Treatments for male infertility range from surgical intervention or intrauterine insemination (IUI) to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Depending on the source of the problem, sperm can be taken from the man's ejaculate for use in assisted fertilization procedures.
One treatment option for men who do have sperm in the ejaculate is intrauterine insemination (IUI). Intrauterine insemination is an infertility treatment in which sperm are placed directly into the female's uterine cavity near the time she ovulates. IUIs are commonly performed when there is a low sperm count or low motility. The sperm that will be injected during the procedure are prepared using a process called sperm washing. The sperm are "washed" to remove any extra cells and debris in an effort to obtain the greatest concentration of the highly motile sperm that will be used for the insemination.
One of the most common problems affecting male sperm levels is a varicocele, a tangle of swollen veins surrounding the testicle. Surgical correction of large varicoceles may improve sperm DNA quality and semen analysis results, as well as restore fertility in about two-thirds of cases.
In some cases there is no sperm in the ejaculate so surgical options for sperm retrieval are explored. Advanced sperm retrieval techniques, including TESA, PESA testicular microdissection and testicular biopsy, combined with IVF and ICSI, now allow men with either a low sperm count or no sperm in their ejaculate the chance to produce a child.
- Testicular biopsy - an in-office surgical procedure in which small pieces of testicular tissue are removed and examined for sperm which can be used in fertility procedures
- Testicular sperm aspiration (TESA) - a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for IVF or ICSI
- Percutaneous sperm aspiration (PESA) - a procedure involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperm
- Testicular microdissection - involves careful surgical intervention in the testicle to locate any areas of potentially active spermatogenesis. This allows minimal extraction of testicular tissue which minimizes the risk of permanent damage to the testicles.
For some couples, the use of donor sperm ivf remains the best option for building a family. Obviously, donor sperm is the only option for men whose testicular biopsy reveals complete azoospermia - no trace of sperm in the testicular tissue. The use of donor sperm may also be considered when genetic screening indicates a possibility of passing on hereditary conditions such as cystic fibrosis to male offspring.
An increased understanding of male factor infertility and the recent advances made in assisted sperm retrieval techniques are now giving men who never thought they could have biological offspring the chance to father a child. Successful fertility outcomes at our center result from a combination of technological advances, scientific expertise and consistent andrology laboratory standards.
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