Think infertility and the picture that comes to mind is usually some poor woman hopped up on a regimen of hormones, getting one or more rounds of expensive in-vitro fertilization (IVF), and hoping desperately that it will take. But sometimes, when a couple wants to have a baby and can’t, the problem is not with the woman. It’s the man, and this side of the story is just as heartbreaking and frustrating, but we don’t hear much about it. Yet another item on the long list of depressing things men don’t want to talk about.
I think maybe we should be talking about it. Maybe, if you’re in this painful situation — maybe you had an illness like the mumps, or testicular cancer – you have been told that there’s no hope that you could ever father a child of your own. But that might not be the case. There’s a lot more hope now.
Pravin Rao, M.D., is an expert at finding what was previously considered unfindable. “A lot of my patients come in thinking that since there’s no sperm in the ejaculate, there’s no hope for having children,” he told me in an interview for the newsletter, Johns Hopkins Urology. But just because there’s no sperm one place, doesn’t mean that there’s no sperm at all. Often, there is.
“That used to be true. But now we are able to achieve pregnancy with very few sperm,” using a process called intracytoplasmic sperm injection, says Rao, who is the director of Reproductive Medicine and Surgery at the Brady Urological Institute. So there are several good things happening here: One, doctors can fertilize an egg with just a few sperm, and two, there are new methods for delving into the nooks and crannies of the testicles, finding sperm, and extracting it. “With improving techniques of finding sperm, we’re able to help many of these families reach their goals.”
Some men who have azoospermia, the absence of sperm in the semen, still may be producing small amounts of sperm within the testes, or testacles. Even though they don’t reach the semen, that doesn’t mean these little guys can’t still work and do their job of fertilizing an egg. It’s just a logistics problem. In about 55 to 60 percent of these men, Rao is successful at retrieving sperm from the testes with micro-dissection testicular sperm extraction (TESE).
This is microsurgery, and it’s extremely delicate. “We look for areas within the testis that might be making sperm,” tiny pockets among the thin, tightly looped seminiferous tubules. “In most men, every tubule is making large amounts of sperm,” Rao says, “but these men are making so little that you don’t see it in their ejaculate. But in just one or a few healthy tubules, we often find sperm.”
How do they find it? Well, there are no helpful imaging or other tests that can show or help predict where these little pockets might be hiding. Thus, “the only way to know for sure is to go in there and find the tubules that look promising.
Once Rao finds some sperm, with the help of reproductive endocrinologists (from Johns Hopkins or other hospitals), the sperm are joined with an egg and implanted in the female partner’s womb through IVF. “On average, it takes two to three cycles to produce pregnancy,” Rao says. The sperm may be used that same day it is harvested, if the eggs are also being obtained then, or they can be frozen for future use. He also performs vasectomy reversal and other procedures to correct issues that can cause a very low to nonexistent sperm count, such as hormonal factors, varicocele, or blocked ejaculatory ducts.
Here is the take-home message from Rao, which I hope you will receive and pass on to someone who might need it: “For many men who think there is no hope, there is actually a lot of hope.”
©Janet Farrar Worthington