MR. JD 26 yrs , Mrs. AF , 25 yrs ( A1 +ve ) , Both of them working in IT industry, married since 2 yrs.
Clinical exam :-
Normal Secondary features
Obstructive Azoospermia Right Obstruction at Cauda epididymis.
Left absence of vas
Both testes normal size & consistency
The couple were counseled
They are keen to get her pregnant with his own sperms .
On 14th May 2016.
Testicular Sperm extraction motile sperms present. Cryopreservation of sperm done. Obstructive Azoospermia / CAVD/ TESE/ ICSI
Pregnancy on going , Foetal Scan Normal.
CASE : Mr. AN Age . 35 Yrs Wife. Mrs. D Age . 30 Yrs married since 4 yrs
Clinical Examination : inability to collect semen for evaluation- reported with nocturnal emission – Trans Rectal Ultra sound Study (TRUS) – No obstruction to Ejaculatory ducts – Prostate / seminal vesicle normal – Vibrator for Semen Collection – Unsuccessful – couple not in favour of Donor Sperm Insemination – TESE Showed presence of motile sperms which were used for ICSI – OCR on 2.3.2011 - 4 oocytes - transferred 1 x 6 cell , 1 x4 cell . Pregnancy confirmed – Delivered healthy Male baby
CASE : Mr. S Age. 34 Yrs Wife : Mrs.M Age. 20 Yrs, married 10 years. No Conceptions – Semen Analysis – Azoospermia
Clinical Examination: Normal Secondary features – Both testes normal – Epididymis enlarged – Vas absent on both sides. Pesa done – actively motile sperms retrieved. OCR done -10 eggs retrieved. Embryo transfer done Day 2. BHCG – 2925.60. US Scan Foetal Sac, FH Good. First Trimester Scan Normal. Delivered Male Baby 2.8 Kgs
Mr. K Age. 30 Yrs Wife. Mrs. M Age (29 yrs) married 3 years wife diagnosed PCOD Clinical Examination : Husband testis moderate, Eipdidymis Normal, Vas Present, No Varicocele. TESE - Live motile sperms retrieved. ICSI – TESE pregnancy positive confirmed By US Scan. Wife delivered 2 female babies. Ist baby 1.4kg IInd baby – 1.6kg – in view of low birth weight . Both of them kept in Neonatal ICU recovered completely.
Mr. K Age. 30 Yrs Wife. Mrs. M Age (29 yrs) married 3 years wife diagnosed PCOD Clinical Examination : Husband testis moderate, Eipdidymis Normal, Vas Present, No Varicocele. TESE - Live motile sperms retrieved. ICSI – TESE pregnancy positive confirmed By US Scan. Wife delivered 2 female babies. Ist baby 1.4kg IInd baby – 1.6kg – in view of low birth weight. Both of them kept in Neonatal ICU recovered completely.
Mr.K Age. 42 Yrs Wife. Mrs.H Age-32 Yrs Blood Sugar Normal, Semen Analysis – 1.5 ml, 20 % Patient Moderately obese
Clinical Examination : Chronic Epididymitis. Semen Analysis : Vol 3.0 ml, P3 – 12 %, Varicocele Surgery – no improvement in sperm parameters. OCR done. 1 X 8 cell, 2 x 6 cell, 1 x 4 cell. D3 Embryo Transfer done. Chorionic sampling – 46 normal sex chromosomes. First trimester scan- Dichorionic Diametode twins. LCS Twins one Male and one Female baby healthy.
Mr.M, Wife Mrs.K Age. 29 yrs married, noticed swelling of Epididymis / CT mediastinal nodes present. AKT, Urine Exam. AFB Negative / PCR positive for TB / ESR Normal / IGM – IGA Negative.
Clinical Examinations: Husband : Anejaculataion – Azoospermia / Hormonal profile – Normal Clinical Exam- Thickened Vas, Moderate sized testis, No evidence of Renal T.B., TRUS: obstruction to Ejaculatory duct, enlarged seminal vesicles. Completion of Anti TB treatment. Gross Thickening, Enlargement of Epididymis. IVP suggestive of Caseation & Calcification of Epididymis Wife : Blood grouping A1+, Mantoux positive, Hormonal Profile normal, Cyst left ovary, Plan for ICSI/Tese. under GA / OCR – 13 eggs - 11 fertilised/ 4 x 8 cell / D3 embryo Transfer / Freezing 4 x 4 cell, 3 x 4 cell. Pregnancy confirmed with BHCG / US Scan. Delivered Female baby – LSCS – Birth wt 2.810kgs.
Mr.A Age. 34 yrs Wife Mrs.K Age. 26 yrs married since 5 yrs. No conceptions, 2 years ago he has undergone varicocele surgery – No improvement- Several sperm specimens repeated by concentration method. Finding presence of occasional 1 – 2 Non motile sperms, Testicular Sperm Aspiration ( TESE) showed presence of motile sperms with normal configuration. After routine stimulation for his wife OCR done. 7 Oocytes retrieved – ICSI done – Six embryos 5x 8 cell. Day 3 transfer done. Pregnancy confirmed with BHCG & US Scan. She delivered Male Baby 3.0 kgs LSCS.
Case : Mr. SK Age, 29 yrs Wife . Mrs. M , Age . 24 Yrs married 3 years – No Conceptions . The Case was referred to MARC for Donor Sperm Insemination ( TDI).
Case Re evaluated at MARC:
Clinical Exam : Normal sized testes – enlarged Epidydimis – absent of Vas – with the diagnosis of Bilateral Vasal Agenesis accounting for Azoospermia, Trial Percutaneous Epididymal Aspiration ( PESA) done which showed presence of actively motile Sperms. The couple felt relieved to know that Donor Sperm Insemination was not necessary. The referring Physician ( Gynecologist ) had not made diagnosis of absence of Vas. There were also wrong reporting of Testicular Biopsy ( Testicular Atrophy). This Case illustrates the need for careful clinical exam for absence of VAS (CAVD) in all cases of azoospermia and to perform TRIAL PESA for confirmation. On 27.9.2010 after routine ovarian stimulation protocol , Oocyte retrieval done transvaginally – 10 eggs were retrieved – 5 fertilised – 4 x 4 cell embryos were transferred on Day 2 ( 19.11.2010). Pregnancy confirmation with BHCG and ultrasound done. Delivered Healthy Male Child .
(OCCASSIONAL TUBULE WITH PRESENCE OF SPERMS- TESE – SPERM RETRIEVAL DONE)
Case : Mr. S Wife. Mrs. G, Age ( 28 yrs) married since 2004. Diagnosed as case of Primary Infertility with Azoospermia on several semen examinations wife had fimbrial block. The couple were advised elsewhere for adoption in view of unfavorable factors in both partners. Patient presented with Testicular Biopsy slides done elsewhere. On review of the Histopathalogy test Biopsy slide there were occasional sperm heads in the midst of Spermatogene arrest in most of the tubules. Unsure of obtaining his own sperms for ICSI, Donor Sperm Option for ICSI was also discussed and accepted by the couple.
Surprisingly inspite of moderate to small size of testis ( 6.0 ml Vol) on the day of OCR, TESE was done which showed 3 – 4 motile sperms ( P1 P2) which were found adequate for ICSI – No donor sperms used – on OCR done after routine stimulation – 12 Oocytes retrieved- 7 fertilised – Day 2 transfer of 4 x 4 xcell (ET ) performed. Pregnancy confirmed with BHCG – US Scan – Pregnancy course uneventful. wife delivered female baby – 3.00 kgs – LSCS done. This case illustrates that in cases of non- obstructive azoospermia, inspite of small size of the testis elevated FSH testicular and T.Biopsy matuaration Arrest in most of the tubules there could be an occasional tubule with normal spermatozoa adequate for Testicular Sperm Extraction & ICSI.
The couple were desperate and willing to accept Donor Sperm option/ adoption. Ultimately the couple could be managed with retrieval of his own sperms giving them great psychological satisfaction of fathering a child with his own sperms.
The Child is healthy & normal.
ICSI WITH HUSBAND SPERMS/ WIFE DELIVERED LCS / MALE BABY CASE: Mr. K, Age: 44 Yrs Wife. P Age : 38 yrs . He was diagnosed as case of Primary Infertility / Azoospermia / Normal Sized testis, Enlarged Epididymis / Absent Vas – Percutaneous Sperm Aspiration (PESA) Showed presence of Sperms counseled for ICSI. Evaluation of his wife ( 38 Yrs) Diag : Primary ovarian failure. Hence donor oocytes retrieved from her Sister – in – Law ( Who has 2 children already) OCR – 6 Oocytes - 5 Fertilized. 2 x 4 cell / Day 2 Transfer BHCG - 327. LSCS - Wife delivered Healthy Male Baby weight 2.2 Kgs.