Friday, January 15, 2010

Testicular Biopsy To Determine Absence of Sperm Prior To TESE & IVF


Question:

Dear Dr. Ramirez,

My husband was born with exstrophy of the urinary bladder (in 1965 before some of the advances in that area), and as a result has had numerous surgeries, etc. He believes he used to have normal ejaculation before a major surgery in 1990; he does not now (none at all). A number of years ago (before we were married), he had a fertility test that involved opening the testicles (I don't remember what it was called), but the doctor failed to find sperm. His current urologist thinks he should give it another try. Which leads to my questions:

1. Is it likely to succeed (my husband said it was extremely painful)?

2. If they do find some sperm, do we need to be ready for IVF immediately? (This is a big issue for us, since IVF is much more expensive than something like IUI with donor sperm, so we'd need to save up for a while. Also, I don't want to have to take fertility drugs unless absolutely necessary, which would be the case with IVF.)

Thank you so much. I've gotten a lot out of reading your answers to other questions.

Answer:

Thank you for the compliment and for your question.

I think that the testicular biopsy would be a good thing to do. The Urologist needs to make sure that all quadrants of the testicle are biopsied to check for sperm. Of course, if the first biopsy shows sperm then he doesn't need to continue further. Because of this, it would be best that an andrologist, a sub-specialist urologist who treats male infertility and sexual disfunction, were present to examine the sperm immediately. It is not necessary for the test, but can avoid all the extra biopsies.

The biopsy is important because this is going to determine if sperm can be harvested from your husband's testicles, which can then be used to inject into your eggs via IVF. That would lead to a genetic child for your husband. Since testicular sperm is not the same (i.e. not activated) as sperm that is ejaculated, it cannot be used in conjunction with an IUI. You would need to do IVF with TESE and ICSI, which can be expensive, so you have to decide if it is important for you to have a child with your husband's genetics. If it is not important, certainly IUI with donor sperm is cheaper.

Fertility drugs are given with IVF to maximize the number of eggs that are retrieved and fertilizable. This is necessary because not all the eggs that a woman has are good eggs. There are no known long-term side effects, problems or complications with taking the fertility drugs, so you don't need to worry about that. The biggest problem is the cost, and the fact that they are injections.

Finally, you don't need to proceed with IVF immediately after the testicular biopsy is done. The testicle can be rebiopsied at the time of the egg retrieval. In fact, they need to coincide. We usually do the TESE under conscious sedation so that it is more comfortable for our patients, because we use conscious sedation for the egg retrieval as well.

I hope that helps. Good Luck to you and your husband.

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

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