40 Years of Male Infertility: Progress Beyond Belief

Posted on by Paul Turek, MD

The case of the month is an actual patient of The Turek Clinic.
Distinguished appearing, he had a concerned look as he sat down across from me. “Years ago, I tried to bank sperm in college, but I was told that there was none,” he said. The story went on. With more than one partner, he was unable to conceive. “And, I’ve got to admit, this issue cost me several relationships and a marriage.”
But she was different. She was young, hopeful, in love and wanted more. “He’s known about this for a good 30 years; there’s got to be something new by now to help us have children.”

As Time Goes By

Indeed there is. Lots. In fact, you’d be hard pressed to find a field in healthcare moving as fast as reproductive medicine. I recently reviewed what’s happened in male infertility over the past 40 years in a lecture given to the American Society of Andrology in Salt Lake City, Utah. Its wild what we’ve learned and what we can do now, quite similar to the vertical trajectory that the tech industry has taken over the same period. Almost unimaginable.
Here are highlights of what’s happened in the past 40 years:

  • We learned that a large chunk of male infertility is genetic. It’s not just about lifestyle or college indiscretions anymore. Chromosomal causes were identified in 1976 and Y chromosomal causes in 1995 and more are on the way.
  • In vitro fertilization (IVF, “test tube baby”), born in 1977, now holds a Nobel Prize and is responsible for about 1.5 to 3% of all births in developed countries.
  • Single sperm injection (ICSI), in which sperm are injected directly into eggs to increase fertilization, was discovered 23 years ago and is now used in over 70% of IVF cycles in the US.
  • Enabled by ICSI, using sperm from the testicle or epididymis in men with azoospermia has been routine for the past 20 years, making every sperm truly sacred.
  • Several sperm search strategies, including FNA mapping and microdisssection TESE, have systemically enabled fertility in sterile men.
  • With the advent of microsurgery, vasectomy reversals are now highly and routinely successful, making vasectomy literally the “new condom.”
  • Erectogenic pills like Viagra, Cialis and Levitra, have stolen the pharmaceutical show and, over the last 17 years, have led to unequaled opportunities for providers to take better care of men.

Today, its more likely that a sterile man has sperm and can have a child than not. Even after cancer, even with genetic issues, even after 30 years. You should have seen the deep, wide smile that crossed his face at the end of the visit. Hope is now present where it never previously existed. And this is good.
Watch my interactive Prezi presentation here: http://bit.ly/1DS02KG.