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Infertility Services – Male Infertility

This is a condition that by itself affects up to 40% of couples facing infertility problems. An additional 20% of infertile couples have combined male-female factor infertility. These figures suggest that the relative incidence of male related infertility problems may be approximately the same as female problems. In fact all over the world, the sperm concentration in the ejaculate is dropping and the cause is still unknown. Though this phenomenon has not caused a reduction in the chances of fathering a child, it may do so in the future. Industrialization has been suggested as a cause but solid evidence is still lacking.


Diagnosis


The most significant element when dealing with male-factor infertility is to establish the correct diagnosis. We cooperate with your urologist and will assist him/her through our Andrology Laboratory to reach the appropriate diagnosis of your condition. Some infertility problems are just a manifestation of more severe medical conditions that if not diagnosed properly may become life threatening or may affect the offspring. The first step is to have a semen analysis and genital examination done at the Center. Based on the test we could advise you on the appropriate treatment plan.


Laboratories


We seek to help you overcome your infertility problem by offering alternatives that might eventually lead to the birth of a baby. However, we do not treat the causal factors of infertility that the urologist traditionally treats. Once the cause of male infertility has been diagnosed, the Center can help you with a range of seminal tests and evaluations from semen analysis to other specialized sperm function testing. These include hemizona assay, sperm antibody and leukocyte quantitation, in-vitro cervical mucus penetration test, acrosome reaction, SCSA, and sperm overnight culture. Also, we have the capability to freeze your sperm (sperm banking) if it is necessary.


Treatment


The information generated from the quantitative and functional tests performed at the Center for Reproductive Medicine and Robotic Surgery is utilized by our staff to implement an individualized infertility treatment. The objective of our treatment is to help you and your partner achieve pregnancy. Depending on the severity of the male factor infertility and on the medical history of your partner, we may suggest you utilize the least invasive modalities for infertility such as intrauterine inseminations (IUI), or In-Vitro Fertilization if the counts of motile sperm are such that a series of IUIs may not be effective. Usually these treatments require that the male partner should be able to provide at least two (for IVF) or five (for IUI) million motile sperm. If the sperm counts are below the above limits, there is still the option for sperm banking to overcome this problem. Donor semen is also available.


ICSI


ICSI is usually the best answer for male factor infertility.

The spermatozoa collected are used to fertilize mature oocytes. Since a low number of spermatozoa may be obtained, the oocytes are fertilized by Intra Cytoplasmic Sperm Injection (ICSI). This procedure optimizes the sperm number since only one motile sperm cell is required per oocyte. Without this method the probability of fertilization and pregnancy for such men is less than 1%. However, when PESA or TESA and ICSI are combined, the probability of fertilization and pregnancy reaches values similar to those observed in conventional IVF.



Treating the most severe cases of male infertility with ICSI


There is a population of patients that may not be able to benefit from IUI or conventional IVF due to inadequate numbers of sperm or fertilizing functional ability of sperm. In the past, the only alternative for patients under this classification was to use donor sperm or to consider adoption. In 1991, a procedure called Intra-Cytoplasmic Sperm Injection (ICSI), which consists of the direct injection of a single sperm into an egg, was perfected. ICSI enhances the probability of achieving pregnancy in even the most difficult of male infertility cases.


When to utilize ICSI


Moderate cases of male factor infertility may be successfully treated by conventional IVF treatment. However, ICSI now offers a new dimension of treatment for all more severe forms of male infertility. ICSI may be indicated when: 1. Patients present low sperm density, motility, poor morphology, sperm antibodies or low scores in functional bioassay. 2. Cases with less than 50% fertilization or total fertilization failure in previous IVF attempts. 3. For azoospermia or lack of spermatozoa in the ejaculate when sperm aspiration is necessary.


Azoospermia


Azoospermia may just be a symptom of deeper medical conditions. Therefore, proper identification of these conditions is of major clinical relevance. The four main causes of azoospermia will be discussed in Male Factor Offspring.


Male Factor Offspring


Male Factor Infertility and Your Offspring
In cases such as Acquired Obstructive Azoospermia (vasectomy, failed vasectomy reversal, inflammatory lesions due to infection) or Inability to Ejaculate (spinal cord injuries, surgery, psychological causes or retrograde ejaculation) no major effects on the offspring over naturally occurring rates should be expected. However, in other conditions such as Congenital Absence of the Vas-Deferens or Testicular Insufficiency (low sperm counts and motility) additional tests may be indicated to rule out the presence of other problems that may affect your offspring.Note there are many more genetic abnormalities associated with male infertility, than in the female.


Read below to Learn More about Male Infertility Treatment


Causes of Male Infertility


Today, male infertility is not an uncommon occurrence with almost 40% of all cases of fertility issues being related to the male. In the past, there were not many options available for male infertility treatment. However, recently there have been large improvements in medical technology and options depending on your circumstance. The first step is to determine the cause of male infertility so that these advanced reproductive technologies can be used to achieve your dream of fathering a child.


Blockages


One of the common problems of male infertility is blockages of the reproductive tract which reduces the amount of sperm that can be ejaculated. Blockages can become so severe that it completely prevents sperm from getting out. Successful treatment for this male infertility involves surgery to remove the blockage. There are also new methods to retrieve the sperm from the testes using microsurgical assisted reproductive technologies.


Varicocele


Varicocele is a condition where dilation of veins in in the scrotum occur which reduces the production of sperm. Men with this condition may produce sperm that are abnormal in shape as well as have poor oxygen and blood supply to the testes. Male infertility treatment for this condition is available by surgically cutting the veins connected to the varicocele to relieve the pressure. Since this surgery is very invasive it is only recommended if the varicocele is very large. It is important to catch this kind of infertility problem early as varicoceles that have been present for a long period of time will often cause irreversible damage.


Hypothalamic and Pituitary Deficiency


In a small amount of cases (about 1 to 2 percent) the cause of male infertility is due to problems producing hormones in the hypothalamus and pituitary gland of the brain. When this occurs men can stop producing sperm altogether. In this case gonadotropin hormone therapy is necessary with human chorionic gonadotropin (hCG) and recombinant human follicle stimulating hormone (rhFSH). With gonadotropin treatment many injections have to be given on a weekly basis for up to six months. Blood tests are often needed to monitor testosterone levels and ensure the proper dose is being given.
This form of male infertility treatment requires a large amount of commitment, sometimes consisting of several years of treatment but the success rate is high. In many instances of gonadotropin treatment, men did begin producing sperm again on their own and could achieve normal fertility. The cost of this treatment can also be very expensive, especially if your health insurance does not cover it.


Male Infertility Treatment Options


Once the cause of the male infertility is determined, a course of action may be possible. Not all cases of male infertility are treatable if they involve severe damage to the testes or are due to abnormal development. But due to recent advancements in reproductive technology, we can extract sperms directly from the testes of men with total azoospermia (total absence of sperms in the ejaculate) using microsurgical testicular sperm extraction. Here using high tech procedures sperms are extracted directly from the testes without even making a cut on the scrotal skin. Hence it has minimal pain and rapid recovery with no skin incision. The sperms obtained are frozen and used in IVF treatment. However, it is important to catch problems as soon as possible as this can impact the available treatments. We have many advanced screening procedures available to find the cause of infertility as well as options for treatment. If you and your spouse are having trouble with fertility, give us a call to schedule a consultation. The Center for Reproductive Medicine and Robotic Surgery is a leading center nationally and internationally in the treatment of male infertility and offers these advanced microsurgical testicular sperm extraction technologies.


At The Center for Reproductive Medicine and Robotic Surgery(CRMRS) we provide private, professional and compassionate fertility care. Dr. Jacob and our reproductive team provide a very personalized approach, from diagnostic assessment and early intervention through high-tech procedures like In Vitro Fertilization (IVF), and Intracytoplasmic Sperm Insertion (ICSI), intrauterine insemination (IUI) and Pre-Implantation Genetic Testing – Aneuploidy (PGT-A).

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