Trying for a baby
Dear Dr Mitchell,
I am 29 years old. I have been married for three years. My husband is 37 years old. We have been trying to get pregnant for years. We went to the urologist after being advised to do so by our doctor who had recommended a semen analysis. He did multiple semen analyses and all came back with the same result, showing no sperm inside the semen. The urologist recommended that he do a test on his testicles, and a blood test for hormone levels and STDs. All were normal, even his prostate. The urologist simply advised us that there was no explanation for his condition and that he would advise us to obtain sperm from a relative such as a brother. What can we do?
I’m truly sorry to learn about your inability to conceive after several years. The complete absence of sperm in the semen samples is significant. This is usually due to failure of production of sperm or an inability to release the sperm because of a blockage in the vas deferens (the tube that takes the sperm from the testes). In some cases, when there is an infection that has not been treated promptly, the vas deferens can become blocked and prevent the sperm from being transported from the testes and results in infertility. In this case, the problem can sometimes be corrected by surgery or by directly aspirating sperm from the testes and using these to fertilise the egg which is also retrieved from the woman and then fertilised as a part of the in vitro fertilisation procedure.
In some cases, there is no production of sperm because of a hormonal problem or because of an inherent problem in the testes resulting in failure of the gland to produce any sperm. The exposure to radiation, chemotherapy drugs or other toxins or chemicals can cause problems with sperm production due to permanent damage to the testes.
A testicular biopsy can be done to determine if there are any sperm in the testes. If sperm are retrieved, then in vitro fertilisation can be done with intra-cytoplasmic sperm injection (ICSI), thus placing the sperm directly into the egg. This gives the best outcome in a situation like this.
If the testicular biopsy does not reveal any sperm, then the option would be to use donor sperm from a family member or from a sperm bank. This is a frequently done procedure and the outcome is usually good. The fact that you are 29 years old is good, since you should have good quality eggs. If the cost for the in-vitro fertilisation is not affordable, then you can do egg sharing where you donate some eggs, reducing the cost of your procedure.
You should consult the fertility management unit at UWI and arrange to see one of the doctors working in the unit. They have excellent results and offer a wide spectrum of management options for infertility. If you do not want to use a family member as a donor, then the staff in the fertility unit will find a suitable match for you who looks like your husband.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.
DISCLAIMER
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
