MALE FERTILITY TREATMENT
Some couples with infertility caused by disorders of sperm number or function may be successfully treated with either intrauterine insemination (IUI) or in vitro fertilization (IVF). In the case of the IUI cycle, a woman is typically taking fertility drugs to stimulate the development of more than one egg in the same cycle. This can be effective in couples when there is a mild abnormality in sperm counts. However, when there is severe impairment of sperm count, motility, or shape, IVF is usually the best treatment option for infertile couples.
Intracytoplasmic Sperm Injection (or ICSI)
ICSI has revolutionized the way we can treat male infertility. Even men with no sperm in their ejaculated sample, pregnancy may be possible with this technique. In this circumstance, a urologist can extract sperm from the man’s epididymis or testicle for use in IVF. With ICSI, a specialized glass needle is used to inject a single normal sperm directly into the center (cytoplasm) of the egg under the guidance of a specially fitted microscope. The success rate with this technique varies considerably among IVF programs and is highly dependent upon the skill of the embryologist performing the procedure.
Candidates for ICSI include men with:
- Severely compromised sperm parameters, including concentration, motility, morphology, or antisperm antibodies.
- Blockage or absence of the vas deferens, where sperm is surgically collected by microsurgical epididymal sperm aspiration (MESA) or testicular biopsy for ICSI.
- Those who had low or failed fertilization on prior IVF attempts.
- Unknown infertility after all diagnostic tests are completed. Our IVF pregnancy rates with ICSI are equivalent to those of couples with non-male factor infertility who do not require ICSI.
When sperm cannot be retrieved through ejaculation, there are several procedures that are typically performed by a urologist to safely retrieve healthy sperm from the testes or the epididymis (the tube that connects the testicle to the vas deferens).
Types of Sperm Retrieval
Depending on your personal situation and diagnosis, your doctor will determine the best method of sperm retrieval that is right for you. Examples of sperm retrieval procedures include:
Testicular Sperm Aspiration (TESA)
TESA is a procedure in which a fine needle and syringe are used to extract sperm from the testicles. This procedure requires a local anesthetic and takes about 20-30 minutes. TESA is treatment option for men who have had a vasectomy, or for men who cannot produce sperm in the ejaculate but are producing sperm in the testicles.
Testicular Sperm Extraction (TESE)
TESE is a surgical procedure that is performed under a microscope to make tiny incision inside the scrotum in the testes, removing a small portion of testicular tissue and extracting viable sperm. TESE is often performed in the urologist’s office with a nerve block or can be performed under anesthesia in a surgical center.
Microsurgical Epididymal Sperm Aspiration (MESA)
MESA is a minimally invasive procedure which involves making a small incision to access the epididymis and the use of microscope to help retrieve sperm from the epididymis tubes. MESA is performed under general anesthesia by a highly skilled micro-surgeon.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA involves inserting a needle attached to a syringe into the epididymis to gently remove the fluid. PESA is performed under local or general anesthesia and is a treatment option for men with obstructive azoospermia.
Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro-TESE is procedure which involves s small incision in the outer cover of the testicle, which is opened and the inside is checked for areas more likely to be making sperm. This technique is done by a urologist trained in microsurgery.
Using Retrieved Sperm in IVF with ISCI
Once the fluid and/or tissue is sperm is retrieved, the sperm cells are prepared and can be injected directly into the egg via intracytoplasmic sperm injection (ICSI). The viable embryos can then be transferred to the female partner’s uterus.
Couples who have been diagnosed with severe male factor infertility or if the male is a carrier of genetic condition and does not plane to pursue preimplantation genetic testing, donor sperm is a treatment option. Donor sperm can be used for IUI or in vitro fertilization.
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