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Male Fertility Treatments

Male Fertility Treatment

While infertility is often associated with female reproductive issues, approximately half of all infertility cases are due to problems on the male side. Since sperm health is crucial for conception, it is important to have your sperm evaluated if you are facing challenges with infertility. Fortunately, many causes of male infertility are treatable.

Couples dealing with infertility due to issues with sperm count or function may find success with treatments like intrauterine insemination (IUI) or in vitro fertilization (IVF). In an IUI cycle, the woman usually takes fertility medications to stimulate the development of multiple eggs in a single cycle, which can be effective when there is a mild abnormality in sperm count. However, if there is severe impairment in sperm count, motility, or morphology, IVF is often the most suitable treatment option.

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Intracytoplasmic Sperm Injection (ICSI)

ICSI has revolutionized the treatment of male infertility. Even men who have no sperm in their ejaculate may achieve pregnancy with this technique. In such cases, a urologist can extract sperm directly from the epididymis or testicle for use in IVF. During ICSI, a specialized glass needle is used to inject a single healthy sperm directly into the egg's cytoplasm under the guidance of a microscope. The success rate of this procedure varies across IVF programs and is highly dependent on the skill of the embryologist performing it.

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Candidates for ICSI include men with:

  • Severely compromised sperm parameters, such as low concentration, poor motility, abnormal morphology, or antisperm antibodies.

  • Blockage or absence of the vas deferens, where sperm is surgically retrieved through procedures like microsurgical epididymal sperm aspiration (MESA) or testicular biopsy for ICSI.

  • Previous low or failed fertilization in prior IVF attempts.

  • Unexplained infertility after all diagnostic tests have been completed. Our IVF success rates with ICSI are comparable to those of couples without male factor infertility who do not require ICSI.

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Sperm Retrieval

When sperm cannot be obtained through ejaculation, several procedures can be performed by a urologist to safely retrieve healthy sperm from the testes or epididymis (the tube that connects the testicle to the vas deferens).

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Types of Sperm Retrieval

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Depending on your specific situation and diagnosis, your doctor will recommend the most appropriate method of sperm retrieval. Examples of sperm retrieval procedures include:

  • Testicular Sperm Aspiration (TESA): A procedure where a fine needle and syringe are used to extract sperm directly from the testicles. This is done under local anesthesia and takes about 20-30 minutes. TESA is suitable for men who have had a vasectomy or those who cannot produce sperm in their ejaculate but are producing sperm in their testicles.

  • Testicular Sperm Extraction (TESE): A surgical procedure where a small incision is made in the scrotum to remove a portion of testicular tissue and extract viable sperm. TESE is often performed in a urologist’s office with a nerve block or under anesthesia in a surgical center.

  • Microsurgical Epididymal Sperm Aspiration (MESA): A minimally invasive procedure that involves making a small incision to access the epididymis and using a microscope to retrieve sperm from the epididymal tubes. MESA is performed under general anesthesia by a highly skilled microsurgeon.

  • Percutaneous Epididymal Sperm Aspiration (PESA): A procedure where a needle attached to a syringe is inserted into the epididymis to gently remove fluid. PESA is performed under local or general anesthesia and is an option for men with obstructive azoospermia.

  • Microsurgical Testicular Sperm Extraction (Micro-TESE): A procedure involving a small incision in the outer covering of the testicle, which is then opened to examine the inside for areas likely producing sperm. This technique is done by a urologist trained in microsurgery.

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Using Retrieved Sperm in IVF with ICSI

Once sperm is retrieved through these procedures, the sperm cells are prepared and can be directly injected into the egg via intracytoplasmic sperm injection (ICSI). The resulting viable embryos can then be transferred to the female partner’s uterus.

Donor Sperm

For couples diagnosed with severe male factor infertility or when the male partner carries a genetic condition and does not plan to pursue preimplantation genetic testing, donor sperm is an option. Donor sperm can be used for IUI or in vitro fertilization.

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