Male Infertility: Testicle Descent & Sperm Analysis - A Case Study

Question
HI MY HUSBAND IS 40 AND HAD PROBLEMS WHEN HE WAS A BABY WITH HIS TESTICLES LOWERING, THEY NEVER LOWERED AND HIS PARENTS DID NOT HAVE MONEY TO GET THEM LOWERED ( HE WAS BORN IN THE DOMINICAN REPUBLIC ). SO WHEN HE CAME TO THE UNITED STATES HE FINALLY GOT INSUANCE AND GOT THEM LOWERED AT AGE 28, AND THE DOCTOR DID A SEMEN ANALYS BEFORE HE DID THE SUGERY AND HE SAID THAT HE HAD NO SPERM THAT IT WOULD BE A MIRICLE!! NOW HE IS 40 AND HE HAS NOT YET WENT BACK FOR A ANOUTHER SEMEN ANALYS, BECAUSE HE THINKS THAT THIER WOULD NOT BE A CHANCE FROM WHAT HIS DOCTOR SAID BEFORE! BUT I KEEP TELLING HIM THAT YOU NEVER NO, THERE ARE SO MANY DIFFERENT TECNOLOGYS RIGHT NOW!I JUST WONDER IF THERE IS EVER WOULD BE A CHANCE FOR US TO HAVE A BABY, MAYBE IF THEY ACTUALLY WENT IN AND TOOK THE SPERM OUT OF HIS TESTICLE AND PUT IT IN TO ME. BUT IF HE IS NOT MAKING HIS OWN SPERM IS THERE ANY OPTION OUT THERE  FOR US IF IT COMES DOWN TO THIS!!  PLEASE HELP!!  I AM 30 AND WE HAVE BEEN TOGETHER FOR 12 YEARS AND WE WANT SO BADLY TO HAVE A BABY OF OUR OWN IT WOULD COMPLETE OUR LIFE!  MAYBE I HAVE A PROBLEM TO AND SHOULD BE CHECKED!!  PLEASE HELP!THANK YOU FOR YOUR TIME!

Answer
Hello Robin,

This is what I would recommend:

Your husband should have a semen analysis again.  If there is no sperm then see a Urologist and have a testicular biopsy done.  This will tell whether or not there is any sperm production and whether it can be obtained directly from the testicle.  If there is none on biopsy, then you have no other option but to use donor sperm from a sperm bank.  This can be done in accordance with a procedure called intrauterine insemination (IUI).  

If there is sperm on the biopsy, then that sperm can be used with a procedure called In Vitro Fertilization (IVF) whereby the eggs are retrieved from your ovaries, the sperm is extracted from your husband's testicles (TESE) and injected into each egg (ICSI).  At your age the chances of pregnancy would be very high.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.