The message will be devastating. When a couple, yearning for parenthood, is told that the husband has “sperm problems”, not only does the future seem bleak but he would also feel that his very manhood is under a cloud.
Not so long ago in Sri Lanka, such couples would have very limited options – get a sperm donation or adopt a baby.
Now, however, with technological advancement there is hope for such husbands, says Sub-fertility Specialist and Gynaecologist Dr. Milhan Batcha of the Family Health Bureau, explaining that about 1% of the population would have azoospermia.
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| Percutaneous testicular sperm aspiration |
One in seven couples is infertile, MediScene learns, with about 5-10% of infertile couples having to face the fact that the husband has azoospermia (no sperm in the ejaculate).
With couples who have fertility problems, usually many sperms are required from the father for the fertilization of the egg of the mother in a conventional in-vitro fertility (IVF) treatment setting. But now just one sperm may be adequate, says Dr. Batcha.
Going into anatomical detail, he says that the male reproductive system consists of the testicles; the duct system which comprises the epididymis and the vas deferens; the accessory glands including the seminal vesicles and the prostate gland; and the penis.
For a person not to have sperm in his ejaculate, Dr. Batcha points out that there could either be a problem in sperm production or a blockage within the reproductive system which stops the sperm from reaching the ejaculate.
According to him, the causes of azoospermia could be –
- Infections such as mumps, especially in adolescence, can destroy sperm-producing cells in the testes, subsequently causing azoospermia or a reduction in the sperm count.
- In genetic problems such as cystic fibrosis, not very common in Sri Lanka, the duct system which carries the sperm from the testes to the penis for ejaculation, is not formed.
- Genetics could also throw up a defective Y chromosome, which determines a person’s sex. The flaw could be a “small deletion” which would leave in its wake a reduction in the sperm-production.
- Sexually transmitted infections such as Gonorrhea or Chlamydia can obstruct the pathway of the sperm in its travel from the testes to the penis.
- Iatrogenic causes – the unintentional but harmful effects of medical treatment such as hernia-repairs can damage the duct bringing sperm from the testes.
When a person with azoospermia presents himself, it is of paramount importance to point a finger to the right area, without telling him to seek redress through donor sperm, says Dr. Batcha.
Referring to sperm-production issues, he said that blood and hormonal tests, scans or even biopsies will help determine the extent of the problem and treatment can be tailored according to that. If sperm production is affected due to a hormonal deficiency, with systematic administration of the required hormone, sperm-production in the testes can be generated.
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| Percutaneous epididymal sperm aspiration |
Subsequently, such husbands become fertile and the sperm thus generated can be used in an Intra-Uterine Insemination (IUI is a laboratory procedure where fast-moving sperm from the father are separated from sluggish sperm and then placed in the mother’s womb to fuse with the egg) or IVF (the procedure of fusing sperm and egg in a laboratory dish and later placing the embryo in the mother’s womb) setting.
If it is an obstruction in the duct carrying the sperm, surgery may be able to open the pathway. “Even if the obstruction cannot be cleared, the doctor can be 100% certain that sperm can be found in the epididymis,” says this Sub-fertility Specialist, pointing out that then sperm can be aspirated and utilized for in-vitro fertilization.
In aspiration (removal) of sperm, a common technique used today is the insertion of a needle through the skin into the epididymis or the testes where the sperm are stored and taking them out, MediScene learns.
Such sperm may be used for IVF or injection directly into the egg (intra-cytoplasmic sperm injection – ICSI), it is understood.
In the case of ICSI even one sperm is adequate, says Dr. Batcha.
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| Micro surgical sperm
aspiration |
The other answer may be a biopsy from the testes, while surgery under either local or general anaesthesia could also be performed to retrieve sperm from the testes he says. "it is not major surgery and the patient can leave the hospital two or three hours after the procedure. However, repeated surgical interventions are not advisable as the testes may become deficient, causing further complications."
A more advanced technique is micro-surgery where a needle is passed into identified areas of the epididymis under microscopic guidance to aspirate the sperm. “This has a high success rate,” according to him.
The testes can also be opened up, a small section of tissue incised and minced to get the sperm, he adds.
If there is no sperm at all, then the answer would be getting a sperm donation or adopting a baby. However, the screening of donor sperm is essential for diseases such as HIV and Hepatitis B, C and D, he warns.
Lamenting the fact that many couples cannot afford these procedures because they are currently done only in the private sector, Dr. Batcha urges that it is time to think of a centre for such procedures in the government sector. With multi-disciplinary teams already in place, a non-profit oriented service is essential, he says, especially in view of the fact that the future lies in stem-cell therapy. Otherwise, Sri Lanka will be left behind. |
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