Androlog Mail:
> For a man with 100% immotile sperm in the ejaculate, of which 10% are live,
> are pregnancy rates better with ICSI (after selecting live sperm with
> a hypo-osmotic swelling test); or is it better to offer TESE-ICSI (ICSI
> with testicular sperm extraction)?
> Dr Malpani, MD
I have read some of the responses to Dr Malpanis question with
increasing concern. So far all has recommended ICSI. None of the one
I have read has requested more information from Dr. Malpani, e.g.
1 How was the semen collected? How long time after ejaculation was the
motility and viability analysed?
2. How many semen samples have been examined? Over what time period?
How many spermatozoa in the ejaculate(s)? What about morphology method
of assessment and referens limits for the laboratory?
3. How was the % live spermatozoa analysed - details of method?
4. Have Dr. Malpani made any electrone microscopic examination to find
the reason(s) for the immotility? Why should testicular sperm be better
than ejaculated sperm if the reason for the immotility is an
ultrastructural defect?
5. What is the medical history of the man? Any problems with the
epididymides? Any biochemical information, e.g. alpha-glucosidase in
seminal plasma?
6. Has the man any brothers with infertility problems?
Today the andrologist seem to have only one thought in their mind,
operation of the man if there is a chance to motivate such a procedure +
ICSI. What about the golden rule to first have as a correct diagnosis
as possible and then discuss the options for treatment including the
contra-indications?
Sincerely,
Rune Eliasson, MD, Ph.D.
Head, Andrology Unit, Sophiahemmet Hospital
Stockholm, Sweden
Telefax: +46 8 739 30 84.
rune.eliasson@remcat.se
This archive was generated by hypermail 2.1.2 : Mon Jun 11 2001 - 22:44:41 CDT