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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 fertilisation 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 Fertilisation 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.
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