Zero sperm need not end fatherhood dream

A zero sperm count can be devastating but the good news is that, if sperm can be found surgically, the chances of a baby from assisted conception are high.

A study by Lucy Pullan, conducted when she was training as an embryologist at Bourn Hall, found that 67.4 per cent of male patients at the clinic with obstructed azoospermia who had IVF treatment following surgical sperm retrieval (SSR) became dads. 

Good results with surgical sperm retrieval

Lucy, now a qualified Clinical Embryologist at the Clinic, explains: “For men with obstructed azoospermia prepared to have surgical sperm retrieval the chances of successful IVF are good. However, there are few methods for predicting the outcome for an individual and it is critical that clinicians are able to fully counsel their patients and manage their expectations.  

“Better models are needed to enable individuals to understand their own chances of success and avoid the emotional, physical, and financial implications of SSR if they are low.” 

Although half of all infertility cases have a male factor, the challenges of a low sperm count or poor-quality sperm have largely been overcome with the advent of IVF with Intracytoplasmic sperm injection (ICSI). This is where just one good quality sperm is required for each egg to be fertilised ahead of IVF treatment.  

Lucy Pullan, embryologist discusses zero sperm count
Lucy Pullan, embryologist

Live birth rate over 60% for obstructed azoospermia

A diagnosis of a zero sperm count is rare and Bourn Hall is one of the few clinics with a specialist male fertility team experienced at treating these patients. It has over ten years of SSR data collected in a consistent format, with the majority of patients with successful retrieval going on to have  IVF at  the clinic. The team therefore believed it was important that they used this data legacy to contribute towards a predictive model.  

“The research also gives insight into the impact of NOA. There are many reasons for the testis not making sperm, such as genetics, disease or chemotherapy, and the success rates for each cause will vary. The only group where no sperm was retrieved at all was where there was a particular microdeletion on the Y chromosome.” 

The study, completed by Lucy as part of her dissertation for the Scientist Training Programme, looked at 336 patients who required SSR over a five-year period. Sperm was retrieved from all the men (100%) with obstructive azoospermia (OA) which can occur when there is an obstruction in the tube perhaps after a vasectomy reversal or because they are the carrier of the cystic fibrosis gene and don’t have a vas deferens (the muscular tubes which transport sperm from the testes towards the penis). For those with non-obstructive azoospermia (NOA) – resulting from a failure of the testis – sperm was found in 34.1% of the patients.  

The vast majority (93.1%) of patients used their retrieved sperm for treatment, which resulted in a live birth for 67.4% of those with OA and 48.2% of those with NOA.  

Lucy continues: “The high success rate for men with OA makes counselling these patients much easier. Our data shows that sperm retrieval is achievable and the chance of successful pregnancy is high. Furthermore, published research shows that SSR has no impact on the health of the baby. 

Zero sperm count came as a shock

Wayne from Norfolk is now Dad to seven-month old twins Noah and Bella, after he and partner Melissa had IVF following successful SSR at Bourn Hall.  When tests had revealed that Wayne had azoospermia he was shocked. 

“I thought it must be some sort of mistake,” he says. “I was pretty gutted to be honest, I thought it was the end of the road.” 

Wayne was initially resistant to the idea of undergoing a sperm retrieval procedure but is now glad that he did as Bourn Hall’s specialist team retrieved and froze six vials of sperm for future IVF treatment – and the couple’s IVF was successful first time. 

“I didn’t think we stood a chance,” says Wayne. “However we made it and I’m so lucky to have two amazing little babies.” 

Read Wayne and Melissa’s story.

Interestingly, the Bourn Hall data showed high success rates for micro-TESE even when a biopsy implied severe testicular histopathology, suggesting that biopsy was a poor predictor of success, although it is important to take a tissue sample at the time of SSR to allow for a complete diagnosis. 

Similarly, although there is an association between high FSH levels and poor testicular function, this study found sperm was successfully retrieved in a minority of patients with high FSH levels, suggesting that this also is a poor indicator of potential success.  

Dr Thanos Papathanasiou
Dr Thanos Papathanasiou

Dr Thanos Papathanasiou, CEO and Medical Director at Bourn Hall, praised Lucy’s research: 

“We are looking to help our patients make informed decisions about treatment and this type of research can be used by our clinicians to give insights into the treatment and a personalised indication of success.  

“It also shows the collaborative strength of our entire team, demonstrating the significant contributions made by each member to help our patients create their family.” 

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