MESA Means Hope For Infertile
Men Who Want To Father Children

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

As a college student and twenty-something young professional, Max Jordan gave no thought to having children. “It’s not that I didn’t want children,” he says, “I was just focused on other things.” It wasn’t until he met his wife Cindy and they married in 2000 that he gave any serious thought to having children.

Jordan, 28, admits that he wasn’t sure if he’d be able to father children because he has Cystic Fibrosis (CF), a genetic disease that causes thickening of sweat, mucus, saliva and digestive juices resulting in severe lung damage and nutritional deficiencies. Although he inherited defective genes for the disease from both of his parents, Jordan’s disease is manageable. He does daily respiratory therapy and maintains a fairly normal lifestyle. He considers himself very lucky. However, he does have one serious, but common side effect of CF-congenital absence of both of his vas deferens. These tubes that carry sperm from the testes to the urethra never developed. His testes make sperm, but they have no way of getting out, so he is considered sterile.

But there was hope for the young couple. Thomas Vaughn, MD, a fertility specialist at Texas Fertility Center in Austin, explained to the couple that there was a way for them to have a biological child. Since Jordan’s wife, Cindy Jordan, is healthy with normal fertility, Jordan’s sperm could be removed surgically and used to fertilize his wife’s eggs in the laboratory. The resulting fertilized embryos could then be placed into his wife’s uterus. Microscopic Epididymal Sperm Aspiration (MESA), surgical removal of sperm, is relatively new and few doctors are trained to perform the procedure. Luckily for the Jordans, Elizabeth Houser, MD, urologist with The Urology Team in Austin, is one of a few urologists in Texas skilled to perform the procedure.

The MESA procedure may sound like something out of a science–fiction novel, but the science behind it is very real. During the sperm removal procedure, the patient is sedated while Houser opens up the scrotum. Using a microscope to locate the sperm within the testes, Houser removes sperm from each testis using a thin tube-like instrument. The sperm is then placed in a test tube, spun in a centrifuge and allowed to sit. The sperm that is strong enough to swim up to the top of the test tube are captured, frozen and later used for fertilization.

The sperm that are removed during the MESA procedure are immature, since sperm normally finish maturing as they travel through the vas deferens. To maximize a couple’s chances of conception, the sperm is injected directly into eggs surgically removed from a woman, in a procedure called Intracytoplasmic Sperm Injection (ICSI), a type of In Vitro Fertilization.

“ICSI offers otherwise hopeless couples a chance at conception,” says Dr. Houser. Both the MESA and ICSI procedures have been done successfully in Austin since 2001. Currently, Dr. Houser and her team have an eighty percent success rate, achieving eight pregnancies from ten MESA procedures.

Jordan had the MESA procedure in early 2004. His wife had thirteen eggs retrieved the following day. The ICSI procedure created ten embryos of which seven were mature enough to be used for in vitro fertilization. In February 2004, two embryos were placed in Cindy Jordan’s uterus. Unfortunately, the procedure did not take and there was no pregnancy.

“We were just devastated,” says Max Jordan. “After all that we had gone through, the stress of the treatments and the medications, it was hard to believe that it didn’t result in a pregnancy.”

The couple took a few months to recover from the disappointment. In the meantime, of the remaining five frozen embryos, two died after defrosting. The remaining three were placed in Cindy Jordan’s uterus in the summer of 2004 and she became pregnant. Baby Alan was born on March 20, 2005.
“He is a miracle! Every time I look at him, I can hardly believe it. Having this child has brought me more joy than I could have ever imagined.” Says Max Jordan.

Houser and her colleagues are bringing hope to seemingly impossible situations. According to The American Fertility Association, one in ten couples have fertility issues. Twenty percent to thirty percent of infertility is due to male factors alone. Thirty percent to forty percent of infertility is due to factors with both partners. But assisted reproductive technology is tipping the odds in favor of infertile couples. Couples that once never even dared to dream of having children now have hope of having biological children of their own.

For Peter Coldicott, the miracle of MESA and the ICSI procedures offered him a chance at having a second family. The now fifty-four year old engineer married his wife, Nancy Coldicott, in 2001. Peter, who has two adult sons from his first marriage, had a vasectomy at age thirty. The couple had accepted the fact they would be childless.

“It was the strangest thing. I was flying on a business trip and happened to glance through American Airlines’ American Way Magazine. There it was, an article describing the MESA procedure. When I got home, I told Nancy about the article and we called Dr. Silverberg to see if we might be candidates.”

Kaylen Silverberg, MD is another fertility specialist at Texas Fertility Center. After reviewing the couple’s medical history, Silverberg told them that indeed they were candidates for MESA and subsequent in vitro fertilization.

“Dr. Silverberg named two physicians in Texas who were trained to do MESA. One fellow was in Houston, and the other was Dr. Houser. The fellow in Houston had done a few procedures and at that time, Dr. Houser had not yet done any. Dr. Silverberg told us this, yet my wife and I felt that logistically Houston might be difficult. We decided to meet with Dr. Houser and see if we could work with her. Within five minutes of meeting with her, we knew that she was the doctor for us and we moved forward.” Coldicott was Dr. Houser’s first MESA patient.

Coldicott had already had his vasectomy reversed. The reversal itself was uncomplicated, but because the vasectomy had been done so many years ago, his body had developed antibodies to his sperm. This is a normal occurrence that typically develops within ten years after a vasectomy. It’s the body’s way of avoiding sperm build up and getting rid of the sperm cells produced. The semen samples obtained following the vasectomy reversal could not be used for fertilization because the antibodies caused the samples to be clumped and the sperm cells to be malformed and malfunctioning. Houser suggested that Coldicott under go the MESA procedure and that the couple consider ICSI. Initially, they were concerned about insurance coverage, but finally decided to go forward with the procedures, which cost a total of twenty thousand dollars, even if they had to pay out of pocket. The Coldicotts were fortunate that their insurance covered eighty percent of the costs.

On Valentine’s Day 2002, Coldicott had the MESA procedure. From one testis, hardly any sperm were obtained. The other side provided plenty of viable sperm and following collection of seven eggs from his wife, five embryos were produced via the ICSI procedure. The three strongest embryos were placed in Nancy’s uterus. Two developed and one died. One of those embryos later split and the couple was blessed with triplets, two identical and one fraternal. Three little girls, Katelyn and Leah (the identical twins) and Grace, the fraternal triplet, were born on October 11, 2002 at thirty-four weeks, only six weeks shy of a full term forty-week gestation.

“It’s really unbelievable”, says Peter Coldicott. To get this type of a chance is an incredible blessing. What Dr. Houser and her colleagues do is nothing short of miraculous. Many couples that thought that they could never have children of their own now have a chance. I’m just so thankful to Dr. Houser.”

Coldicott also credits the success of his family to the generosity of his Lago Vista community. “ When Nancy came home, my niece from England came and stayed with us for six months to help out. Our church set up a roster and sent shifts of people to come and help us. From 6 am to midnight for the first three to four months, someone from church was at the house helping out-cleaning, making meals, helping with the babies. We were so blessed. It’s been a remarkable experience that was worth every ounce of time and effort.”

For now, not every infertile couple will be able to have biological children. Medical research continues to close in on the causes of infertility as technology continues to provide solutions. For Max Jordan and Peter Coldicott, MESA brought them hope and answered their prayers. To couples still waiting, hopefully in due time, your miracle will come.

Darline Turner-Lee had her own struggles with fertility before giving birth to a daughter and now awaiting the birth of her second child. She fully supports other couples on their journeys and may be reached at dturner-lee@goodlifemag.com

Resources and Support for Infertility (sidebar)

The American Fertility Association-This is a national, non-profit organization whose purpose is to educate the public about reproductive disease, and support families during struggles with infertility and adoption. For more information, visit http://www.theafa.org or call 888-917-3777.

American Society for Reproductive Medicine-This is a non-profit organization striving to be the nationally and internationally recognized leader for multidisciplinary information, education, advocacy and standards in the field of reproductive medicine. The society’s website, http://www.asrm.org, contains information for physicians, and patients looking for physicians and researching treatments

Resolve: The National Infertility Association-This organization seeks to provide resources and support to men and women facing infertility. For more information, visit http://www.resolve.org or call 888-623-0744.

Texas Fertility Center-This Austin practice consists of board certified reproductive endocrinologists who specialize only in infertility. Their primary mission is to assist couples in achieving pregnancy.
For information on the practice and physicians, visit http://www.txfertility.com or call 512-451-0149 to schedule a consultation.

The Urology Team—This Austin urology practice has physicians trained in cutting edge urology treatments, including the fertility procedures addressed in the accompanying article. The physicians treat both male and female urology problems. For information visit www.urologyteam.com or call 512-231-1444 or 877-231-1444 (toll-free).