A little magic in my office

I had magical moment in my office the other day.

Man with azoospermia (no sperm in his semen).  Had testicular atrophy and elevated pituitary hormones consistent with testicles that were not producing sperm. My options:

• Traditional open diagnostic testis biopsy
• Immediate testis sperm retrieval attempt
• Referral for donor sperm
• Testicular mapping biopsy

What did I choose?

• Mapping.  

What is a mapping? 

• Mapping is a diagnostic procedure that can be done in the office setting under a local anesthetic.  I numb the patient then use tiny gauge needles to aspirate seminiferous tubule in a grid pattern in each testicle then I inspect the fluid under 200X in my laboratory microscope.  I then notate where in the grid the testicles contain sperm, if at all, then I return to those area at a future time to harvest the sperm for reproductive purposes. 

How is this different for a diagnostic biopsy? 

• In a diagnostic biopsy I only sample one area and I sent the specimen for pathology in a fixative solution.  The pathologist then gives me a diagnosis of normal spermatogenesis vs hypospermatogenesis vs Sertoli only syndrome.  Then I either tell the patient there is nothing more I can do or that he needs more invasive surgery to harvest sperm for reproductive use.  I only resort to diagnostic biopsies in rare instances.   

In this case, I did a mapping and inspected the fluid in my lab while my patient waited in my office's waiting room.  I found sperm in 6 locations in the right testicle and one in the left.  I counseled the patient that we could harvest the sperm in the right testicle, now, while he was still numb, and we did just that, right in my office's procedure room. Thirty minutes later, the testicular sperm extraction procedure was completed with

sperm being found right where the mapping told me it would be found.  I then processed the sperm in my lab for cryopreservation.  Next week the patient will pick up the specimen and transport it in a liquid nitrogen transport tank to an IVF facility. 

Now that is magic.

Dr Schoor 

Indicators that you (your husband) have a sperm production disorder

You are a smoker

You have an obesity problem

You have  history cancer or cancer therapy

You have  history of gonadotoxin exposure

You smoke marijuana

You use testosterone 

You use chronic opioids

You have an endocrineopathy/hormonal problem

You have abdominal fat, ie a large belly 

You have gynecomastia, ie man-boobs

You may a varicocele-dilated veins of the spermatic cord

You have a testicular mass

You have small testicles 

Any questions?  Contact me

Vasectomy questions

No, you do not need spousal consent and to require is a HIPAA violation, most likely. 

No, there is no minimum age, aside for 18, the age of consent.   NYC has a minimum age of 21. 

Marijuana and sperm

How does pot affect sperm?   Better question is how doesn't it affect sperm. 

Pot:
Decreases LH and FSH release
Lowers T
Attaches to sperm head and tails
Decreases sperm production
Promotes loss of spermatogonia

Beware.

5 things that kill sperm production

These 5 things will damage sperm production.  So if you are trying to get your wife pregnant, avoid them.

1. Marijuana: really bad for spermatogenesis for a multitude of reasons.  Also bad for sperm themselves
2. Cigarettes: see marijuana 
3. Abdominal obesity: surprisingly bad.  Causes both hormonal imbalances and sperm stem cell death
4. Testosterone injections: causes decrease on the natural T production needed to produce sperm
5. Heat: the testes hang in the sack for a reason.  Keep them cool by avoiding hot tubs, spas and steam rooms

Thanks

Dr Schoor

5 quick urology questions. 5 quick answers

Using SMART Goals in Male Infertility

Smoking-bad for sperm
Abdominal obesity-bad for sperm
Sedentary lifestyle-bad for sperm

Tell a patient, "lose weight", "eat better", "exercise" -worthless for sperm

Better approach- SMART

1: Walk track once this week and call me to tell me
2: Eat one vegetarian meal next week. 
3: Go one day without smoking.

Small, manageable, achievable, relavent, and testable goals.  Now that is SMART.