The case of the month is an actual patient of The Turek Clinic.
He was wary as he walked into the office, as though he were doing something illegal. “Doc,” he said, “I’m lined up to do a blind sperm retrieval soon and I keep hearing about this mapping thingie. Not sure what I should do.”
He was diagnosed with azoospermia a year or so back. “It bums me out. Nobody can find any sperm after countless samples.” From his physical exam and hormone studies, it was pretty clear that this was not due to a blockage, but probably the dreaded nonobstructive azoospermia.
“You could consider FNA Mapping, but lets do a really thorough semen evaluation first.” I suggested a centrifuged pellet assessment of his semen, essentially a “spun down” version that concentrates all cells in a tiny volume that is much easier to search. It has the power to detect sperm in 10-20% of azoospermic men when compared to the routine semen analysis.
Well, it showed sperm. Exactly 20 moving sperm. He was taken aback. “What does this mean?” he asked. “It means that you may not need the ‘mapping thingie’ or a sperm retrieval at the time of IVF-ICSI.” It’s a long word but good news: cryptozoospermia.
A Numbers Game
Being the “first do no harm” kind of guy that I am, I suggested that he provide us with weekly semen samples that we would carefully examine and freeze if motile sperm were found. “I’ll be your accountant, and tell you when you have enough,” I told him.
“But is this sperm any good?”
“Sure is, if we can find it.”
“Can I hug you?”
Slow but Sure
And here’s what actually did over the next 2 years to avoid a blind testicular sperm retrieval procedure:
- One week later: 2 samples banked; 2 moving sperm and 10 moving sperm.
- Job relocation (1 year), returns
- 13 months later: banked 10 motile sperm
- 9 months later: banked 90 motile sperm
- Next two months: banked 6 samples harboring a total of 450 motile sperm.
“You’re pretty motivated!” I told him. “And, as your sperm accountant, I now deem you done with sperm banking. Go ahead with IVF-ICSI using sperm from your fresh ejaculate and back it up with your banked sperm.” No need for the ‘mapping thingie’ or a sperm retrieval procedure because our research has shown that the risk of needing it was extremely low. He liked that.
He just sent me a photo of the fetal ultrasound. First shot. Fresh sperm. Nothing thawed. The lesson? Sometimes it doesn’t hurt to think before you act.