Male Infertility

Male factor as a cause of infertility accounts to about 35% of infertility patients. A male infertility factor is often defined by abnormal semen parameters, in simpler terms low sperm count but may be present even when the semen analysis is normal. Male infertility can be due to a variety of conditions, many, but not all, of which can be identified and treated. When the cause of abnormal semen parameters cannot be identified, as is true in many patients, the condition is termed idiopathic. Ideally, the identification and treatment of correctable conditions will improve and increase sperm motility of the male partner and allow conception to be achieved naturally.In some cases, men with very low sperm counts and low motility scores can sometimes have children.

An initial screening evaluation of the male partner of an infertile couple is indicated when pregnancy has not occurred after 12 months of unprotected intercourse or after 6 months of failure to conceive when the female partner is >35 years old. Earlier evaluation may be warranted when medical history and physical findings indicate or suggest specific male or female infertility risk factors and for men who question their reproductive potential.

Options for Semen analysis – check the sperm count, motility and morphology

At a minimum, the initial screening evaluation of the male partner of an infertile couple should include a reproductive history and analysis of at least one semen sample. The semen analysis provides information on semen volume if low as well as sperm concentration, motility and morphology

Treatment for male factor infertility includes treatment to treat the cause if any specific cause is identified or IUI, IVF, ICSI, IMSI or even surgical procedures like PESA, TESA, TESE etc based on the severity of the abnormalities in the semen parameters.

Azoospermia

Azoospermia (zero sperm), defined as the absence of spermatozoa in the ejaculate after the assessment of centrifuged semen on at least two occasions, is observed in 1% of the general population and in 10 – 15% of infertile men with low volume of sperm.

Surgical sperm retrieval techniques are applied in azoospermia cases of either obstructive or non-obstructive aetiology. The approach to azoospermic patients has changed significantly with the introduction of sperm retrieval techniques and assisted reproductive technologies, especially intracytoplasmic sperm injection (ICSI). In addition to improving pregnancy rates using sperm from ejaculated semen, ICSI has provided new possibilities for achieving pregnancy with sperm retrieved from the epididymis or testis.

Surgical Sperm Retrieval is offered to couple with Azoospermia:

PESA-(Percutaneous Epididymal Sperm Aspiration) is done in case of blocked ducts leading to azoospermia. Here, under local anesthesia, a needle is inserted in the duct and the sperms are aspirated.

TESE-(Testicular Sperm Extraction) is done in case of non-obstructive azoospermia. Under local/short general anesthesia, sperms are obtained by biopsy from testes directly.

TESA-(Testicular Sperm Aspiration) is done in case of non-obstructive azoospermia. Under local/short general anesthesia, sperms are obtained from the testes by relatively less invasive procedure.

The sperms thus retrieved are used for ICSI.