A real story of how we solved the case of a man with zero sperm count (azoospermia) - an excerpt by Dr Anjali Malpani
August 18, 2023

In 1993, a couple from Chennai, Balagopal and Latika, visited a clinic in Mumbai. Balagopal had a zero sperm count and had tried homeopathy and Ayurveda, but their condition persisted. The couple flew to Mumbai to see Dr. Aniruddha, who examined Balagopal. He had a testicular failure, meaning his testes were not producing sperm. Microsurgery could relieve reproductive system blockages, but testicular failure was untreatable. Balagopal's wife and he were arguing in Tamil, and Balagopal appeared upset with the situation. The couple had been unable to have children before, and the doctor learned to let patients calm down and process the news before counseling them. Balagopal's countenance brightened as he hoped that a sperm bank could help. The couple left for Chennai, leaving the clinic to continue their journey.

The author discusses the TESE (Testicular Sperm Extraction) research in Belgium, which aims to retrieve sperms directly from the testes with a needle. The procedure, called Intracytoplasmic sperm injection (ICSI), revolutionized non-obstructive azoospermia treatment and allowed men to father a child with their own sperm. The author, Dr. Aniruddha, shares his excitement about the idea and the couple's hope for the procedure to be introduced to India.

The couple begins their journey to Mumbai, where they undergo a testicular biopsy to determine if Balagopal is producing sperm. They are shocked to find no sperm in the testes, and Dr. Aniruddha searches the testicular tissue for sperm. They find twenty sperm, and the couple is informed that they can father a child soon.

However, the couple loses three years of waiting for TESE-ICSI, and Latika has no follicles. Balagopal, who had waited for over three years to avoid using donor sperm to father a child, suggests donating eggs for his wife. The author is furious that the man who had fought for three years to pass on his genes didn't care about his wife's participation.

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Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.