old sperm after radical prostectomy?
1 Replies
scrapper1 - July 24

My DH had a radical prostectomy at age 49 in 2003. Now, in 2006, he had a TESE so we could begin IVF tx's. We can't pass the PGD tests d/t "no normals" on two cycles.

My question to you is: Is the fact that his sperm sat there for 3 years in the testicle with no place to go playing any factor in our "genetics" problem with getting no normal embies? We are using ICSI, and improved our fert rate from 40% on our first cycle to 75% on our second with the addition of luveris and higher doses of follistim.

I just wonder if a new TESE would help, or even a fresh sperm with TESE being performed at same time of ER would help.....

just trying to find some other causes....

thanks in advance

 

Dr Smith - July 24

I'm not a urologist, so I don't know if a radical prostectomy also cuts the vas deferens (the tube that connects the testicle to the outside). As long as the connection from the testicles to the urethra is open, the sperm move (albeit slowly) through the male reproductive plumbing whether there is an ejaculation or not. The sperm are not actually "sitting around". Even if the vas deferens was cut, the sperm may still be draining into the body cavity or scrotum through the open end (as they do folowing a vasectomy). The only time they would be "sitting around" would be if the plumbing was completely clogged by scar tissue or deliberatley ligated.

Regardless of the plumbing issue, there is a genetic impact from using testicular sperm for IVF. Testicular sperm are very immmature and fertilization rates can be lower when testicular sperm are used. Even when the fertilization rate is reasonably good (as in your second cycle), fertilization is only the beginning of a long process of embryo development. Each stage of development requires the correct genetic instruction for the embryo to continue. Controlling for maternal age (comparing apples to apples), significantly fewer embryos reach the blastocyst stage (the stage at which implantation is possible) when testicular sperm are used. This is presumably due to abnormal genetics or the gross immaturity of the sperm. So, the use of testicular sperm is certainly contributing to the "no normals" problem.

However, it takes two to tango. If you are over 35, the age of your eggs will also come into play. By age 35, the majority of the eggs are genetically abnormal. If a limited number of eggs are retieved (i.e. <10) and you are using testicular sperm, the odds of a term pregnancy are slim to none.

If you are over 35 or have less than 10 eggs retrieved, I'd say that your best chance of having a baby would be through the use of donated sperm and/or donated eggs. Sorry, I know you didn't want to hear that, but I'm being as honest as I can. IVF with TESE just doesn't work very often (<10% in the best prognosis patients).

 

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