This year marks the anniversary of the death of Anthony Hirsh FRCS, DObst RCOG, one of the first truly dedicated specialists in male infertility. Tony was passionate about this field, going to great lengths to treat men with azoospermia. Tony was a pioneer in testicular sperm extraction. He implemented the technique of retrieving sperm from the vas deferens and in 1993 achieved the first successful IVF pregnancy using such sperm from a spinal cord injured patient.
Tony was trained in the USA in microsurgical epididymal sperm aspiration (MESA), and was one of the first to use this technique in the UK for management of obstructive azoospermia. Later on, his determination to treat non-obstructive azoospermia led him to acquire skills in micro-TESE to enable the retrieval of very small numbers of spermatozoa isolated from selected foci in the seminiferous tubules. This technique was a huge breakthrough for men who previously had to resort to sperm donation. Tony took his surgical skills to Abuja in Nigeria where he performed micro-TESE on azoospermic men for subsequent IVF treatment.
Tony was always keen to incorporate the latest research findings into his clinical practice, especially in terms of investigation and diagnosis of male infertility. He recognised very early on the value of sperm DNA fragmentation testing for male infertility and was instrumental in establishing tests for seminal oxidative stress using chemiluminescence more than twenty years ago at the Hallam Medical Centre. He was also aware of the difficulties fertility investigation posed within specific religious and cultural communities and was instrumental in recommending procedures such as post coital testing that could be used to accommodate their concerns. Tony’s academic career began with a two year research position as UK research co-ordinator in a multicentre clinical trial investigating a hormonal method of male contraception funded by the World Health Organisation.
Apart from his interest in reproductive endocrinology, Tony was fascinated by testicular histology, erectile and ejaculatory dysfunction and the role of varicoceles in infertility. He spent some time investigating the use of Doppler flow in the evaluation of varicoceles in fertile and infertile men. Tony’s work was published in peer reviewed journals and he frequently presented at national and international meetings. He was a member of several professional societies and was one of the few urologists who joined the British Andrology Society as a committee member in the early days of the Society. Tony served on the National Institute for Clinical Excellence’s clinical guideline development group on national guidelines for treatment of infertility (2002-04).
During his career, Tony touched many people’s lives, including urologists, gynaecologists, research scientists and embryologists, and especially the very many infertile men that he helped over the years. Here are a few recollections from colleagues:
Memories from an Urologist
I first met Tony by chance at a fertility meeting in London and we became friends instantly as we shared a common interest in microsurgery for the management of male infertility. Having dealt with so many cases over the years, he was always ready to provide unique tips and tricks for difficult cases and I still use these pearls of wisdom to this day. A number of compatriots in the USA still fondly remember how Tony used to pick them up in his Jaguar which was somewhat unreliable. He was meticulous with his surgery and took a great interest in the testicular anatomy particularly the vasculature at which point he would always reference an anatomical specimen kept at the Royal College of Surgeons in Edinburgh. He would also spend hours checking archived slides in failed cases before offering a repeat microdissection TESE procedure. Tony was a great colleague and was always passionate about the field of male infertility. Although sadly no longer with us- never forgotten.
Mr Asif Muneer MD FRCS(Urol)
Consultant Urological Surgeon and Andrologist
University College London Hospital
Memories from an Embryologist/Clinical Scientist
I met Tony nearly 20 years ago when he was looking for an embryologist to assist him in theatres with his micro testicular sperm extraction (micro-TESE) procedures. Tony was a brilliant and meticulous surgeon and was able to locate healthy areas of spermatogenesis in seminiferous tubules the majority of the time irrespective of the pathology, with the smallest of biopsies and limited extraneous damage to the surrounding tissue. I was struck by his determination to find sperm for his patients, insisting that we spend hours searching for sperm if there were none initially. Tony recognised that micro-TESE was the last resort for these men to have their own biological child and he understood the impact that an unsuccessful TESE could have on a man. I had many a discussion with him about the importance of implementing novel tests as part of clinical diagnostic evaluation of male infertility, particularly in unexplained or idiopathic cases. It was through his encouragement and support that we eventually managed to validate an oxidative stress assay as a CE marked test in our laboratory. I feel very privileged to have known and worked with Tony. I have always been inspired by his passion for Andrology, enjoying our discussions about the latest developments in the field. He was a man of tremendous integrity and a very caring clinician with a great sense of humour. He was unique and is sorely missed.
Dr Sheryl T Homa PhD ARCS FIBMS
Honorary Senior Lecturer in Biosciences, University of Kent
Scientific Director, Andrology Solutions, London
Memories from a Gynaecologist
Tony Hirsh was a gentle and kind, quiet spoken, very intelligent man. He taught me the intricacies of andrology whilst a sub specialist trainee at Bourn hall. It’s a tricky subject but Tony’s passion and knowledge were an inspiration. He would put couples completely at ease within minutes even though he often delivered a devastating blow, guiding them through the details of the problem and the surgery required to hopefully achieve pregnancy. Tony was a perfectionist. I assisted with his meticulous vasectomy reversals and his micro TESEs. He inspired all his students to learn more, and to remember the importance of diagnosing and treating male problems, rather than simply bypassing them by moving straight to IVF or ICSI. This crucial element of fertility practice and care of an infertile couple can sometimes be dismissed in today’s conveyor belt and financially over-stretched medical fertility service provision.
Miss Sara J Matthews M.D. M.R.C.O.G
Consultant Gynaecologist & Subspecialist in Reproductive Medicine and Surgery
Portland Hospital for Women and Children, London