Treatment Options for Male Infertility

About 20- 30% of couples worldwide struggle with infertility issues with male infertility accounting for 50% percent of the cases. The causes of male infertility are varied and may be a result of age, lifestyle choices, or medical conditions that affect the pituitary gland known to enable the testes to produce sperm. Although male infertility can be a daunting diagnosis especially when planning to start a family, all hope is not lost as more often than not male infertility issues may be treated. 

Whereas lifestyle changes may naturally improve sperm health in some cases, there are a number of male infertility treatment options available today such as hormonal medication, surgical procedures, In Vitro Fertility (IVF) where the egg is fertilized in a laboratory and the resulting embryo deposited back to the womb or Intracytoplasmic Sperm Injection (ICSI) where the sperm is injected directly into the egg. This article looks at various male infertility treatment options.

Medications & Lifestyle Changes for Sperm Health

Male fertility is key in fertilization. For a man to have healthy sperm, he has to eat a healthy diet, exercise regularly, avoid excessive intake of alcohol and tight fitting underwear and heat. Additionally medications for certain medical conditions may also affect sperm health. When trying to conceive, a patient needs to disclose all medications they are taking to the fertility specialist who  would then assess potential effects on the sperm and advise on suitable substitutes. 

Sperm health is mainly characterized by:

1. Normal count of at least 15 million sperm per millimeter of a single ejaculate, 
2. Normal shape 
3. Sufficient movement. 

Certain adjustments need to be made for improved sperm health. They include:

A healthy diet: Semen is composed of different proteins, vitamins and minerals including selenium, urea, lactic acid and cholesterol. Taking foods rich in healthy fats, proteins like lean poultry, low fat dairy products, magnesium, copper, zinc, Vitamin C and E are crucial in the enhancement of better sperm quality and reduces the risk of abnormalities in sperm parameters including DNA fragmentation.

• Exercises: Daily exercising lowers stress levels and  improves the quality of sperm.
• Alcohol intake and smoking: Heavy drinking is associated with low sex drive, inability to sustain an erection as well as poor sperm quality and reduced testosterone levels while smoking is known to reduce sperm counts making conception a challenge.
• Medication: Medications used to manage blood pressure and depression as well as illegal drugs and cancer treatments are known to negatively impact fertility. Seek medical advice from the fertility specialist on alternatives to medications that can affect fertility. The physician can also store sperm before commencing the treatment.
• Heat: The ideal scrotal temperature for spermatogenesis is about 3 degrees celsius lower than the normal body temperature. Avoid exposure to heat and tight fitting clothing that may affect sperm production if the scrotum gets too hot.

Surgical Treatments

Over the years the surgical solution for male factor infertility has improved tremendously giving hope to men as they are able to sire their biological children.  A semen analysis will give a general overview of the fertility health of a patient. Additionally a physical exam together with a testicular ultrasound will aid a fertility specialist to determine the need for surgery. There are a number of surgical options that can improve male fertility such as varicocele repairs and sperm retrieval procedures.

Varicocele Repair

Varicoceles are basically enlarged veins as a result of pooling of blood in the scrotum. Most men are known to have them from as early as adolescence. They are usually painless and sometimes can be felt physically upon touch. The swelling may sometimes reduce when a patient lies on their back. These Varicoceles affect fertility in that the pooling of blood causes scrotal temperature to rise thus affecting sperm production and quality. There are several options for varicocele repair such as:

• Laparoscopic Varicocele Ligation is an out-patient procedure likely to take about 2 hours under general anesthesia. Small incisions are made in the abdomen and cameras and surgical equipment inserted to reach and clip the veins feeding the varicoceles. Post surgical pain is managed by painkillers and a patient is able to resume work in about 2 weeks.
• Microscopic varicocelectomy: Although this procedure may take longer than the laparoscopic option due to its complexity, it is similarly done under general anesthesia. Known for its efficiency and safety, it is considered as the best approach to varicocele repair. Small incisions are made in the abdomen to reach the swollen veins to redirect the blood to the inner thighs and pelvis. The recovery after this procedure is less painful and faster and it equally has a higher fertility success rate. 
• Varicocele Embolization: Performed under local anaesthesia and intravenous sedation; this is where a catheter is inserted into the enlarged vein and a small coil is used to block abnormal blood flow.

Sperm Retrieval Procedures 

Sperm retrieval procedures are usually done on men with no sperm in their ejaculate and sperm is removed directly from the testes. These procedures include:

• Testicular Sperm Aspiration (TESA): This procedure is done for prior vasectomy cases and involves the extraction of sperm directly from the testes under local anaesthesia mostly for In Vitro Fertility.
• Percutaneous Epididymal Sperm Aspiration (PESA): Done under local anaesthesia, a fine needle is injected into the epididymis for sperm retrieval for IVF.
• Micro Epididymal Sperm Aspiration (MESA): This is a micro surgical technique performed under general anaesthesia to harvest large quantities of sperm.
• Testicular sperm extraction (TESE): A tiny incision is made on the testes in search of sperm. It is coordinated with the female egg retrieval for fertilization. 
• Microdissection TESE (Micro TESE): This is done for men with trouble producing sperm. It is a microsurgical procedure done under general anesthesia to retrieve sperm.

IUI & IVF for Male Factor Infertility 

Intrauterine insemination (IUI) is a fertility treatment option where sperm is injected directly into the uterus for conception whereas In Vitro Fertilization (IVF) is when eggs are fertilized outside the uterus in a laboratory and the resulting embryo transferred in the uterus. These two are excellent Assisted Reproductive Technologies that can be utilized by individuals experiencing challenges with infertility, for successful conception. It is important however to improve sperm production and quality through lifestyle changes and other interventions before embarking on these procedures.

How ICSI (Intracytoplasmic Sperm Injection) Works 

Intracytoplasmic Sperm Injection (ICSI) is a kind of IVF and is often  recommended in cases of extreme male factor infertility and failed prior IVF attempts. A single sperm is carefully selected and injected into a mature egg to improve chances of successful fertilization. Similar to IVF, the resulting embryo is then implanted into the uterus. When the embryo attaches to the uterine lining, it is considered a successful pregnancy.

Choosing the Right Treatment Path at Facility Associates of Memphis  

Understanding the different treatment options available for male infertility will largely influence the choice of the right treatment path with the decision being affected by factors like age, underlying fertility issues, finances and personal preferences. Our specialist at Facility Associates of Memphis are committed to providing personalized specialized care and support on your journey towards parenthood. Book your appointment today to discuss the right treatment path available for you.

FAQs:

Who needs a sperm retrieval procedure?

Sperm retrieval may be necessary for men with azoospermia (absence of sperm in semen), individuals who have undergone a vasectomy, or those with specific genetic conditions that affect sperm production or transport.

What are the different types of sperm retrieval procedures?

• TESE (Testicular Sperm Extraction): Collects sperm directly from the testicles.
• Micro-TESE: A refined technique using a microscope for precise sperm extraction from the testes.
• PESA (Percutaneous Epididymal Sperm Aspiration): Draws sperm from the epididymis.
• MESA (Microsurgical Epididymal Sperm Aspiration): Uses a surgical microscope to retrieve sperm from the epididymis.

Is sperm retrieval painful?

These procedures are performed under local or general anesthesia, ensuring that any discomfort is kept to a minimum.

Can retrieved sperm be used for IVF?

Yes, retrieved sperm is often used with IVF and ICSI to facilitate egg fertilization.

What is the success rate of sperm retrieval procedures?

Success rates range between 50-90%, but is dependent upon the underlying cause of infertility and the treatment technique used.