Saturday, January 25, 2020

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.