Problems of impaired fecundity and Infertility have been a serious concern through ages and are also a considerable clinical problem even today, which affects 10–12% of couples worldwide. Of all infertility cases, around 30–40% are due to “male factor” infertility and as many as 2% of all men develop suboptimal sperm parameters. Male factor infertility refers to a failure to result in pregnancy in a fertile female due to problems in the male semen sample.. Causes in the wake of male Infertility are many – hereditary, hormonal imbalances, psychological issues, relationship problems to mention a few.
When the problems are not rectified at the right time, it will bring a lot more problems in the future. The most important reasons of male infertility are low sperm concentration (oligospermia), abnormal sperm morphology (teratospermia) and poor sperm motility (asthenospermia). Other factors less well associated with infertility include semen volume and other seminal markers of prostatic, epididymal and seminal vesicle function.
Almost 90% of male infertility problems are connected to count and there is a positive association between the sperm count and abnormal semen parameters. The problem with sperm count, morphology and motility stems from disorder in control mechanism, including testicular, pre-testicular and post-testicular factors. The good news is, most cases of male infertility are treatable and so it is essential to share your concerns with your partner and doctor.
Treatment for Male Infertility
The success of male infertility treatment depends on the diagnosis of the underlying cause of the trouble. Male infertility can be mild, moderate or severe. mild dysfunctions that are associated with performance anxiety or fear often can be effectively treated with improved communication between partners, Psychotherapy and counselling. To identify a man’s cause of infertility, the doctor likely will begin with a physical exam and comprehensive history of his symptoms. They may instruct to take STI screening, semen analysis, hormone and genetic testing to rule out any underlying medical problems that may be contributing to the infertility.
Most of the male infertility is idiopathic. Nevertheless, there are also multiple known causes of male infertility and got good prognosis. Some of these can be treated medically with high success rates.
Fertility specialists have a broad spectrum of options to choose from when treating male factor infertility. Both surgical and non-surgical treatments can be used to overcome or resolve Male infertility.
Surgery for Male Infertility
Varicocelectomy: Enlargement of veins inside the scrotum (varicocele) may impair fertility varicocelectomy is a minor outpatient surgery often used to repair bloated scrotal veins. Studies have shown that repairing these dilated veins results in improved sperm movement, structure and concentration.
Vasectomy Reversal (vasovasostomy): The tubes within the male reproductive system that transport sperm may be blocked in the vas deferens, possibly by injury or vasectomy. Vasectomy reversal reverses a preceding vasectomy by reconnection of the two end of vas deferens to permit for passage of sperm during ejaculation.
Epididymovasostomy: when there is a blockage found in the epididymis, this microsurgical procedure may be performed by an experienced microsurgeon. Epididymal barrier may be present if the man has had a vasectomy, or due to previous infection or injury, or if he is a carrier of a cystic fibrosis gene.
Non-surgical Treatments for Male Infertility
Medications and Hormone therapy for male infertility: When a man’s infertility is caused by hormone imbalances, erectile dysfunction, or due to an untreated infection, it may be treated with the help of medications.
Sperm Harvesting: sperm retrieval procedures can allow a doctor to retrieve sperm within the body for men with significantly low sperm counts, those who are unable to ejaculate or in case of azoospermia(Men who don’t have sperm in their semen). There are several methods commonly used for sperm harvesting:
- Microsurgical epididymal sperm aspiration (MESA)
- Percutaneous epididymal sperm aspiration (PESA)
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE)
Electroejaculation Therapy (EEJ): In spite of a rather startling name, EEJ is a non-invasive and proven to be a safe as well as effective means to obtain motile sperm suitable for assisted reproductive techniques (intrauterine insemination or in vitro fertilization).EEJ is treatment for men who produce sperm normally but cannot ejaculate. EEJ is performed under local anesthesia and as an outpatient basis which takes around 30 minutes.
Intrauterine Insemination (IUI): Intrauterine Insemination is a fertility treatment option for couples facing unexplained infertility or low sperm counts. It is usually together with medication to stimulate the ovaries (i.e. gonadotropins or Clomids), however, it may also be used on its own, in some cases of male factor infertility
In vitro fertilisation (IVF) for male infertility:
When surgical and medical treatment does not progress sperm production, in vitro fertilization (IVF) is a highly effective option for many cases of male infertility stemming from a wide range of issues. Fertilization takes place under controlled conditions using a sperm sample and mature eggs retrieved from woman’s ovaries. The retrieved eggs are mixed with the sperm and they are placed in a special incubator. The fertilised eggs develop into embryos and the healthiest as well as most viable are then implanted into the woman’s uterus through a thin tube inserted through the cervix. IVF can be used separately or with other advanced Assisted Reproductive Technologies (ART) for instance, ICSI.
Intra-cytoplasmic sperm injection (ICSI) for male infertility:
Intracytoplasmic Sperm Injection (ICSI) has revolutionized the way for the treatment of male infertility. Even men with no sperm or poor sperm quality or sperm that cannot penetrate or fertilize the egg, pregnancy may be possible with this technique. The sperm cannot penetrate the outer layer, for a variety of reasons as the egg’s outer layer may be hard or thick to infiltrate or the sperm may be incapable to swim. In these cases, ICSI can be performed by injecting the sperm directly into the cytoplasm the egg.
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