In recent years there has been a sharp increase regarding the unlikelihood of spontaneous fertilization, this is due to a number of male and/ or female factors. A couple are considered infertile when they are unable to conceive naturally after a year. According to scientific research, about 15% of couples are unable to conceive naturally. Male infertility accounts for 40% of infertility cases due to underlying disorders.
Unexplained fertility is a phenomenon defining 15% of infertile couples that undergo all required tests, without reaching a diagnosis from a physician.
Causes of Male Infertility
In the complex mechanism of the male reproductive system, a few possible factors lead to the development of male infertility, the main reasons are:
- Hormonal dysfunction as a consequence of congenital or acquired disorders of the endocrine glands
- Genetic mutations that lead to anatomical or physiological disorders of male genital organs
- Erectile dysfunction and premature ejaculation or difficulty
- Neurological diseases, including the effects of trauma and spinal and pelvic injuries
- Consequences of infectious and inflammatory diseases of the male genital organs and prostate
- Metabolic disorders
- Autoimmune diseases
- Cryptorchidism (undescended testicles)
- Varicocele - varicose veins in the testicle
- Hypospadias - abnormal exit opening of the urethra
- The impact of drugs, including the uncontrolled use of anabolic steroids
- The impact of alcohol, smoking, and household chemicals containing heavy metal salts
- Exposure to ionizing radiation
- Prolonged overheating of the testes associated with a sedentary lifestyle, the specifics of some professions and some sports (cycling)
Types of male infertility
AsthenospermiaAsthenozoospermia (or asthenospermia) is the medical term for reduced sperm motility. Complete asthenozoospermia may be seen in metabolic deficiencies, ultra structural abnormalities of the sperm flagellum and necrozoospermia.
It decreases the sperm quality and is therefore one of the major causes of infertility or reduced fertility in men.
AzoospermiaAzoospermia is the medical condition of a man not having any measurable level of sperm in his semen. It is associated with very low levels of fertility or even sterility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations.
OligospermiaOligozoospermia, refers to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility (technically "oligoasthenoteratozoospermia").
TeratospermiaTeratospermia or teratozoospermia is a condition characterized by the presence of sperm with abnormal morphology that affects fertility in males.
Diagnosis of Male Infertility
- General Physical Examination and Medical History
- Scrotal Ultrasound
- Transrectal Ultrasound
- Hormone Testing
- Testicular Biopsy
- Anti-Sperm Antibody Tests
- Specialized Sperm Function Tests
Intracytoplasmic Sperm Injection (ICSI)
Intra-cytoplasmic sperm injection (ICSI) is a procedure consisting of injection of a single sperm directly into an egg in order to fertilize it. This fertilized egg (embryo) is then transferred to the uterus of the expecting mother. The procedure for ICSI is similar to that for IVF. The difference is that whereas in the IVF process the fertilization is induced in a dish, in ICSI the physician selects sperm from a given sample and then a single sperm is directly injected into each egg. ICSI is known to be the most successful form of fertility treatment and forms almost half of all assisted means reproduction methods.
Process of ICSI
The ICSI process consists of the creation of several mature eggs. It is possible that you will be given fertility drugs to encourage your ovaries to produce several eggs for fertilization The ICSI process is commonly used by couples who are experiencing the condition of male factor infertility. It is also used by couples who have tried other assisted means in the past and have not been successful.
There are five major steps in the process
- The male member is asked to produce a sperm sample or one is surgically extracted from him.
- The eggs are surgically extracted from the female member
- Using a small hollow needle the sperm is injected into the egg
- The fertilized egg is now kept under observation and its development is tracked systematically
- Once it is assured that the embryo is showing all signs of normal growth , the embryo is implanted into the uterus and allowed to mature and grow
Both fresh sperms and frozen sperms may be used for the process. The process happens using a method called micromanipulation. This uses a special tool along with specialized equipment to pick up a single sperm and directly inject it into the egg. A cycle of ICSI treatment takes from four to six weeks. In the first case the couple has to spend a day at the clinic for egg and sperm retrieval procedures.
A simple method of obtaining a semen sample is called percutaneous epididymal sperm aspiration (PESA). Simply put, it is a sperm retrieval technique. This technique is helpful for men who are suffering from conditions such as obstructive azoospermia, ejaculatory duct obstruction, and congenital bilateral absence of the vas deferens. Even though the sperm production is normal in these men, the sperm parameters may decrease due to chronic obstruction. Microsurgical techniques are used to extract the sperm.
Men who have severe azoospermia and vasectomy may not be able to conceive. The advent of ICSI made this possible. They can become fathers if sperm can be found in their testicles or in the epididymis. Percutaneous epididymal sperm aspiration makes this possible. It is an in-office procedure where the sperm is collected from the epididymis by inserting a needle through the skin of the scrotum. Sperm may be extracted through open microsurgical techniques or percutaneous sperm retrieval. A butterfly needle is used to extract sperm in percutaneous sperm retrieval.
PESA is a less invasive technique with minimal risks and complications. It can produce enough sperm for ICSI procedure. Men who have nonobstructive azoospermia will have lower fertilization rate as compared with others as they may have impairment of normal spermatogenesis. In such cases, sperm may not even be found in their epididymis. Such cases may require an open testicular biopsy or fine-needle aspiration of the testes for sperm retrieval.
Microsurgical epididymal sperm aspiration is performed as an open operation under the operating microscope. Individual tubules of the epididymis are isolated and micropuncture aspiration is taken. This approach has the advantages of reliable retrieval of large numbers of epididymal spermatozoa that can be readily frozen and thawed for subsequent attempts at fertility. Since MESA involves direct retrieval of spermatozoa from the epididymal tubule, it minimizes the contamination of the epididymal fluid by blood cells, which may affect spermatozoa fertilizing capacity during the IVF.
TESE is performed as an outpatient procedure and the patient is discharged within 2 hours after the surgery. The night before surgery, the patient should shave scrotum, penis and groin perfectly and clean them. On the day of surgery, the patient with a companion goes to the surgical center while fasting. If the patient is taking medicine for a particular disease, on the day of surgery can take the medicine with some water. TESE is done in the operating room in sterile conditions under local anesthesia. However, if the patient had multiple surgeries before, or if he insists, local anesthesia, besides intravenous administration of sedative medications can both be applied under supervision of a specialist.
Varicocele is a disease in which the testicular veins are dilated resulting in infertility. Pain and testicular diminution are common symptoms of varicocele. This defect can be rectified only through a surgical procedure known as varicocelectomy. A study conducted on 98 patients has revealed that 72 % of the patients were having left varicocele and 28 % were having dual varicocele. This procedure is normally carried out as a laparoscopic surgery as a one day procedure.
This procedure is carried out under general anesthesia. The bladder of the patient will be emptied using a urethral catheter. With the help of carbon dioxide, the peritoneal cavity will be inflated to get a clearer view and make the surgery easier. Through a small incision in the abdomen a laparoscope will be inserted. The camera on top of the laparoscope helps the surgeon to view the site of operation and the organs situated therein. Miniature instruments for conducting the surgery are pushed through other small incisions made near the incision for the laparoscope. Witht the help of laser beam the surgeon cuts the posterior peritoneum. Doppler test is made use of for identifying spermatic artery. The surgeon clips the gonadal veins using endoscopic clip leaving the artery untouched .
Sperm cryopreservation additionally known as sperm solidifying and sperm managing is the process of storing and conserving sperms that can be used in future. Many times it so happens that the heath of the sperm is harmed because of maturing, restorative medicines, and diseases so men, who wish to store the semen for future utilization, sperm cryopreservation is the well-suited decision. However it can't be specified as to how long the sperm might be put away without being damaged or ineffective; in few instances where the sperms have been put away for 20 years have been seen to work effectively in pregnancy.
These stored sperms are utilized as a part of the infertility treatments like IUI, IVF and ICSI. It might be also be utilized for sperm donning where the beneficiary needs the medicine in an alternate time or place, or for men experiencing a vasectomy to still have the alternative to have children. If you need sperm cryopreservation, without hesitation come to us, our specialists will give you every support and the right treatment you need.