Biology Always Wins

The case of the month is an actual patient of The Turek Clinic.
“I thought for sure that I never wanted kids. They broke the mold when they made me,” he told me. But then, he met the woman he never thought he would meet. “She changed everything. Nothing was the same after her,” he said with a wide, intoxicating smile.

A Perfect Record

He came in to talk about a vasectomy reversal. He had the vasectomy 11 years prior. No unexpected loads, no muddied waters, no Craignancies in his past. A perfect record capped off with a vasectomy.
As is my habit, I took a good long history and performed a physical exam on him. As a guy who crosses his t’s and dots his i’s, I also checked his reproductive hormones, since he had not conceived in the past. Just making sure that things are a “go” for a new launch. Vasectomy reversal microsurgery is certainly a pleasure for me to perform, but it’s more important that it’s the right choice for the patient.

A Man’s Intuition

A week after his visit, we talked on the phone. Something didn’t sit right with me. His testicular volume, a great measure of sperm output, was a little low. And, although his testosterone level was normal, his follicle stimulating hormone (FSH) was on the high side. Maybe sperm production wasn’t completely normal. Maybe it was non-existent. In either case, a vasectomy reversal might NOT be the way to go, as I couldn’t reassure him of a robust sperm count after the procedure. Best to be sure the engines are ready for the launch.

The Biological Truth

“What are you saying Doc?”
“Well, you might not be fertile after a vasectomy reversal. Your engine’s not running well.”
“How do you know for sure?”
“Right now it’s a strong hunch, but instead of investing time and money in a reversal, I’d suggest looking closer at the engine to see how well it’s running.”
“How do we do that?”
“Lets ‘map’ the puppies and see what’s going on.”
I am a firm believer in following instincts. And although surgeons can be good, maybe even great, they are always, and I mean always, trumped in the end by biology.
Sure enough, testicular mapping showed that sperm production was present but in only very low amounts. So low that there was no way he would have had sperm in the ejaculate after a reversal. Fast-forward 3 months: we performed a testicular sperm retrieval instead of a vasectomy reversal and his wife went through in vitro fertilization and ICSI and they conceived first shot. Point is that even if you have a big hammer, not everything is a nail. In the words of William Penn: “Sense shines with a double luster when it is set in humility.”