Microscopic Testicular Mapping (Sperm Mapping)

Background
Microscopic Testicular Mapping refers to a procedure where multiple fine needle biopsies (fine needle aspirations or FNA) are done on the testes in order to see if there are any areas where sperm are produced. The reason why this is useful that the testes are "heterogeneous;" different areas of the testes have different pattems of sperm production. Thus, even if the majority of the areas of the testes produce no sperm, there may be some hader-to-find areas that do. Sperm mapping, therefore, tells us if there are some areas of sperm production in the testes, and where they are so they are easier to find. If no sperm are found on the sperm mapping, it can be presumed that there are no sperm produced anywhere in the testes and no fufther evaluation or treatment is possible. This saves the couple ftom having the man go through an open testicular biopsy and prevents a couple from undergoing a fruitless in vitro fertilization cycle.

Men who have no sperm in the ejaculate can be divided into two broad categories. The first group produces sperm in the sperm cannot get out (called obstructive azoospermia or OA.) There are several reasons and treatments for this condition including missing or blocked vas deferens, obstructions either at the level of the epididymis (the delmte tubular structure draining the testes) or higher up in ne more muscular vis deferens, or a condition where he may have become mechanically blocked during hernia or hydrocele repairs.

The second group has a problem producing sperm.This may-produce no sperm at all,or such low numbers of sperm that none are seen in the ejacuiate. These men are described as having Nonobstructive Azoospermia (or NOA.)

The first step with these men with nonobstructive azoospermia is to try to correct any cause of their azoospermia. This could include varicoceles or hormonal abnormalities'

Once the sperm production has been maximized, the next step is to see whether or not, they are making any sperm anywhere in the testes. There are two ways of approaching this.

MICROSCOPIC TESTICULAR SPERM EXTRACTION
The first way of approaching this is to do a microscopic testicular sperm extraction.In this technique, the patient is brought to the operating room and the scrotum opened as well as the testes opened. Using an operating microscope, mutiple areas are sampled. The hope is to find tubules that looked different than the other tubules in the testes and are thus indicative of there being sperm. If no specific tubules that look like they would have sperm, are found then tubules are taken systematically throughout the testes to try to find areas or sperm production, simultaneously an embryologist is looking through the tissue to try to determine whether or not there are any sperm there. If no sperm are easily found, the tissue is often then qraluated for several hours after that and processed to see even if a few sperm can be found. If they can then these sperm are then injected into the oocytes or eggs of their female Partners.

In order for this technique to be used, simultaneously the patient's partner must have undergone an in vitro fertilization cycle where she is stimulated by hormones to make a lot of eggs. These eggs are then aspirated from the ovaries with the needle ihrough the vagina. If sperm are found, they are then injected into the eggs with a procedure called intracytoplasmic sperm injection or (ICSI). If fertilization occurs, some embryos are then placed back into the uterus.

This is at this point the sophisticated and most common way of treating couples where the man has nonobstructive azoospermia, who are interested in having a biological child. The advantages of this procedure are that the male patient undergoes only one procedure, which is the testicular sperm extraction. His partner which undergo the in vitro fertilization and its preparation, The disadvantage of this is that if no sperm are found then the in vitro fertilization cycle was not necessary. Even if the couple is willing to use donor sperm, this can often be achieved with simple inseminations (taking the sperm and putting them in the partner's uterus) as opposed to the more complex in vitro fertilization cycle.

SPERM MAPPING
The second option is testes fine needle aspiration mapping. This procedure is of course only performed after a patients potential sperm production has been maximized. First, because if there are steps to hike to maximize his production, they may be successful enough to make it so the man has enough sperm production, so that there are sperm in the ejaculate. Second, maximizing his potential makes it more likely to find sperm at the time of the sperm mapping.

Contact our clinic for more information or to arrange a consultation appointment to see at one of our many other procedures will help you fulfill your dream of parenthood.
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