A sophisticated microsurgical procedure, used to retrieve sperm cells from a man with testicular failure, has for the first time produced a successful pregnancy in South Africa.
Stellenbosch University urologist and male infertility expert Amir Zarrabi performed the intricate testicular sperm extraction (Micro-TESE) surgery on a 38-year-old man with non-obstructive azoospermia (NOA), also known as testicular failure.
Men with this condition do not ejaculate sperm as a result of severely impaired or absent sperm production.
Micro-TESE surgery extracts sperm directly from the testicle, and is a last resort for men who would otherwise not be able to be biological fathers.
After extraction, the sperm can be used for intracytoplasmic sperm injection (ICSI), a process used to inject a single sperm into an egg cell in the laboratory to achieve conception.
Alternatively, the sperm can be freeze-stored until the couple is ready to undergo ICSI.
Thinus Kruger and his team at the Aevitas Fertility Clinic in Cape Town performed the ICSI procedure on the patient.
“NOA affects about 1% of the male population and is an important cause of male infertility,” Zarrabi said.
“NOA is commonly caused by genetic abnormalities, undescended testicles, chemotherapy or infections such as mumps that spread to the testicles,” he added.
It is not always possible to extract sperm and the success rate of this procedure is between 30% and 60%.
“Couples are counselled before the procedure to explain their chances of success and to manage their expectations. Even if we do retrieve healthy sperm, other factors related to ICSI and the normal risks of pregnancy also come into play,” Zarrabi said.
Micro-TESE surgery was first performed in the US in 1999. Zarrabi was the first surgeon to perform the procedure in South Africa in 2014. In 2016, he studied under Dr Peter Schlegel, the American urologist from Weill Cornell Medical College in New York who developed the procedure.
“This opens up a world of new possibilities for many infertile couples in South Africa who previously had no chance of having a child of which they are both biological parents,” said Zarrabi.
His work on Micro-TESE surgery forms part of his PhD research on male infertility in South Africa.