Sperm Aspiration from the testis is a procedure that has been in vogue since the early 60’s. However, it got its due recognition only after Dr.Paul Turek applied it for mapping sperm and proved its merits. Testicular biopsy has its limitations in the sense that only the area biopsied can be studied. The presence of sperms in the rest of the testes (same side) and the non biopsied testis is not known. If one were to climb a tree looking for mangoes, there are a few branches that have them and a few that don’t. Climbing the wrong branch does not denote that the rest of the tree does not have the fruit. Sperm Mapping is like a GPS for the testis. It helps us identify the hot spots with sperm. In the figure given below Dr.Turek proved that sperm production in patients with Non Obstructive Azoospermia is indeed patchy with variability existing between the biopsy and FNA in the same testis, variability within the testis and intertestis variability.
How ‘Patchy’ or ‘Focal’ is Sperm Production?
How is Sperm Mapping done?
The map is usually an office procedure done under local anaesthesia. In extremely anxious patients a mild sedative can be given. A testis wrap is then applied by means of a gauze. This fixes the testis and makes it more prominent. About 18-20 marking are made on each testis with a marker. A fine needle with a special stainless steel syringe holder is used to perform the aspiration. These cells obtained are then smeared on a slide and fixed with alcohol. They are then sent to the pathologist for review. The results of the map take about 3 weeks. This is because the slides are reviewed time and again by means of Special Microscopes used by Dr.Karthik and his team of experienced pathologists. Dr Karthik learnt this specialized technique from Dr.Turek in his office and had an opportunity under Dr.Turek’s guidance to analyse testicular histology slides time and again till he perfected the technique of identifying hot spots with sperms.
Sperm Mapping being performed
Special Syringe used for Sperm Map
FNA and smear
Sperm Map involves removing only cells for study (Cytology)
Sperm Mapping in Azoospermia
In obstructive Azoospermia, sperm is found virtually in all cases. In non obstructive Azoospermia, only one out of two patients will have sperm. There is an inherent problem in the testis and serum FSH levels are very high. A testis biopsy at one site gives us restricted information. Multiple testis biopsies are not recommended as they are traumatic and will disrupt the sperm producing mechanism and may lower testosterone levels. A FNA map is a great solution to this problem in Nonobstructive Azoospermia as it may help track the hot spots where sperm are located.
Based on the no of hot spots which reveal sperm, treatment can be planned as indicated in the below fig:
The Tough Cases
This is data presented by Dr.Turek and the choice of sperm retrieval technique is decided by the map.
At Metro Male Clinic, Dr.Karthik’s results are very similar.