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 pathology slides can be borrowed and sent to a formal major 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 a recovery period). However, there are risks: if the pathology report indicates the presence of sperm, 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: there is a risk that the male partner may not be able to produce sperm on the day of the sample collection, and the female partner's eggs will be temporarily frozen. If the pathology report indicates good spermatogenesis in the testicles, and the physical examination shows normal vas deferens, well-developed epididymis, and seminal vesicles, some patients may also consider a vas deferens-epididymis anastomosis surgery: IVF may be more expensive, but it has a certain success rate; and a vas deferens-epididymis anastomosis surgery may only be successful for some patients, and even after successful anastomosis, IVF may still be required due to poor semen quality or postoperative re-obstruction. The European male infertility treatment guidelines state that the reconnection rate for patients suitable for a vas deferens-epididymis anastomosis surgery is 60%-87%, with a cumulative pregnancy rate of 10%-43%.If no sperm is found, the only option is usually to use sperm from a sperm bank to achieve fertility goals; adoption; some patients may consider micro-epididymal sperm aspiration, where surgery with a microscope may help locate sperm, and then achieve fertility through IVF (but patients planning for 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 IVF and other treatments. When seeking medical treatment, it is essential to go to a formal hospital. I know a few hospitals in Shanghai, such as Tongji Hospital, the 10th People's Hospital of Shanghai, and the First People's Hospital of Shanghai.