Jason and Jennifer Schiraldi knew their chances of having children weren't great, but they never would have believed how small that possibility was until Cleveland Clinic doctors discovered infertility issues with both of them.
After a standard course of testing to address the couple's fertility concerns, Jason was diagnosed with azoospermia, the inability to create viable sperm, while Jennifer was found to have a diminished capacity to produce eggs.
"We knew that our chances weren't good, but we didn't know that this had never happened before."
In situations where both partners experience fertility issues, special attention and teamwork are necessary to achieve pregnancy.
In the case of the Schiraldi's, male fertility issues called for a novel solution to a problem that has challenged medical researchers for almost 15 years. With severe male factor infertility, the number of sperm available may be very limited. The laboratory needs to be able to reliably isolate and freeze what few sperm that can be found. Amazingly, one single sperm is all that the fertility experts had to work with for Jason.
"We knew that our chances weren't good, but we didn't know that this had never happened before," says Jennifer.
The couple’s successful outcome would depend on the collaborative efforts of In Vitro Fertilization Lab Director, Nina Desai, PhD., and Edmund Sabanegh, MD, Director of the Center for Male Fertility at Cleveland Clinic's Glickman Urological & Kidney Institute.
Dr. Sabanegh had elected to perform a delicate microsurgical testicular biopsy on Jason with the hope of extracting enough sperm for the couple to proceed with an IVF cycle. Meanwhile, Dr. Desai’s lab was responsible for assessing the tissue samples for the presence of sperm and ultimately freezing the tissue for Jennifer’s treatment cycle.
"We've been working on trying to figure out a way to do single-sperm freezing since about 2001," says Dr. Desai. "We take this half a micro-liter or so of fluid, place it on the gutter, and then we slow freeze this and immerse it in liquid nitrogen."
Since the laboratory was only able to freeze a single motile sperm from Jason's sample, the hope was that if all the tissue was screened, more viable sperm would be found.
The Single-Sperm Freezing process starts with very careful microsurgical biopsy of the testicles through surgery to identify potential areas of sperm production. In the IVF laboratory, a sample is screened at 300 times magnification for presence of sperm. Living sperm are identified and picked up with a glass needle. After incubation with a cryoprotectant, sperm are ready to be frozen.
The sperm are moved with a fine glass needle, and the use of the microscope, to the freezing device. The sperm is sequestered in one microliter or less of fluid and then placed on a plastic capillary tube with a preformed gutter. The capillary tube is then placed into another straw and sealed. The straw is then slowly cooled before storage in liquid nitrogen.
On the day of Jennifer’s egg retrieval, three technicians searched for nearly four hours, but were unable to find any living sperm. The decision was made to use the single sperm that had been initially found and frozen to inject one oocyte. Jennifer’s remaining eggs had to be frozen due to lack of sperm.
"They couldn't calculate the odds, because it's never happened," says Jason.
Fortunately for the couple, one sperm was all it took. The egg was successfully fertilized and developed normally. After three days, the embryo was transferred to Jennifer's uterus. Sixteen days later, Jennifer and Jason learned that they were going to be parents. Their daughter Kenley was born on April 20, 2010, after a healthy and successful pregnancy.
"I always say she's our wish that came true," says Jennifer. "If they want to call it a miracle I'm fine with it."
Glickman Urological & Kidney Institute,
Cleveland Clinic Children's