Patient's question:
Doctor, I had an epididymal puncture which did not reveal any sperm, and a testicular puncture found 2 C-grade sperm.Doctor's answer:
In a testicular biopsy, if sperm is found, the pathological slides can be borrowed and sent to a reputable large hospital's pathology department for consultation to further confirm the presence of sperm. If sperm is present, IVF can be considered (it is generally recommended to wait 3 months after the biopsy, as the human sperm production cycle is 70-74 days, with an average of about 3 months per cycle, giving the testicular sperm production function time to recover). However, there are risks: if the pathological report indicates the presence of sperm, then single sperm injection (ICSI technology) can be performed. Generally, the female partner should retrieve eggs on the day the male partner provides a sperm sample. However, you should discuss the risks in detail with your primary reproductive gynecology expert: on the day of sperm retrieval, there is a risk that the male partner may not be able to produce sperm, and the female partner's eggs will be temporarily frozen. If the pathology report shows good spermatogenesis in the testicles, and the physical examination reveals normal vas deferens, well-developed epididymis, and seminal vesicles, some patients may also consider a vas deferens-epididymis anastomosis procedure: IVF may be more expensive, but it has a certain success rate; the vas deferens-epididymis anastomosis procedure also only allows reconnection in some patients, and after reconnection, IVF may still be required due to poor semen quality or postoperative obstruction. The European male infertility treatment guidelines state that the reconnection rate for patients suitable for a vas deferens-epididymis anastomosis procedure is 60-87%, with a cumulative pregnancy rate of 10-43%.If no sperm is found, it is generally only possible to achieve fertility by using sperm from a sperm bank; adoption; some patients may consider micro-epididymal sperm aspiration, where a surgical microscope may be used to locate sperm, and then IVF can be performed to achieve fertility (but patients who wish to undergo micro-epididymal sperm aspiration should not supplement with androgens).
If there is no sperm in the testicles and medication is ineffective; if sperm is present in the testicles, medication may still play a role under the premise of performing IVF, etc. It is essential to seek medical treatment at a reputable hospital. I know a few hospitals, such as Shanghai Tongji Hospital, Shanghai Tenth People's Hospital, and Shanghai First People's Hospital.