Second chances


Today is Easter Sunday, also known as Resurrection Sunday. This is a festival celebrating the resurrection of Jesus Christ from the dead, described in the New Testament as having occurred on the third day of the burial after his crucifixion.

Coincidentally, today is also Qing Ming, known commonly in Malaysia as the tomb sweeping day. This is a traditional Chinese festival mostly noted for the connection with the Chinese ancestral veneration and the tending of the family graves. 

Albert Einstein once said: “Coincidence is God’s way of remaining anonymous.” I often wonder what he meant by that. Did Einstein truly believe in God? 

I am not a Christian, but I celebrated Easter in the United Kingdom for many years by enjoying the Bunny Chocolates and Daffodils. Now back home, Qing Ming is particularly close to my heart. Today is day the young and old from the family gather to honor the ancestors at the graves by offering tea, wine, foods and joss paper accessories. In recent years, Qing Ming meant more to me as a family gathering and celebration. In some way, Qing Ming is like Easter to me. It has become a symbol of hope, renewal and new life. 

On that note, lets deal with the potential new lease of life for David.

 

Dear Dr. G,

My name is David. I am a 36-year-old divorcee.

During my first marriage, my ex-wife and I tried for a baby for four years and this had put a tremendous strain on the relationship.

Truthfully, I was reluctant to see a doctor for any infertility issues. Sadly, our marriage came to an end two years ago.

Today, I am in a new relationship and hoping to get married by the end of the year. I have actually built up courage to see a urologist for my fertility issues.

I was distraught to discover I have no sperm in my ejaculated semen.

The urologist did some tests and told me I have CAVD. Coincidentally, the doctor also told me that I have an absent kidney.

He recommend that I have an operation to retrieve the sperms for freezing, in anticipation for IVF in the future.

Can you tell me what is CAVD? How is this condition diagnosed?

Is it hereditary and can it be passed to the next generation?

Is the operation necessary for the sperm retrieval? Is IVF the only option for me to father a child?

Finally, what impact will a single kidney have on the rest of my life?

Thanks for answering the questions and warmest regards

David.

 

The absence of the any sperm in the ejaculated semen is a medical condition called azoospermia. This can affect about 1% of the male population and may be detected in up to one in five men presented with the problems of infertility. The obstructed ejaculatory ducts as the main cause of azoospermia can happen in many men. The main etiology may be vasectomy, obstruction secondary to sexually transmitted infections or Congenital Absence of the Vas Deferens (CAVD). 

The Vas deference is the ductal systems that deliver sperm from the testicles to the prostate for ejaculation. The reproductive ducts fail to form properly prior to birth in CAVD. The defect can be either unilateral (CUAVD) or bilateral (CBAVD). 

CAVD is associated with Cystic Fibrosis as the result of the mutation in the CFTR gene. Such mutations can also result in Unilateral Renal Agenesis in 40% of men with this genetic condition. Although the association is not considered to be coincidental, the mechanism behind the disappearance of the kidney is largely unknown. The vast majority of men will live blissfully with a solitary kidney, although they have to be extra cautions to protect the kidney. 

The diagnosis of CAVD is usually made with the composition of the semen analysis and hormonal levels of FSH. A Transrectal Ultrasound scan may also demonstrate dilated seminal vesicle suggesting chronic obstruction. 

Before the IVF era, there was no possibility for men with CAVD to father a child. With the modern Artificial Reproductive Technology (ART) and the combination of testicular sperm extractions (PESA, MESA or TESE), individuals with CAVD are often given a second chance. Although the success rates of the IVF for CAVD is good, the genetic counseling is mandatory as the risk of either Cystic Fibrosis or Renal Agenesis is elevated in the offspring. 

When former American child star, Brooke Shields underwent fertility treatment, she said: “The difficulty of IVF or any fertility issues is the hope and the shattered hope, the dreams that might happen this time and then it does not happen”. 

Of course, couples using IVF treatment might have to deal with the possibility of passing genetic mutations to the next generation. 

But the reality is, modern technology is making what used to be an impossible dream, an absolute reality for many. When it comes to fertility treatments, I agree with what Martin Luther King’s advice: “We must accept finite disappointment, but never lose the finite hope”. 

On that note, I wish everyone a Happy Easter and have a safe Qing Ming. And for David, good luck with your second chance.

 

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