The Male Infertility Gauntlet: Less is More
“Less is more.” Is there a better description for the modernist architectural style of Ludwig Mies van der Rohe? His Barcelona Pavilion is one of the world’s most exquisite examples of architecture as sculpture, akin to the Parthenon in Greece, or the Pantheon in Rome. It simply works. It also reminds us of how complex “less” can be, and shows us that “more” is not always better.
Is Bigger Better?
I am reminded of this as I prepare several lectures for the Argentina Society of Reproductive Medicine this week. The society is highlighting the issue of how to find sperm in men with azoospermia and testicular failure. Which technique is best? What should we use?
Well, like architecture, it’s a balance of theory and fact, form and function, that creates true value. Take the sterile young man with a low-normal testosterone level due to severe testis failure. Yes, there is a good chance that he has sperm and can be a Dad, but there’s also a good chance that invasive procedures used to find sperm may result in low testosterone levels requiring lifelong hormone replacement–not a desirable outcome. How do we run this theoretical gauntlet?
A Will and a Way
Well, there is a way. All things medical have an associated risk-reward profile. For sperm retrieval procedures, rewards are clear: Sperm for IVF-ICSI. Risk is more complex, involving pain, low testosterone, and other complications that generally correlate with invasiveness. I tend to view the sperm retrieval risk-reward conundrum much like Mies van der Rohe might have: What is the least invasive way to create the most effective result? No surprise then to find that this principle underlies the development of FNA Sperm Mapping for finding sperm in sterile men.
Mies van der Rohe undoubtedly knew plenty about Classical, Baroque, Victorian and Art Deco style, but he chose the simplicity of modernism to accomplished his architectural feats. He also employed a signature material: glass, and lots of it. In my infertility practice, I use all of the tools of the trade to find sperm in sterile men, including sperm aspiration (TESA), biopsy or testis sperm extraction (TESE), microdissection TESE. But how does one know which technique works best for each patient? Enter, stage right, my signature technique: FNA Sperm Mapping. It is as transparent as glass.
With FNA Sperm Mapping, I can design a sperm retrieval technique specific for each patient and thereby achieve “reward” with minimum “risk.” See the figure to better understand my Mies-aligned world view on sperm retrieval. It is my belief that knowing before you go is the best way to run the gauntlet. And by the way, I also agree with another of Mies’s famous statements: “God is in the details.”