone levels, which men need to live normal lives. Find a urologist with experience to reduce the chances of sperm retrieval-induced
- Find the most experienced surgeon you can when your jewels and hormones are on the line. Understand too that, similar to heart or prostate surgeon quality, the volume of cases correlates to surgeon proficiency. Sperm retrievalists should be doing at least 20-25 cases annually to stay at peak performance. They should tell you their personal complication rates, including hypogonadism.
- Find the most experienced lab you can. From the female egg point of view, there are hundreds of high quality IVF labs out there. But from the sperm point of view, far fewer IVF labs perform at similarly high levels. Ask the IVF programs that you are considering how many cases of complex testicular sperm retrievals they process annually.
- Sperm work well from the testicle. In the vast majority of cases, testicular sperm from men with testis failure should perform just fine with IVF-ICSI. As long as living (motile or simply vital) sperm are chosen for use, there is no reason to “blame” sperm for poor embryo development or failed IVF cases.
So you may be not be a BioDad this Father’s Day, but let’s plan to celebrate your success next year!