Seeing men in a whole new light

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Dr. Keith Jarvi’s enthusiasm is contagious. The Director of the Murray Koffler Centre for Urologic Wellness at Toronto’s Mount Sinai Hospital proudly demonstrates the Centre’s most recent technological addition — a high-resolution ultrasound machine that will be employed in establishing causes of male infertility.
“Do you want to see what we see?” invites Dr. Jarvi, as he taps a few buttons, ushering a black- and-white speckled image onto the screen. To the untrained eye, the picture resembles nothing more than a TV snowstorm. To Dr. Jarvi and his team, however, this image represents a significant breakthrough, one that will allow them to determine if and where patients are producing sperm.
Infertility affects 15 per cent of Canadian couples, with men contributing to the infertility of half of those couples. For 20 per cent of infertile men, no-sperm ejaculation is an issue, with the absence of sperm being attributed to either a lack of production or an obstruction.
A key indicator of production is the size of the millions of small sperm-containing tubules found inside testicles. Whereas in normal men those tubules can measure 300 microns each, in infertile men, those tubules may be much smaller; as low as 50 microns each.
Proper diagnosis concerning production has traditionally been a multi-step and invasive procedure starting with biopsy of the testicle. This involves needles, knives, bleeding and the risk of infection or even loss of a testicle. Not just invasive, a biopsy can also be incomplete. Some men may produce sperm in some parts of their testicles but not others. The normal routine of a single biopsy, like the virtual needle in a haystack, may or may not find that specific area.
To address this problem, if that initial biopsy does not conclude that a patient is indeed producing sperm, the next stage is significant surgery. The testicle is opened, allowing clinicians to “read it like a book”, using a microscope to inspect the size of those spaghetti-like tubules. The results from this examination then inform the next step, another biopsy.
This has been the routine, until now. The purpose of Dr. Jarvi and his co-investigator Dr. Kirk Lo’s (one of the other urologists working in men’s reproduction) study is to show that contemporary technology can provide a better bridge to obtaining that important information. Powerful high-resolution ultrasound imaging, they believe, can replace these procedures allowing for non-invasive and comprehensive diagnosis, making it possible to both rule out unnecessary surgery and guide operations so that they may yield the most accurate results.
High-resolution ultrasound was not originally intended for use with humans, let alone research into sperm production. Dr. Jarvi reports, colleague Dr. Ellen Greenblatt, Director of Reproductive Endocrinology and Infertility, made the suggestion that high-resolution ultrasound – a technology she is familiar with from discussions with Dr. Lee Adamson, a researcher at the Samuel Lunenfeld Research Institute – might prove helpful.
Enter Visual Sonics, a world leader in pre-clinical research technology. The company worked with Centre staff and Health Canada, modifying the power of the ultrasound to comply with safety standards. Four years later, the end result is a $250, 000 imaging machine which poses no greater health risk than an average ultrasound, yet enables a resolution twenty times higher. This allows imaging as low as 50 microns – smaller than the average size of a human hair.
Study plans are taking off far more quickly than initially imagined. Starting with the recruitment of subjects just two weeks ago and expecting that process alone to take a year, investigators are pleased to already have five of 60 patients registered.
Subjects will undergo ultrasound prior to surgery, with information gathered through the ultrasound correlated to that from the surgery. If results indicate that the size of tubules suggested in the ultrasound is in fact the same size as that revealed through surgery and that there is the presence of sperm, the hypothesis will be proven.
According to Dr. Jarvi, “For years we’ve known that the size of the tubules is an accurate predictor of the presence of sperm. Now we’re just measuring the size of tubules in a different way. In theory it should work.”
If so, Dr. Jarvi, Dr. Lo and their team look forward to offering a tested and proven new service to their relieved clients pretty soon.