Male infertility is often assessed first through a semen analysis. But in some complex cases, one routine test may not capture the complete picture. When sperm are present in extremely small numbers, advanced semen processing and detailed laboratory evaluation can play an important role in deciding the next step. For four years, Mansi Desai (29) and her husband Chirag Desai (30) had been trying to conceive. Earlier evaluations had suggested azoospermia, a diagnosis where sperm are not detected during routine semen analysis. This left the couple unsure whether treatment could move forward using Chirag’s own sperm. When they came to Birla Fertility & IVF, Ahmedabad, the team began with a fresh and detailed assessment before finalising the treatment plan.
Under the care of Dr. Nimisha Shantilal Pandya, a carefully timed IVF-ICSI plan was created. On the day of egg retrieval, multiple semen samples were collected so the embryology team could identify viable sperm for ICSI. Since the number of mature oocytes was also limited, close coordination between the clinical and laboratory teams was essential.
Mansi’s evaluation showed a borderline normal ovarian reserve. While her egg numbers were not high, IVF could still be planned with the right clinical support and timing.
Chirag’s evaluation required a more specialised laboratory approach. Through advanced semen processing and detailed examination, the embryology team identified rare sperm that had not been detected earlier. This changed the diagnosis to cryptozoospermia, a condition where sperm are present in extremely small numbers and require specialised techniques to identify.
This finding changed the treatment direction for the couple. They could proceed with IVF-ICSI using Chirag’s own sperm.
A small number of mature oocytes were retrieved, and fertilisation was achieved. The embryos were cultured to the blastocyst stage and cryopreserved. A frozen embryo transfer was then planned under suitable conditions to support implantation.
Following the transfer, pregnancy was confirmed through beta hCG testing. A subsequent scan confirmed a healthy foetal heartbeat.
Mansi later delivered a healthy baby, completing a treatment journey shaped by detailed diagnosis, advanced embryology support and personalised IVF care. This case highlights an important message for couples dealing with male infertility: a routine semen report may not always give the full picture, especially when sperm are present in extremely small numbers.
Note: Patient names have been changed to protect privacy.
