Any fertility treatment can have an effect on semen quality roughly three months after it is began, which is the length of time required for one cycle of spermatogenesis (sperm production). If medical or surgical therapies are not appropriate, assisted reproductive technology (ART) can help the couple achieve pregnancy. When choosing treatment options, consider your long-term goals, results of the female’s evaluation, and financial concerns.
The most successful treatment for male infertility involves reversing infectious, chemical, or endocrine imbalances. This is called “specific therapy,” and it is successful for many men because treatment focuses on correcting well-defined problems. Examples of specific therapy are:
Treatment for varicocele, acute prostatitis, and/or epididymitis
Administration of testosterone for hypoandrogenic hypogonadism
Replacement of pituitary hormones for radiation or surgically induced pituitary disease
Another type of treatment is empiric therapy, which attempts to correct ill-defined conditions. Empiric therapy involves use of clomiphene citrate, ProXeed, or tamoxifen for low sperm density or sperm movement (motility) issues. These medications are often limited because many intact mechanisms in the man’s body counteract the intended effect.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a technique that helps achieve fertilization for male factor infertility problems, such as low sperm count, problems with sperm shape, and issues with sperm motility. The procedure helps a man overcome many barriers to fertilization, and gives couples hope for achieving pregnancy. First developed San Francisco at the UCSF Medical Center, this technique involves using microtechnology to insert a single sperm into the female’s egg.
After the female partner undergoes ovarian stimulation using fertility medications, many eggs develop. These eggs are removed from the ovaries, and then incubated in the laboratory. The man gives a semen specimen, and the sperm is prepared in the laboratory to remove dead sperm and debris (a process known as washing). The specialist uses a tiny glass needle to insert the sperm into the egg, which involves a microscope. Fertilization rates with ICSI are 70-80%.
Vasal Aspiration Sperm Extraction
Sperm aspiration involves a minor surgical procedure to collect sperm from the ductal system. This is used for clients who have acquired or congenital obstruction of the ductal system at the level of prostate, or in the pelvic or abdominal regions of the vas deferens. This procedure is also useful for men who have a history of vasectomy. The procedure is done using local anesthesia. A small incision is made over the scrotum, and the vas deferens is suctioned using a small catheter. The sperm is specially processed for insemination or IVF.
Epididymal Aspiration Sperm Extraction
The epididymal aspiration sperm extraction procedure is performed for men whose vas deferens is scarred or absent from prior surgery, infection, or trauma. The sperm are collected from a single epididymal tubule or from blind needle puncture. Around 10-20 million sperm are obtained and processed for fertilization. This procedure results in 60-80% egg fertilization rate, and 55% pregnancy rate.
Testicular Sperm Extraction (TESE)
The TESE procedure involves a small amount of testicular tissue, which is taken by biopsy. Because TESE sperm are immature, this procedure must be combined with ICSI. TESE is recommended for clients who have blocked epididymis near the testis due to infection or prior surgery, or from a block within the testes ducts. One drawback from using testis sperm is that it does not readily freeze for preservation.