Male Factor Infertility

That Can Be Treated

Male Factor Infertility is very common and can be treated at the Center for Reproductive Health through treatment options that include Intrauterine Insemination (IUI) or Intracytoplasmic Sperm Injection (ICSI).

Male factor infertility affects about 50% of couples who experience infertility. The term ‘Male Factor Infertility’ refers to a couple’s inability to become pregnant due to abnormality in sperm production, function, or delivery. In 30% of couples, male factor is the sole cause of infertility. There are several different possible diagnoses for male factor infertility including:

• ­   Structural Abnormalities

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  • Congenital defects

  • Vasal obstruction

• ­   Sperm Production Disorders

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  • Vasectomy

  • Varicocele

  • Low sperm production

  • Abnormal sperm morphology

  • Azoospermia

• ­   Ejaculatory Disturbances

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  • Impotence

  • Ejaculatory dysfunction

  • Premature ejaculation

• ­   Immunologic Disorders

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  • Cystic fibrosis related infertility (CF carrier)

  • Hormonal Imbalance

  • Antisperm Antibodies

Because there is such a wide array of causes for male factor infertility, it is very common and is nothing by which to be discouraged. The Center for Reproductive Health offersa variety of correctional services to help solve male factor infertility. Our board-certified urologist provides advanced reproductive care to identify and treat male infertility issues that a couple might be facing. Several options are availablefor patients, including vasectomy reversals, depending on their diagnosis/condition.

Fertility Options for Men with abnormal sperm:

• ­Surgical correction of a varicocele or vassal obstruction

• ­Hormonal medications to treat a hormone imbalance

• ­Antibiotic therapy to treat infections

• ­MESA(Mircosurgical Epididymal Sperm Aspiration)

• ­TESA (Testicular Sperm Aspiration)

• ­PESA(Percutaneous Epididymal Sperm Aspiration)

• ­MESA, TESA, and PESA are used in order to extract sperm to use for ICSI (Intracytoplasmic Sperm Injection) in In Vitro Fertilization

Fertility Options for Men with abnormal sperm:

• ­Vasectomy reversa

• ­PESA (Percutaneous Epididymis Sperm Aspiration)

• ­TESA (Testicular Sperm Aspiration

• ­MESA (Mircosurgical Epididymis Sperm Aspiration)

• ­MESA, TESA, and PESA are used in order to extract sperm to use for ICSI (Intracytoplasmic Sperm Injection) in In Vitro Fertilization

TESA (Testicular Sperm Aspiration)

• TESA is a method of extracting sperm from the testis using a fine needle to obtain a small sample of tissue to be examined under a microscope. If sperm are not found in the sample, the doctor will continue the procedure with a small incision in the scrotum and testis where the sperm can be aspirated.

PESA (Percutaneous EpididymalSperm Aspiration)

• PESA involves the same technique as TESA but the needle is placed directly into the epididymis to extract the sperm.

MESA (MircosurgicalEpididymalSperm Aspiration)

• MESA is a method that uses a surgical microscope to locate the tubules of the epididymis precisely in order to retrieve a large number of sperm from the epididymal tubes with a small needle.

ICSI (Intracytoplasmic Sperm Injection)

• The sperm extracted from TESA, PESA, and MESA are usually used to fertilize the egg through Intracytoplasmic Sperm Injection or ICSI. This method involves injecting the aspirated sperm into the partner’s egg with a very small needle. The fertilized egg is then put back in the female’s uterus to implant naturally.

Vasectomy reversal

• If you have undergone a vasectomy surgery in the past and want to build a family now, one option for you is a vasectomy reversal surgery. The surgery entails reconnecting the parts of the vas deferens that were previously disconnected during the vasectomy surgery. During the reversal, the doctor will cut a very small incision into each side of the scrotum. He will then use very small stitches to connect the ends of the vas deferens after they are trimmed and recuperated.

The Center for Reproductive Health can evaluate and treat the following:

• ­Advanced sperm function

• ­Vasal obstruction

• ­Cystic fibrosis related infertility (CF carrier)

• ­Ejaculatory dysfunction

• ­Abnormal sperm morphology

• ­Vasectomy

• ­Low sperm production

• ­Premature ejaculation

• ­Impotence

• ­Congenital defects

• ­Azoospermia

• ­Immunologic Disorders

• ­Hormonal Imbalance

• ­Antisperm Antibodies

Intrauterine Insemination (IUI)

Also called artificial insemination, Intrauterine Insemination (IUI) involves sperm being inserted into the woman’s uterus at the time of ovulation.

Treatment Details

The goal of Intrauterine Insemination (IUI) is to increase the number of sperm that reach the fallopian tubes, which in turn, increases the chance of fertilization. The sperm may come from the male partner, from a sperm donor, or some from both.

The sperm sample is “washed,” meaning the highest quality sperm is separated and concentrated before insertion.

The IUI process is easy, quick, and usually painless. Intrauterine Insemination can be performed during a natural ovulation cycle, but may work best if a regiment of medications is employed first to promote the development of more ovarian follicles.

After the administration of the ovulation induction medication, the follicular development is monitored by pelvic ultrasound.

The final sperm sample will be placed inside the endometrial cavity using a catheter specially designed for IUI.

This procedure may be selected as a treatment for patients with any of the following conditions:

• ­Unexplained infertility

• ­Low sperm count

• ­Decreased sperm motility

• ­Need for donor sperm

• ­Ejaculation dysfunction

• ­Semen Allergy

• ­Hostile cervical condition

• ­Cervical scar tissue

Intracytoplasmic Sperm Injection

Intracytoplasmic sperm injection or its acronym ICSI (pronounced “icksy”) is a procedure used in assisted reproduction treatment in which a single sperm is injected directly into an egg. ICSI requires a woman to undergo an IVF cycle so that eggs can be obtained for insemination.

When is ICSI used?

ICSI was originally used to overcome male infertility problems, such as low sperm count (oligospermia), poor motility or movement (asthenozoospermia), and in cases where sperm morphology (sperm shape or what they look like) is abnormal (teratozoospermia).

ICSI is commonly used in cases where sperm are harvested from the male reproductive tract (epididymis or testis) as in cases of previous vasectomy, other obstructions, or because of problems with sperm production requiring intervention by a urologist to obtain sperm either by percutaneous epididymal sperm aspiration (PESA) or testicular epididymal sperm aspiration (TESA).

ICSI is also performed in cases where prior fertilization attempts using standard insemination (10,000 sperm added to each egg) failed to fertilize the eggs, and in cases where there may be a low number of eggs obtained or if eggs are thought to be of poor quality.

Most recently, ICSI has been used in many IVF centers to simply maximize fertilization; many barriers to fertilization can be overcome with this innovative but labor intensive procedure.

How is it done?

ICSI is performed under a microscope using micromanipulation devices. A holding pipette stabilizes the mature egg with gentile suction using a specially designed aspiration device. Another tool holds a very fine glass micropipette containing a sperm that had been previously picked up into the needle.

The micropipette is inserted into the center of the egg so the sperm can be gently injected into the egg. The needle is then removed.

Following ICSI, the egg with the injected sperm is placed into cell culture and checked the following day for signs of fertilization.

What is its success rate?

A position paper published by the Practice Committee of the American Society of Reproductive Medicine has stated that it considers ICSI safe and effective therapy for male factor infertility.

Both success rates and costs vary greatly between different IVF centers. The fertilization rate within the IVF Laboratory at The Center For Reproductive Health is exceptional (over 85%), and our costs for this procedure are highly competitive in the region. ICSI may not be for everyone, but for those who otherwise could not be parents, ICSI offers them the potential to achieve their dream of having a successful pregnancy.

Epididymal and microsurgical sperm aspiration

Are also available as a treatment for Male Factor Infertility.

This is an effective procedure in previous vasectomized males who are either expected to fail through a vas reversal or in males with significant sperm antibodies.

Epididymal sperm aspirations can be done without surgery, without discomfort, much lower expenses and greater success rates.