There are many treatments for male infertility, depending on the cause and severity of the problem and whether or not the female partner has any conditions contributing to infertility. Although not all types of infertility can be treated, most can be overcome through assisted reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
Blockages and other physical fertility problems can often be addressed with surgery. Generally, these are outpatient procedures that can be performed under local or general anesthesia and require only short recovery periods. If the blockage being treated is the sole source of infertility, the chances of conceiving naturally after surgery are usually excellent. If there is major impairment of sperm production, after TESE procedure (surgical removal of the sperm), IVF with ICSI is performed.
Learn more about surgical options in the section on azoospermia below.
When male infertility is the result of obesity or environmental factors, the best treatment option is usually to make lifestyle changes that eliminate the problem. These changes, losing weight, quitting smoking, and avoiding exposure to harmful chemicals, as these will not only improve fertility, but also overall health. Several nutritional products (Conception XR - ConceptionXR.com; COAST Male Fertility Supplement - CoastReproductive.com) ontaining antioxidants such as Vitamin C, Zinc, and Carnitine, may also improve sperm production and function. CoQ10 supplement is a vital antioxidant that improves sperm productions and function.
To learn more about lifestyle changes, read the article above under the environmental and lifestyle causes section.
Some hormonal imbalances and certain other conditions may be treatable with medication. If the source of male infertility is an infection, medications can help to treat the infection, but it will take two to three months before the effects will be detectable through a semen analysis, as sperm cells must mature over time.
If low testosterone is a contributing case, Letrozole or Clomid® (by stimulating FSH production) may be utilized to improve sperm production and increase testicular testosterone production. Administering testosterone to a man will actually decrease his sperm production! (see Dr. Jacobs' blog on August 1, 2013)
Intrauterine insemination (IUI) can often overcome male factor problems by significantly increasing the number of motile sperm that can enter the fallopian tubes after placement in the uterus.
In vitro fertilization (IVF) is a highly effective method of bypassing many types of infertility. If sperm production is particularly low or if there is a high number of abnormal sperm cells, intracytoplasmic sperm injection (ICSI) may be used. ICSI is an advanced IVF technique that can improve the chances of successful pregnancy by increasing the number of eggs that are fertilized by microscopically placing normal appearing sperm into each egg. Certain causes of male infertility prevent sperm from being carried out of the testicles, despite adequate production. In these cases of obstructive azoospermia, a Percutaneous Epididymal Sperm Aspiration (PESA) can be performed to collect sperm cells directly from the epididymis for use in IVF. In cases involving non-obstructive azoospermia with impaired sperm production, TESE may be performed to obtain sperm for IVF/ICSI.
Azoospermia is a condition where no sperm are found in the ejaculated semen. In cases with low ejaculatory volume (less than 1 ml) retrograde ejaculation should always be ruled out. Azoospermia may be caused by obstruction of the epididymis or vas deferens (called obstructive azoospermia or OA) or there may be problems associated with defective spermatogenesis (called non-obstructive azoospermia or NOA). A general urologist or specialist andrologist can usually distinguish between the two types by measuring testis size, FSH hormone levels, and occasionally a biopsy of the testis is necessary.
Obstructive azoospermia (OA) may be associated with congenital defects such as congenital bilateral absence of the vas deferens (CBAVD), often associated with cystic fibrosis or may also be due to injury, infection or elective vasectomy. If the obstructive azoospermia can be corrected surgically, this is often a more cost-effective option. If surgical repair or reconstruction is not possible, or is ultimately not successful, then sperm must be extracted from either the testis or epididymis. The extracted sperm can then be utilized with in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). In these cases, extraction of sperm from the epididymis is often easier, yielding abundant sperm. For obstructive azoospermia, MESA, (microscopic epididymal sperm aspiration) or PESA (percutaneous epididymal sperm aspiration) are usually successful due to abundant sperm. MESA will often yield a better sample however.
Non-obstructive azoospermia (NOA) associated with defects in spermatogenesis may also be congenital or can be acquired later in life due to injury or infection. In some cases, pre-treatment with medications such as clomiphene citrate to stimulate spermatogenesis may help as adjunctive therapy prior to sperm retrieval. In cases of severe oligospermia, (sperm count less than 5 million/ml) and especially with azoospermia, genetic screening may be very helpful. For example, the chance of finding sperm in men with NOA is essentially 0 percent if they have a genetic microdeletion of the Y chromosome at the AZF A or B locus. On the other hand, cases caused by mumps, torsion, cryptorchidism or idiopathic causes may be associated with a 50-70 percent chance of finding sperm. In cases of non-obstructive azoospermia, sperm are generally extracted from the testis by various methods. In approaching an NOA patient, it is very important to determine a) who has sperm? and b) where is it? Microdissection TESE (testicular sperm extraction) is often successful due to the concept that the seminiferous tubules containing sperm are "thicker" than those that don't. General anesthesia and 25 times magnification are required. Another successful technique involves office FNA mapping (fine needle aspiration) followed then by directed TESE. This can often be done with local anesthesia and no need for an operating microscope.
In cases of OA and NOA involving both epididymal and testicular sperm extraction, the IVF/ICSI pregnancy rates appear to be essentially the same with fresh or frozen sperm. Since IVF/ICSI is far less than 100 percent successful, it behooves the reproductive urologist or andrologist to utilize sperm retrieval techniques that are reliable, associated with low morbidity, but also have the potential to harvest sufficient sperm in order to enable cryopreservation for future IVF/ICSI attempts.
In obstructive and non-obstructive azoospermia, a urologist or andrologist can use many different methods for extracting sperm from the testis and/or epididymis including open surgical extraction, microsurgery, as well as needle aspiration. With obstructive azoospermia, since larger numbers of sperm are present all choices are possible, but extraction of sperm from the epididymis is often easier. However, with non-obstructive azoospermia, in order to obtain enough sperm from the testis, open surgery, microsurgery and/or directed multiple needle punctures are required.
Contact our practice for more information about male infertility or semen analysis. We serve Chicago, Illinois and all of the surrounding communities.