Hope For Infertile Men

by William Cutrer, M.D. and Sandra Glahn, Th.M.

Cigar, the retired Kentucky Derby winner, earned $9,999,815 during his legendary thoroughbred race career. But then he was discovered to be sterile. If he had been fertile, he’d be making $50,000+ in stud fees per effort. Animal husbandry research, driven by the desire for financial gain in cases such as this, has brought us numerous advancements in treating human fertility problems. In the last decade, we have seen particular progress in the treatment of male infertility, which had lagged behind treatment for female infertility.

Let’s say a husband has a very low sperm count, his specimen contains some normal motile sperm. What options are available and ethically permissable? For those who believe they must connect the sex act with conception, there aren’t any good options.

However, for those who believe technology can be employed, there are some possibilities, which would include these high tech micromanipulation procedures.

Intracytoplasmic Sperm Injection (ICSI)

Consider the chicken egg. It has an easily recognizable shell, an egg white, and the yolk. Likewise, the microscopic human egg has a “shell,” a material called cytoplasm (like the egg white), and a nucleus (like the yolk). While the human shell is not hard like the chicken egg, its “shell” cells are denser. And as a woman ages, her remaining eggs usually develop with increasingly tougher “shells.”

To aid husbands with low sperm counts or whose sperm have difficult penetrating the egg, we have ICSI. This involves injecting a single human sperm into a human egg by piercing the shell with a specially prepared microscopic needle. Specialists retrieve maturing eggs from the woman, and they obtain sperm from the male. The embryologist then selects and loads a single healthy-looking sperm into the micro-injecting apparatus.

Having loaded it into the needle, the embryologist stabilizes the egg under the microscope and pierces the “shell.” The sperm is then injected directly into the cytoplasm. From this point, the genetic material of the sperm must align with the egg’s. In a complex series of events, the egg “knows” penetration has occurred, and the genetic material of the egg, located in the nucleus, unravels and aligns with the male’s chromosomes. Only then has a unique individual emerged.

With ICSI doctors have absolute control of number of embryos replaced, so we face no worries about unintended multiple pregnancies, nor must couples face the decision of whether or not to cryopreserve (freeze) “extra” embryos. They also do not face the question of pregnancy reduction.

ROSNI (Round Spermatic Nuclear Injection)

Some men have a zero sperm count but still make sperm… sound impossible? Not really. The “plumbing”— the tubes that bring the sperm from the testicle to be delivered—can fail to develop properly. A key part of the tubing called the vas deferens can fail to develop at all, leaving sperm forever in the testicle to die and dissolve. But, now we can access these sperm with biopsy or even surgery on the testicle to obtain it for use in ICSI or ROSNI.

With ROSNI, doctors obtains immature sperm by needle aspiration via whatever part of the male tubular system has developed. They can then inject the immature sperm into the “egg” using a micromanipulative procedure, much as described in ICSI.

Doctors recommend this procedure for the husband with essentially no chance of producing a biological child otherwise. Using ROSNI, physicians fertilize eggs individually. Thus, as with ICSI, the issues of high order multiples, embryo reduction, and cryopreservation do not come into play.

So far, there is no evidence of birth defects associated with these procedures.

But they do raise some other questions: Is it acceptable to separate procreation from sexual functioning? Should it concern us that an embryologists are the ones to choose half the genetic input of a human being based on a sperm’s visual characteristics? For many sincere believers, these dilemmas are insurmountable; for others they present only minor concerns.

Both groups acknowledge the ultimate sovereignty of God over human creation: Your eyes beheld my unformed substance. In your book were written all the days that were formed for me, when none of them as yet existed (Psalm 139:16).

Again, the problem of using medical science in a situation where natural procreation can never occur may not fit your theological system. Yet ethically speaking, the sperm is the husbands (though obtaining it is quite difficult). The eggs are the wife’s, so we have not gone outside the marriage. And we have accomplished the good goal of trying to produce offspring for two people whom God has joined together.