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?
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.
- 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.
Now that is magic.