Measure Twice, Cut Once

Posted on by Paul Turek, MD

The case of the year is an actual patient of The Turek Clinic (identity protected).
They hailed from Cairo, Egypt. Maybe it was a karma-thing but, as a couple, they were as gracious and timeless as the nearby Giza pyramids. They were also desperate to have children and exhausted by what they had gone through for his diagnosis of azoospermia.

The Beginning of Life

“You’re our last hope,” he exclaimed over the phone from Cairo almost two years ago. “I would like to take a Second Opinion Clinic for my diagnosis of sterility.” Indeed. Be happy to take a look at things and see if I might be able to help.
He sent his medical records. He had been through a lot. He had twisted one of his testicles as a young teen and almost lost it. He had it surgically untwisted and fixed in place so it wouldn’t happen again. The first fertility hit. A bit later he marries and is unable to conceive. His evaluation revealed no ejaculated sperm, hit two, and a high FSH level and low testosterone levels, for a combined 3rd hit. Classic nonobstructive azoospermia.
The fourth hit could have been a score but it wasn’t. He underwent sperm retrieval in London that involved sampling of the epididymis for sperm (none present) and an unsuccessful, 3-hour, microdissection testicular sperm extraction on both sides. Again no sperm. That’s when he called me.

One in a Million

Rather than just going in and looking for sperm again, willy nilly, I proposed something different: “Please wait and heal, and during that time we will work on medically optimizing you for one last go at this.” While he was still 7500 miles away, here’s what we did:

  • He recovered from the microdissection for 7 months
  • During this time, he took a pill (aromatase inhibitor) to straighten out his testosterone balance
  • He concentrated on eating a good antioxidant diet and lost 55 lbs of weight

I then asked him to come to America for Sperm Mapping™ in the office to see if there might be usable pockets of sperm for IVF-ICSI. And guess what? There were. I mean there was…one. One of 36 sites sampled showed a single sperm. Yup, one in a million cells happened to be a sperm.
But that’s enough. He rested 3 more months and then returned for a sperm retrieval with me. But this time things were different. We concentrated on just one little part of the left testicle where the map showed sperm. And, in one fairly dramatic but short hour, the lab had found enough motile sperm for all of his wife’s eggs at IVF, and even extra for freezing. And boy, those embryos looked mighty fine several days later!
They came in to see me after the procedure just before returning to Cairo. They were beaming. Chock full of hope. After all that research and effort, they got just the shot that they wanted. After a big bear hug, he handed me a colorful Egyptian papyrus 2015 calendar as a gift. How thoughtful. Later that day, I flipped the calendar to nine months from now and circled their expected birth date, simply awed by the power of human perseverance. In the words of Babe Ruth, “Every strike brings me closer to the next home run.”
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