1 00:00:00,160 --> 00:00:02,799 Welcome everyone to the Becker's Healthcare podcast series. 2 00:00:02,799 --> 00:00:05,359 I'm Mariah Muhammad, writer and moderator of Becker's 3 00:00:05,359 --> 00:00:07,040 Healthcare. And I'm thrilled to have with me 4 00:00:07,040 --> 00:00:08,580 today doctor Kian Asinath, 5 00:00:08,880 --> 00:00:11,919 urologist and male fertility specialist with Keck Medicine 6 00:00:11,919 --> 00:00:12,660 of USC. 7 00:00:13,115 --> 00:00:15,035 Doctor, welcome to the podcast. We're very excited 8 00:00:15,035 --> 00:00:16,414 to have you join us today. 9 00:00:16,954 --> 00:00:19,054 To get us started with our in-depth, 10 00:00:19,754 --> 00:00:20,254 topic, 11 00:00:20,635 --> 00:00:21,535 would you mind, 12 00:00:21,994 --> 00:00:24,094 kinda explaining what is a microsurgical 13 00:00:24,714 --> 00:00:26,335 to testicular sperm extraction 14 00:00:26,714 --> 00:00:27,454 or microtessi? 15 00:00:29,210 --> 00:00:31,149 Absolutely. It's really nice to join you today. 16 00:00:31,529 --> 00:00:32,509 A microtessi 17 00:00:32,969 --> 00:00:34,030 stands for a microsurgical 18 00:00:34,409 --> 00:00:35,789 testicular sperm extraction. 19 00:00:36,409 --> 00:00:37,549 It's a microsurgical 20 00:00:38,090 --> 00:00:42,250 procedure. It's used to extract sperm directly from 21 00:00:42,250 --> 00:00:42,909 the testicle 22 00:00:43,625 --> 00:00:46,104 for men who have no sperm in the 23 00:00:46,104 --> 00:00:46,604 ejaculate, 24 00:00:47,625 --> 00:00:49,644 also known as non obstructive 25 00:00:49,945 --> 00:00:50,445 azoospermia, 26 00:00:50,905 --> 00:00:52,664 meaning they have no sperm and it's not 27 00:00:52,664 --> 00:00:55,324 due to some sort of blockage or obstruction 28 00:00:55,384 --> 00:00:56,204 in the pathway 29 00:00:56,585 --> 00:00:57,725 of sperm transport. 30 00:00:59,100 --> 00:01:00,619 Got it. Thank you so much for giving 31 00:01:00,619 --> 00:01:03,420 us that that definition really quick. So how 32 00:01:03,420 --> 00:01:05,359 does a how does a microtessi 33 00:01:05,739 --> 00:01:06,239 change 34 00:01:06,540 --> 00:01:09,519 when the patient has a test testicular cancer? 35 00:01:10,795 --> 00:01:13,295 Well, it it's different in the sense that 36 00:01:13,594 --> 00:01:15,515 there's a tumor in the way. Right? And 37 00:01:15,515 --> 00:01:17,694 so we're typically doing a microtessy 38 00:01:18,155 --> 00:01:18,894 for men, 39 00:01:19,275 --> 00:01:21,594 generally, with two testicles who have no sperm 40 00:01:21,594 --> 00:01:22,494 in the ejaculate. 41 00:01:23,515 --> 00:01:26,369 The procedure itself can take anywhere from two 42 00:01:26,369 --> 00:01:28,469 to three up to four hours depending 43 00:01:29,170 --> 00:01:31,090 on how much tissue we're we're looking through 44 00:01:31,090 --> 00:01:33,729 with the microscope to find sperm. And so, 45 00:01:33,729 --> 00:01:36,049 you know, we open up one testicle. We 46 00:01:36,049 --> 00:01:38,369 look through the seminiferous tubules. We try to 47 00:01:38,369 --> 00:01:40,769 find areas that are dilated with sample tissue 48 00:01:40,769 --> 00:01:41,269 systematically 49 00:01:41,810 --> 00:01:43,465 and look under a microscope to see if 50 00:01:43,465 --> 00:01:44,984 we find any sperm. And if we don't 51 00:01:44,984 --> 00:01:45,484 find 52 00:01:45,784 --> 00:01:48,105 any sperm on one side or very little 53 00:01:48,105 --> 00:01:50,745 sperm on the on one testicle, then we'll 54 00:01:50,745 --> 00:01:52,505 open the other testicle and do the same 55 00:01:52,505 --> 00:01:53,005 approach. 56 00:01:53,465 --> 00:01:55,564 In a patient with testicular cancer, 57 00:01:56,599 --> 00:01:58,840 their the real estate, if you will, or 58 00:01:58,840 --> 00:02:01,019 the amount of tubes or tubules 59 00:02:01,479 --> 00:02:03,799 that are normal are are much less depending 60 00:02:03,799 --> 00:02:06,519 on how big the tumor is. Sometimes the 61 00:02:06,519 --> 00:02:08,860 entire testicle is occupied by cancer. 62 00:02:09,175 --> 00:02:11,335 And so it makes it rather much more 63 00:02:11,335 --> 00:02:11,835 difficult, 64 00:02:12,854 --> 00:02:14,155 to look for sperm. 65 00:02:14,775 --> 00:02:16,474 That's that's kind of the first approach. 66 00:02:17,014 --> 00:02:19,414 And then the difference is also, you know, 67 00:02:19,414 --> 00:02:21,675 when we do a micro oncotecee 68 00:02:22,055 --> 00:02:25,379 or a microtesti for a patient with cancer, 69 00:02:26,159 --> 00:02:26,979 the testicle 70 00:02:27,439 --> 00:02:30,340 and stromatic cord is removed from the patient, 71 00:02:30,479 --> 00:02:33,520 and the procedure is performed ex vivo, which 72 00:02:33,520 --> 00:02:35,520 means it's outside of the human body. So 73 00:02:35,520 --> 00:02:37,539 we use it as a back table microscope, 74 00:02:38,025 --> 00:02:39,724 and we open up the testicle 75 00:02:40,264 --> 00:02:41,645 in a longitudinal 76 00:02:41,944 --> 00:02:44,585 plane rather than a typical equatorial or or 77 00:02:44,585 --> 00:02:45,724 transverse plane. 78 00:02:46,824 --> 00:02:48,824 Perfect. Thank you so much for explaining that. 79 00:02:48,824 --> 00:02:50,759 And, obviously, it seems like you know, 80 00:02:51,080 --> 00:02:52,919 a lot about this topic. So can you 81 00:02:52,919 --> 00:02:55,479 explain what is your background and experience with 82 00:02:55,479 --> 00:02:56,620 performing this procedure? 83 00:02:57,639 --> 00:02:59,900 Absolutely. Well, you know, I did a, completed 84 00:02:59,959 --> 00:03:02,759 my residency in urology at USC, which I'm, 85 00:03:02,759 --> 00:03:03,579 you know, really, 86 00:03:04,074 --> 00:03:05,754 fortunate to be able to join the world 87 00:03:05,754 --> 00:03:08,555 class faculty. But I completed my fellowship in 88 00:03:08,555 --> 00:03:10,574 male fertility and reproductive microsurgery 89 00:03:11,354 --> 00:03:12,735 at Northwestern University, 90 00:03:13,514 --> 00:03:16,314 under the training of, doctor Bob Branigan. And 91 00:03:16,314 --> 00:03:18,169 so, you know, I spent a year with 92 00:03:18,169 --> 00:03:19,870 him really learning the intricacies 93 00:03:20,490 --> 00:03:23,949 and and the finesse of male reproductive microsurgery 94 00:03:24,169 --> 00:03:27,229 and was able to really learn these techniques 95 00:03:27,289 --> 00:03:28,990 for for many of these patients. 96 00:03:29,784 --> 00:03:31,544 Got it. Yeah. That definitely makes a lot 97 00:03:31,544 --> 00:03:32,985 of sense. Can you tell me a little 98 00:03:32,985 --> 00:03:35,384 bit about this case, and what does this 99 00:03:35,384 --> 00:03:35,884 patient, 100 00:03:36,344 --> 00:03:38,824 what made this patient unique, and what also 101 00:03:38,824 --> 00:03:40,905 led to the decision to perform this procedure, 102 00:03:40,905 --> 00:03:41,639 would you say? 103 00:03:42,759 --> 00:03:44,280 Yeah. So it's a really, 104 00:03:44,759 --> 00:03:46,759 really unique case, actually. So this is a 105 00:03:46,759 --> 00:03:50,280 patient that, was referred to me, from about 106 00:03:50,280 --> 00:03:52,280 an hour, two hours away from the USC 107 00:03:52,280 --> 00:03:52,780 campus. 108 00:03:53,560 --> 00:03:56,155 He was a young male, otherwise healthy, but 109 00:03:56,155 --> 00:03:57,615 he only had one testicle. 110 00:03:58,155 --> 00:04:00,155 When he was born, he his other testicle 111 00:04:00,155 --> 00:04:02,254 was undescended, and it was removed, 112 00:04:03,675 --> 00:04:05,355 when he was a child, not due to 113 00:04:05,355 --> 00:04:06,335 cancer. It was just 114 00:04:06,635 --> 00:04:08,819 atrophic and small. So he was he was 115 00:04:08,819 --> 00:04:10,680 sent to me. He only had one testicle. 116 00:04:11,300 --> 00:04:13,000 And so, unfortunately, he developed 117 00:04:13,459 --> 00:04:15,780 a cancer in that one testicle, a pretty 118 00:04:15,780 --> 00:04:16,919 sizable testicular 119 00:04:17,300 --> 00:04:17,800 cancer. 120 00:04:18,660 --> 00:04:20,660 And so, you know, the treatment for a 121 00:04:20,660 --> 00:04:22,884 testicular tumor is you remove the testicle, and 122 00:04:22,884 --> 00:04:24,824 so that would make him infertile. 123 00:04:25,285 --> 00:04:27,285 And so he, you know, he was wanted 124 00:04:27,285 --> 00:04:30,105 to, be able to maintain his fertility or, 125 00:04:30,245 --> 00:04:31,764 you know, be a parent and be a 126 00:04:31,764 --> 00:04:34,979 father biological father someday. So he went to 127 00:04:34,979 --> 00:04:37,220 free sperm prior to surgery on two to 128 00:04:37,220 --> 00:04:38,199 three different occasions, 129 00:04:38,819 --> 00:04:40,759 and he had no sperm in the ejaculate. 130 00:04:41,699 --> 00:04:44,659 And, his hormones prior to surgery were all 131 00:04:44,659 --> 00:04:46,035 really elevated, which suggested 132 00:04:46,995 --> 00:04:49,254 that there was a problem with sperm production, 133 00:04:49,314 --> 00:04:51,415 meaning it's not some sort of blockage. 134 00:04:52,194 --> 00:04:54,035 And so, you know, it was it was 135 00:04:54,035 --> 00:04:55,795 very much all hands on deck. You know, 136 00:04:55,795 --> 00:04:57,955 this was his last chance to try to 137 00:04:57,955 --> 00:05:01,175 achieve, you know, maintain, and preserve his fertility 138 00:05:01,839 --> 00:05:04,639 after this surgery. So one testicle with a 139 00:05:04,639 --> 00:05:06,560 tumor in it and no sperm in the 140 00:05:06,560 --> 00:05:08,720 ejaculate, you know, it's pretty high stakes. And 141 00:05:08,720 --> 00:05:10,959 so, you know, I was able to participate 142 00:05:10,959 --> 00:05:12,720 in his care and really lead him through 143 00:05:12,720 --> 00:05:13,459 this process. 144 00:05:13,839 --> 00:05:16,479 And so, took him to the Operating Room, 145 00:05:16,479 --> 00:05:19,435 and we I removed the testicle and spermatic 146 00:05:19,495 --> 00:05:19,995 cord. 147 00:05:21,014 --> 00:05:23,495 And using the same micro testy approach, we 148 00:05:23,495 --> 00:05:25,194 performed a micro oncoteesi, 149 00:05:25,495 --> 00:05:28,534 which refers to the testicular sperm extraction in 150 00:05:28,534 --> 00:05:31,254 a patient with testicular cancer or any form 151 00:05:31,254 --> 00:05:31,914 of cancer. 152 00:05:32,750 --> 00:05:34,750 Again, this is done ex vivo, which just 153 00:05:34,750 --> 00:05:36,669 means outside of the human body using a 154 00:05:36,669 --> 00:05:37,490 back table, 155 00:05:38,189 --> 00:05:40,370 and a surgical microscope. And so 156 00:05:40,910 --> 00:05:43,069 it made the case really challenging because there's 157 00:05:43,069 --> 00:05:43,637 only one testicle. Right? We don't have a 158 00:05:43,637 --> 00:05:43,862 second testicle that we can go through the 159 00:05:43,862 --> 00:05:44,529 testicular tissue to look for sperm. And 160 00:05:46,750 --> 00:05:47,250 the 161 00:05:49,865 --> 00:05:51,625 sperm. And the one testicle that we have 162 00:05:51,625 --> 00:05:53,485 had a lot of cancer in it. So, 163 00:05:53,705 --> 00:05:55,785 you know, really had to take our time, 164 00:05:55,785 --> 00:05:57,944 take my time, and and and look through 165 00:05:57,944 --> 00:06:00,824 areas of seminiferous tubules not affected by cancer, 166 00:06:00,824 --> 00:06:04,170 number one, that also looked potentially dilated and 167 00:06:04,170 --> 00:06:05,930 sampled those to see if there was any 168 00:06:05,930 --> 00:06:06,830 sperm found, 169 00:06:07,449 --> 00:06:08,350 on that side. 170 00:06:08,810 --> 00:06:11,129 And, you know, ultimately, the case was a 171 00:06:11,129 --> 00:06:11,629 success. 172 00:06:12,410 --> 00:06:14,650 I did find rare sperm, which was, you 173 00:06:14,650 --> 00:06:16,889 know, really the silver lining because his hormones 174 00:06:16,889 --> 00:06:18,704 were so elevated. I'd never 175 00:06:19,185 --> 00:06:20,004 seen preoperative 176 00:06:20,464 --> 00:06:20,964 hormones, 177 00:06:21,504 --> 00:06:22,805 known as FSH 178 00:06:23,264 --> 00:06:24,805 be as high as almost 60. 179 00:06:25,264 --> 00:06:26,245 And, you know, 180 00:06:27,104 --> 00:06:29,344 you know, he really trusted in me. He 181 00:06:29,344 --> 00:06:31,284 really believed in the process. And, 182 00:06:31,589 --> 00:06:33,110 you know, he knew that we had we 183 00:06:33,110 --> 00:06:35,350 were doing our best to find sperm for 184 00:06:35,350 --> 00:06:36,949 him that day. You know, I I always 185 00:06:36,949 --> 00:06:39,110 tell patients prior to surgery who undergo a 186 00:06:39,110 --> 00:06:41,029 micro test whether it's due to cancer or 187 00:06:41,029 --> 00:06:41,529 not. 188 00:06:42,310 --> 00:06:44,149 I can't promise you we'll find sperm, but 189 00:06:44,149 --> 00:06:45,689 I could promise you that, 190 00:06:46,165 --> 00:06:48,245 we're doing everything we can today to give 191 00:06:48,245 --> 00:06:50,004 you the best sort of outcome. And so 192 00:06:50,004 --> 00:06:51,764 while we didn't find millions of sperm, which 193 00:06:51,764 --> 00:06:53,444 we typically don't find in this case, we 194 00:06:53,444 --> 00:06:54,824 did find some rare sperm. 195 00:06:55,605 --> 00:06:58,879 His family ultimately transported the tissue to the 196 00:06:58,879 --> 00:07:01,199 Fairfax Cryobank, which is a local cryobank near 197 00:07:01,199 --> 00:07:03,199 our hospital, and they were able to freeze 198 00:07:03,199 --> 00:07:05,120 that. And so, you know, one day down 199 00:07:05,120 --> 00:07:06,720 the road when he's looking to achieve a 200 00:07:06,720 --> 00:07:07,220 pregnancy, 201 00:07:07,680 --> 00:07:10,000 they could thaw that tissue and and use 202 00:07:10,000 --> 00:07:12,740 some of that sperm for in vitro fertilization 203 00:07:12,959 --> 00:07:13,620 or IVF. 204 00:07:14,824 --> 00:07:17,064 Got it. Yeah. That definitely sounds like a 205 00:07:17,064 --> 00:07:18,685 a very difficult process, 206 00:07:19,305 --> 00:07:20,925 but, obviously, kinda rewarding. 207 00:07:21,305 --> 00:07:23,705 For those professionals who are also in your 208 00:07:23,705 --> 00:07:25,545 field and kinda do what you do, can 209 00:07:25,545 --> 00:07:27,305 you tell us a bit more about what 210 00:07:27,305 --> 00:07:29,405 you needed from the, hospital 211 00:07:30,089 --> 00:07:31,310 operations perspective 212 00:07:31,770 --> 00:07:34,009 to kinda make this procedure possible. Like, what 213 00:07:34,009 --> 00:07:35,790 kind of teams had to be involved, 214 00:07:36,330 --> 00:07:38,009 how long it it took to kinda set 215 00:07:38,009 --> 00:07:38,910 up this process, 216 00:07:39,529 --> 00:07:42,110 the most challenging aspect, any of that. 217 00:07:43,134 --> 00:07:44,895 Absolutely. Well, you know, this was the first 218 00:07:44,895 --> 00:07:45,395 time, 219 00:07:45,855 --> 00:07:48,415 we had performed this sort of surgery at 220 00:07:48,415 --> 00:07:51,295 the Keck Medical Center of USC. You know, 221 00:07:51,295 --> 00:07:52,995 we do a lot of, microsurgical 222 00:07:53,295 --> 00:07:54,834 work with cancer patients. 223 00:07:55,134 --> 00:07:57,395 It's typically at one of our satellite hospitals, 224 00:07:58,110 --> 00:07:59,729 at the Verdugo Hills Hospital. 225 00:08:00,189 --> 00:08:02,189 You know, I actually tried to take the 226 00:08:02,189 --> 00:08:04,430 patient there, but it it's there's an insurance 227 00:08:04,430 --> 00:08:05,949 issue, so it only had to be done 228 00:08:05,949 --> 00:08:06,689 at Keck. 229 00:08:07,149 --> 00:08:08,990 And so you know? And then when a 230 00:08:08,990 --> 00:08:10,750 patient has cancer, there's a little bit of 231 00:08:10,750 --> 00:08:12,430 a time rush with these things. We can't 232 00:08:12,430 --> 00:08:14,084 just, like, take our time to try to 233 00:08:14,084 --> 00:08:16,165 set things up. It's we wanna take this 234 00:08:16,165 --> 00:08:18,725 taken care of within ultimately, hopefully, within the 235 00:08:18,725 --> 00:08:20,725 first one to two weeks of of meeting 236 00:08:20,725 --> 00:08:21,545 him. So, 237 00:08:22,004 --> 00:08:23,764 you know, there's a few things involved in 238 00:08:23,764 --> 00:08:25,764 in doing this procedure. You need a surgical 239 00:08:25,764 --> 00:08:28,529 microscope, which we have. You need a back 240 00:08:28,529 --> 00:08:31,589 table phase contrast microscope, which is a separate, 241 00:08:32,610 --> 00:08:35,330 microscope, kinda like a tabletop microscope if, you 242 00:08:35,330 --> 00:08:38,129 know, folks remember in in in in, high 243 00:08:38,129 --> 00:08:41,009 school or or college doing the laboratory experiments. 244 00:08:41,009 --> 00:08:42,625 It's a little bit more of a higher 245 00:08:42,625 --> 00:08:44,065 end version of that where we can look 246 00:08:44,065 --> 00:08:44,725 at different, 247 00:08:45,664 --> 00:08:47,904 degrees of magnification. So we had to get 248 00:08:47,904 --> 00:08:49,824 that set up, which we hadn't had or 249 00:08:49,824 --> 00:08:51,284 used in in a long time. 250 00:08:51,824 --> 00:08:52,964 We had to obtain, 251 00:08:54,464 --> 00:08:55,214 a special 252 00:08:55,700 --> 00:08:58,279 fluid or media for the sperm and testicular 253 00:08:58,419 --> 00:09:00,840 tissue for transport known as sperm wash media, 254 00:09:01,059 --> 00:09:02,740 which we never had at Keck at the 255 00:09:02,740 --> 00:09:04,660 Keck Hospital because we don't do these kinds 256 00:09:04,660 --> 00:09:05,960 of the cases there routinely. 257 00:09:06,740 --> 00:09:08,500 And the last part was we had to 258 00:09:08,500 --> 00:09:09,000 get 259 00:09:09,605 --> 00:09:12,404 a kind of, consent form from the patient 260 00:09:12,404 --> 00:09:14,084 in the hospital that the patient was gonna 261 00:09:14,084 --> 00:09:14,584 be 262 00:09:14,964 --> 00:09:15,464 taking 263 00:09:16,084 --> 00:09:18,884 specimen or tissue from surgery outside of the 264 00:09:18,884 --> 00:09:21,284 hospital to a local cryobank, which is not 265 00:09:21,284 --> 00:09:22,824 routinely done at Keck Hospital. 266 00:09:23,365 --> 00:09:25,230 Right? And so to get those set up, 267 00:09:25,789 --> 00:09:27,470 you know, I really worked closely with our 268 00:09:27,470 --> 00:09:27,970 urology, 269 00:09:28,750 --> 00:09:29,730 surgical coordinator, 270 00:09:30,669 --> 00:09:34,029 who is incredible at helping get, sperm wash 271 00:09:34,029 --> 00:09:35,809 media in a really rapid manner, 272 00:09:36,429 --> 00:09:37,970 getting the back table microscope 273 00:09:38,605 --> 00:09:39,904 up and ready to go, 274 00:09:40,605 --> 00:09:43,164 securing the surgical microscope on a, you know, 275 00:09:43,164 --> 00:09:44,625 in a in a timely fashion. 276 00:09:45,085 --> 00:09:47,725 And then the last piece was getting the, 277 00:09:47,725 --> 00:09:50,225 you know, the legal department, the legal teams 278 00:09:50,684 --> 00:09:52,625 involved in drafting a 279 00:09:53,019 --> 00:09:55,659 a liability waiver or consent that the patient 280 00:09:55,659 --> 00:09:57,519 and his family would sign prior to surgery 281 00:09:58,220 --> 00:10:01,339 to give them the authorization to take the 282 00:10:01,339 --> 00:10:01,839 specimens 283 00:10:02,220 --> 00:10:04,620 outside of USC. Right? Typically, when you do 284 00:10:04,620 --> 00:10:05,759 surgery at a hospital, 285 00:10:06,274 --> 00:10:08,674 they go to the pathology laboratory where they 286 00:10:08,674 --> 00:10:10,434 study it in the lab, and it's all 287 00:10:10,434 --> 00:10:12,195 done in house in the hospital. It's we've 288 00:10:12,195 --> 00:10:14,434 never had this case where the patient would 289 00:10:14,434 --> 00:10:16,195 be able to take their their, 290 00:10:16,754 --> 00:10:18,929 specimen outside. And so we had to get 291 00:10:18,929 --> 00:10:21,090 that drafted up. So it was really a 292 00:10:21,090 --> 00:10:23,090 huge team process. It really took a village 293 00:10:23,090 --> 00:10:25,410 to to get there. It was by no 294 00:10:25,410 --> 00:10:27,649 means you know, while I would may maybe 295 00:10:27,649 --> 00:10:29,970 spearheading the process, you know, it really required 296 00:10:29,970 --> 00:10:32,595 effort and help from all sorts of different 297 00:10:32,595 --> 00:10:34,055 folks. So surgical coordinator, 298 00:10:34,675 --> 00:10:35,975 operating room director, 299 00:10:36,355 --> 00:10:38,215 the, you know, the legal team was involved. 300 00:10:38,274 --> 00:10:40,675 You know, patient was highly motivated. I was 301 00:10:40,675 --> 00:10:42,774 highly motivated as his physician. So, 302 00:10:43,235 --> 00:10:45,154 you know, ultimately led to a a great 303 00:10:45,154 --> 00:10:45,654 outcome. 304 00:10:46,730 --> 00:10:49,070 Yeah. That's amazing. And, doctor, 305 00:10:49,769 --> 00:10:52,089 very quickly, what advice would you give to 306 00:10:52,089 --> 00:10:52,909 other physicians 307 00:10:53,370 --> 00:10:55,850 who may need to advocate for the patients 308 00:10:55,850 --> 00:10:57,549 in new or unique ways, 309 00:10:58,089 --> 00:11:00,169 just in general or maybe to do this 310 00:11:00,169 --> 00:11:01,070 type of procedure? 311 00:11:02,105 --> 00:11:03,704 Well, I think for, you know, this kind 312 00:11:03,704 --> 00:11:06,424 of case, you know, we tip we generally 313 00:11:06,504 --> 00:11:07,804 and guidelines recommend 314 00:11:08,424 --> 00:11:11,144 always wanna free sperm and bank sperm prior 315 00:11:11,144 --> 00:11:12,985 to removing the testicle. You know, a lot 316 00:11:12,985 --> 00:11:13,644 of folks, 317 00:11:14,320 --> 00:11:15,220 a lot of oncologists 318 00:11:15,759 --> 00:11:17,679 and patients are kind of in a rush 319 00:11:17,679 --> 00:11:19,440 to get the cancer out, which totally makes 320 00:11:19,440 --> 00:11:19,940 sense. 321 00:11:20,399 --> 00:11:22,639 And the thought process is there's another testicle 322 00:11:22,639 --> 00:11:24,480 that make that's making sperm. And so you 323 00:11:24,480 --> 00:11:26,100 can always freeze sperm after 324 00:11:26,554 --> 00:11:29,274 the orchiectomy or removing the testicle, but definitely 325 00:11:29,274 --> 00:11:32,315 wanna do it before the systemic chemotherapy if 326 00:11:32,315 --> 00:11:33,054 that's needed. 327 00:11:33,434 --> 00:11:35,274 But, really, I you know, I'd I'd wanna 328 00:11:35,274 --> 00:11:36,954 shed light on the fact that up to 329 00:11:36,954 --> 00:11:38,254 thirty percent of patients 330 00:11:38,919 --> 00:11:39,740 will have 331 00:11:40,040 --> 00:11:42,540 low sperm counts, low sperm production 332 00:11:43,000 --> 00:11:45,100 even before removing the testicle. 333 00:11:45,480 --> 00:11:47,799 And so we really wanna encourage banking sperm 334 00:11:47,799 --> 00:11:48,940 prior to the orchiectomy 335 00:11:49,879 --> 00:11:51,464 or at least getting some sort of semen 336 00:11:51,464 --> 00:11:53,704 testing and hormone testing to make sure that 337 00:11:53,704 --> 00:11:55,004 there's sperm present. 338 00:11:56,105 --> 00:11:58,365 That's really the first case. And, you know, 339 00:11:58,424 --> 00:12:00,684 this sort of testicular biopsy 340 00:12:01,144 --> 00:12:02,605 or testicular sperm extraction, 341 00:12:03,865 --> 00:12:06,149 should ultimately done for that reason at the 342 00:12:06,149 --> 00:12:08,789 same time of the testicular removal. Right? Because 343 00:12:08,789 --> 00:12:10,309 we don't wanna take the patient back to 344 00:12:10,309 --> 00:12:12,169 the Operating Room for a second surgery 345 00:12:12,870 --> 00:12:15,110 if in the event they did have no 346 00:12:15,110 --> 00:12:15,610 sperm 347 00:12:15,990 --> 00:12:17,745 and induce them to a second form of 348 00:12:17,745 --> 00:12:20,705 anesthetic prior to chemotherapy. Right? It's it's, we 349 00:12:20,705 --> 00:12:21,985 wanna take care of it in the same 350 00:12:21,985 --> 00:12:24,644 setting. So I recommend, you know, all urologists, 351 00:12:24,785 --> 00:12:25,285 oncologists, 352 00:12:26,465 --> 00:12:28,785 trying to recommend and have the patient banks 353 00:12:28,785 --> 00:12:30,545 from prior to norkiactomy or at least have 354 00:12:30,545 --> 00:12:32,725 that fertility preservation discussion. You 355 00:12:33,320 --> 00:12:36,039 know, ultimately, doing a micro testy or micro 356 00:12:36,039 --> 00:12:36,860 onco testy, 357 00:12:37,559 --> 00:12:40,039 is most commonly performed by really kind of 358 00:12:40,039 --> 00:12:42,539 experienced reproductive microsurgeons. There's 359 00:12:43,159 --> 00:12:45,879 not that many urologists who specialize in this 360 00:12:45,879 --> 00:12:48,299 kind of work and this microsurgical work. 361 00:12:48,654 --> 00:12:50,014 You know, there may be only a handful 362 00:12:50,014 --> 00:12:51,934 or maybe up to 10 folks within the 363 00:12:51,934 --> 00:12:53,075 entire state of California 364 00:12:53,615 --> 00:12:55,875 doing this kind of work. So really encourage, 365 00:12:56,495 --> 00:12:58,735 folks out in the community to kinda refer 366 00:12:58,735 --> 00:12:59,475 these patients 367 00:12:59,774 --> 00:13:02,759 to tertiary academic centers who may have a 368 00:13:02,759 --> 00:13:04,600 male fertility specialist and, 369 00:13:05,320 --> 00:13:07,639 reproductive microsurgeon who can carry out this kind 370 00:13:07,639 --> 00:13:09,320 of work. And, ultimately, you know, for any 371 00:13:09,320 --> 00:13:11,559 sort of work you want to do that's 372 00:13:11,559 --> 00:13:13,100 never been done at a hospital, 373 00:13:13,720 --> 00:13:15,159 you know, you need to have patients. There's 374 00:13:15,159 --> 00:13:17,339 some regulatory hurdles that need to go through. 375 00:13:17,914 --> 00:13:19,914 Really, obviously, test test your patience, but you 376 00:13:19,914 --> 00:13:21,034 really need to have a team, and you 377 00:13:21,034 --> 00:13:23,274 need to get you need to get the, 378 00:13:23,274 --> 00:13:25,054 you know, folks in charge, 379 00:13:26,875 --> 00:13:28,394 as a part of your plan. Right? And 380 00:13:28,394 --> 00:13:30,794 so, ultimately, when this case was done, the, 381 00:13:30,794 --> 00:13:32,954 you know, the operating room director reached out 382 00:13:32,954 --> 00:13:34,980 to me and was like, this was a, 383 00:13:34,980 --> 00:13:37,940 you know, really fascinating case because, a, it's 384 00:13:37,940 --> 00:13:40,500 never been done before here at this hospital. 385 00:13:40,500 --> 00:13:42,259 And so we should shed light on it 386 00:13:42,259 --> 00:13:44,100 to the rest of the physicians here at 387 00:13:44,259 --> 00:13:46,419 locally within USC. And so we presented the 388 00:13:46,419 --> 00:13:48,605 case at, you know, one of our town 389 00:13:48,605 --> 00:13:49,985 hall meetings. And so, 390 00:13:50,445 --> 00:13:51,884 you know, I think shedding light on that 391 00:13:51,884 --> 00:13:52,705 is very important. 392 00:13:53,804 --> 00:13:56,465 Yeah. Definitely. I completely agree with you there. 393 00:13:56,524 --> 00:13:57,884 And thank you so much for those final 394 00:13:57,884 --> 00:13:59,725 thoughts, doctor. This has definitely been a very 395 00:13:59,725 --> 00:14:00,785 informative discussion. 396 00:14:01,470 --> 00:14:02,909 So I wanna thank you so so much 397 00:14:02,909 --> 00:14:05,070 for coming on Becker's health care, especially for 398 00:14:05,070 --> 00:14:06,750 the first time. And I look forward to 399 00:14:06,909 --> 00:14:08,209 Absolutely. Again soon. 400 00:14:08,750 --> 00:14:10,269 Thank you so much. It's been a pleasure 401 00:14:10,269 --> 00:14:11,409 chatting with you today.