Indian Express,
T S Gopi Rethinaraj

Is there any viable option for infertile male patients to father a child? Yes, says a city-based doctor, who attains the distinction of being the first medico in the country to treat such patients successfully. The new treatment is expected to illumine the lives of many unhappy couples.

Dr Aniruddha Malpani
A well known specialist in infertility problems, has successfully impregnated a woman with testicular sperms for the first time in the country. Besides, he has also achieved fertilization with precursor germ cells like spermatids , which is contrary to the known scientific wisdom that only matured and developed sperms can initiate pregnancy.

At least one, out of every ten couples in the country, suffer from infertility problems, in which the contribution of the male is nearly 50 per cent. In the case of males, nearly 80 per cent suffer from Azoospermia, (defective sperm generation). The sperms are produced in the testes as a result of a complicated series of successive cell divisions called meiosis sperms, produced by the testes, are immobile. They become mobile after they reach the Seminal Vesicle in the case of normal males. However, in the case of patients with Obstructive azoospermia, there is a block in the vas deferens or the epididymis. Vas Deferens is a tube that carries the sperm from the testes to the required destination and epididymis is the store-house of the sperms. On the other hand, in Non-Obstructive Azoospermia, the spermatogenesis (the sperm-generative process) itself is defective, despite a clear passage in the vas deferens or the epididymis.

"In the case of azoospermic patients, we extracted the testicular sperms from a testicular biopsy and then injected it into the egg by the Micromanipulation technique," said Dr. Malpani. "This is something wonderful because last year, we had not even imagined that such things could happen," he said adding that previously he had no choice but to resort to In Vitro Fertilization or Donor Insemination for such patients.

"Donor insemination, though successful, creates a lot of psychological problems for the parents as well as the child in later stages," said the doctor-wife of Dr Malpani, Anjali. "This has led to deep emotional conflicts between the couples," she said adding that the females were the most resistant to Donor Insemination.

One significant thing in Dr Malpani's treatment is there is no over-riding necessity to satisfy the conventional criteria like sperm count and sperm motility. "One sperm per egg is sufficient," says Dr Malpani. Here, a single sperm is carefully taken and injected into the egg by Intra Cytoplasmic Sperm Injection (ICSI).

The micro-manipulator, used by Dr. Malpani, is a sophisticated system, which includes a tissue - culture microscope and pipettes of a ultra-fine cross-section ,that can be manipulated. The sperm form the biopsy is sucked with pipette and then carefully injected into the egg.

"Though we have many options like in vitro fertilization and donor insemination, we do not impose anything and leave the potion to patient' choice," said the doctor adding, " Our recent experience shows that testicular sperm extractions, followed by ICSI, is the best option available for azoospermic patient."

Though micro-manipulation is common, testicular sperm injection is a new concept in India. " Our present 25 per cent success rate gives a lot of hope, " enthused the pioneer adding that with increasing number of patients in the future, the success rate would also shoot up.

Previously, males with nonobstructive azoospermia, elevated levels of follicle stimulating hormone and small testes were considered to be sterile.

Dr. Malpani's clinical success shows that even the most sterile patient can now be successfully treated by testicular sperm injection.

However, the treatment charges are quite expensive, ranging around Rs 90,000 for a single attempt.

" This cost, though cheap compared to that of the western countries, is beyond the reach of many in our country," Dr. Malpani lamented, adding that the charges would get reduced as the treatment percolates down to a wider strata of the society.

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

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