Available treatments for male infertility include medication to increase sperm production, sperm aspiration for men who are physically unable to ejaculate, microsurgical reconstruction to remove obstructions in the sperm ducts and surgical repair of varicocele (varicose veins in the testicle). For men who have undergone a vasectomy in the past, the procedure can successfully be reversed using a microsurgical technique. Treatment options also include testicular and epididymal sperm extraction for in vitro fertilization procedures. These procedures allow some men who have no sperm in the ejaculate to be able to father a child.
Sperm Preparation Techniques
Sperm preparation techniques are considered one of the options for the treatment of male infertility. They are performed in conjunction with intrauterine insemination
, in vitro fertilization
, or intracytoplasmic sperm injection
. Using these techniques, viable, motile sperm is isolated and used for fertilization. Sperm could be isolated from seminal fluid, or in some cases from testis or epididymis in cases with genital tract obstruction. The choice of the sperm preparation method depends on the sample source and quality.
Special Treatments for Sperm
Several methods are available to enhance semen specimens that display signs of compromised. At ReproMed, we have solutions that compensate for inherent defects found in semen specimens. For example, we can overcome specimen hyperviscosity that impairs sperm recovery. We can also enhance sperm motility in specimens where negligible number of moving sperm is seen. In addition, the Andrology Laboratory under the supervision of Dr. Tamer Said is currently developing a revolutionary method that will significantly enhance the sperm fertilization potential. Please visit our Research page for more information regarding our innovative approach for sperm preparation.
Surgical Sperm Retrieval
Surgical sperm retrieval coupled with ICSI
was first introduced in 1993 for the treatment of men in whom no sperm could be found in the ejaculate due to obstruction in the genital tract. Soon thereafter, this technique was also used for men who had deficient spermatogenesis, i.e. non-obstructive azoospermia. Since the introduction of different sperm retrieval techniques in assisted reproductive programs, many men were offered the chance to father their own genetic children.
Percutaneous Epididymal Sperm Aspiration
Percutaneous epididymal sperm aspiration (PESA) is a minimally invasive technique of sperm retrieval that may be performed in an outpatient clinic setting under local anesthesia. While holding the testicle between the index finger and the thumb, a butterfly needle is directly passed through the scrotal skin into the epididymis. PESA was reported to be successful in 62% of cases diagnosed with obstructive azoospermia. It has been reported that PESA may be repeated on the same epididymis up to three times, with good opportunity to retrieve sufficient motile spermatozoa for ICSI. PESA carries many advantages as it offers minimal discomfort for the patient, low complication rate compared to open surgery, repeatability and the production of clear aspirated fluid with usually minimal blood contamination and less debris.
Micro-Epididymal Sperm Aspiration
Micro-epididymal sperm aspiration (MESA) was the first surgical sperm retrieval method introduced that involved the epididymis. MESA is performed by applying an incision in the upper scrotum to expose the epididymis. Suitable dilated epididymal tubules are identified under the microscope. Thereafter, fluid and sperm are aspirated with a needle. MESA is the preferred method in patients with an incomplete work-up because if indicated, a vasoepididymostomy can be performed concomitantly with a full scrotal exploration. Our Male Fertility Specialists have highly developed microsurgical skills that enable the performance of sophisticated techniques such as MESA.
Testicular Sperm Extraction
The procedure is done via a routine testicular biopsy and the extracted tissue is manipulated to extract sperm. Thereafter, the resulting sperm would be used for ICSI. The technique was used successfully in cases of bilateral congenital absence of the vas when epididymal spermatozoa could not be retrieved. The incidence of success of TESE-ICSI is relatively high (33% delivery per cycle). Later on, the same technique of TESE–ICSI was found to be successful in 50% of cases diagnosed with defective spermatogenesis. Several approaches have been described for isolation of the rare spermatozoa present in the testes of men with limited sperm production. The most successful approach employed at ReproMed is microscopic TESE. This approach allows the direct identification of the testicular foci that display signs of active sperm production.
Microsurgical Reconstructive Surgery
Refined microsurgical reconstructive techniques (vasovasostomy and vasoepididymostomy) allow men with genital tract obstruction whether in the epididymis or in the vas deference to have the opportunity to father their own biological children. At ReproMed, our Male Fertility Specialists use the most advanced microscopic approach to bypass obstruction in the male genital tract. The indication for recommending and performing a vasoepididymostomy is the presence of sperm production in the testis and an evidence of an epididymal obstruction and an open vas deferens.
Vasovasostomy is mainly indicated for vasectomy reversal The number requesting surgical reversal has grown dramatically. Estimates indicate that 2 to 6% of vasectomized men ultimately seek reversal. Changes in social status such as divorce with subsequent remarriage is by far the most common reason given for requesting reversal. In developing countries, the death of a child is the most common reason.
Varicocele is found in approximately 10-15% of unmarried military recruits, 35 % of infertile men who have never fathered a child and 81 % of men who were once fertile but are now infertile (secondary infertility). Repair of varicocele will relieve pain in symptomatic cases and improve semen parameters, testicular function, and pregnancy rates in couples with male factor infertility associated with varicocele. Studies have shown that varicocele repair can improve all three of these parameters. Today there are many techniques for varicocele repair that will influence the chances of a poor outcome or complications. The use of a microscope as employed at ReproMed enables the surgeon to ligate all affected veins while preserving the tiny artery that brings blood to the testes.
Please contact us if you require further information regarding our Male Fertility Services.