Sperm Mapping: how can help sterile men become fathers

“They told me I’m sterile,” my patient said in disbelief. “Does it really mean there is no hope for me?” This is a question that I hear every day in my practice. The short answer is: there is hope.

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When a man is diagnosed as sterile, it does not mean that his body is not producing sperm; It just means that there is no sperm in your ejaculation. Sometimes it is due to a blockage in the system, but most of the time the body simply does not produce enough sperm to leave. Then, doctors have to get sperm directly from the testicle where it is made. Sperm recovery procedures for sterile men are not for the faint of heart, but for those who really want to be bio-parents, sperm extraction from the testicle along with IVF is their only hope.

looking for sperm (and if found, recover it) . The reason why such a large procedure is needed is because sperm are not found everywhere in the testicle when sperm production is low. It is possible that it is only found on a few microscopically difficult islands to find within a sea of ​​700 feet of empty tubules. Understandably, the side effects of the technique include pain, but they can also affect testosterone levels, since this precious hormone is also produced by the testis.

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Called “sperm mapping,” developed by me and my colleagues at the University of California, San Francisco. In this approach, instead of opening the testicle to find the sperm, we locate the sperm in the testicle before reaching the scalpel. It is a “know before you go” approach. The procedure involves examining the testicles by fine needle sampling in a grid pattern to locate sperm pockets. After mapping, a second procedure is needed to recover sperm, but since we have traced where to find sperm, the recovery procedure can be more precise and less invasive. In other words, by having the “map” in advance, a patient can avoid an invasive and involved micro-TESE procedure in favor of a simpler sperm recovery procedure, such as needle aspiration or a directed biopsy.

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The short answer is that without prior knowledge of the presence of sperm, sperm recovery procedures find sperm in only 50-60% of cases. Guided by FNA mapping, a sperm recovery procedure finds sperm in 95-100% of cases. Given the large expense of IVF and the invasive nature of sperm recovery, some patients may want to know that they have the best possible chance of sperm being found and this guarantees FNA mapping beforehand. On the contrary, if an FNA mapping procedure suggests that no sperm are present, then invasive micro-TESE procedures become unnecessary since sperm are not present in the testicle.

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Until recently, no one had conducted a scientific investigation that directly compared sperm mapping and micro-TESE face to face.

The study of approximately 600 men found that sperm mapping successfully located and extracted sperm that led to pregnancies in a third of men who had previously undergone failed micro-TESE procedures.

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So, for those men who have been told they are sterile, there are now ways to find out in advance if they should consider invasive sperm recovery procedures and expensive IVF cycles. And for men who have already failed sperm recovery procedures, this research gives them new hope for them to be bio-parents.

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