Learn all about male infertility treatment
Three significant factors influence male infertility treatment.
- Is the cause of infertility identifiable?
- What is the severity of the sperm defect?
- What is the age of the female partner?
For mild male factor, unexplained cause, intrauterine insemination (IUI) is usually the first-line recommendation. Concentrated sperm are placed directly into the uterine cavity, thus eliminating their passage through the vagina and cervix. However, most authorities consider (IUI) to be ineffective in cases of severe male infertility.
Intracytoplasmic sperm injection (ICSI) as a male fertility treatment
Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility. The ideal treatment, when surgical and medical management fails to improve sperm function, is in vitro fertilization (IVF). Many men also opt for intracytoplasmic sperm injection (ICSI) as part of IVF. It involves the placement of a single sperm directly into the egg using a microscopic pipette.
ICSI bypasses sperm defects because embryologists select a single sperm and place it inside the egg. IVF/ICSI can help in cases of severe male factor infertility. It can also help with other conditions, such as failed fertilization in previous IVF cycles.
Male fertility treatment after a vasectomy
Couples have the option of a vasectomy reversal or IVF-ICSI with epididymal or testicular sperm extraction. It can sometimes take 6-9 months to recover adequate sperm counts following vasectomy reversal. Also, the greater the length of time between the vasectomy and the reversal, the lower the chances of success.
Microepididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) are outpatient procedures to retrieve sperm special circumstances. We will work closely with urologists to coordinate these procedures at our facility.
When a physician performs MESA procedure, they will put the patient under local anesthesia and general sedation. Then the doctor makes an incision in the scrotum. This exposies the epididymis and the tubules immediately adjacent to the testicles that collect the sperm. Utilizing an operating microscope, the doctor makes an incision in these tubules. He or she then aspirates sperm.
Although we can often collect millions of motile sperm, this sperm cannot penetrate an egg. As a result, we must inject it into eggs using ICSI. The advantage of MESA for men with obstructive azoospermia is that we can usually freeze the sperm. If his partner has to undergo more than one IVF cycle, the MESA should provide adequate sperm for all procedures.
Testicular sperm extraction (TESE)
A TESE or testicular sperm extraction is a male infertility treatment that entails directly aspirating the sperm from the testes or retrieving sperm from a testicular biopsy. Generally, we perform it using local anesthesia block. In many cases, the disadvantage is that testicular sperm are much more scarce and consequently more difficult to freeze. Typically, there is only enough sperm recovered for one IVF procedure. If further there are IVF attempts, we may need to repeat the TESE procedure.
Non-obstructive azoospermia (NOA)
Men with very poor sperm production and no sperm in the ejaculate often demonstrate high blood FSH levels and sometimes low testosterone levels. The testicular size may be small. These men have relative testicular failure. TESE or testicular biopsy is usually the only option for them as there are no sperm in the epididymus and even testicular sperm production can be “patchy” and scarce within the testes. Men with this diagnosis who have been told they have no sperm on routine testicular biopsy frequently can be found, on further investigation, to have sperm present in a scattered distribution within the testicle. If so, these areas can be re-aspirated for IVF-ICSI with some degree of success, depending on the amount of sperm obtained.
The andrology department at Fertility Specialists of Texas performs semen analysis, semen cryopreservations, intrauterine insemination (IUI) preparations, and in vitro fertilization (IVF) sperm preparations. Having an in-house andrology department ensures the safety of the sample and allows it to be analyzed and processed under optimum and sterile conditions.
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