Effective Treatment of Even the Most Complex Cases of Male Infertility
The evaluation of the man mainly includes a spermogram, a hormonal profile and a scrotal ultrasound.
Mitosis IVF Centre can address any problem regarding the sperm and succeed in fertilizing the woman’s eggs by using the most advanced IVF techniques.
Causes of Male Infertility
Sperm is considered normal when sperm concentration is above 15 million per ml of seminal fluid, with good mobility, that is over 32% front accelerated motion and normal sperm morphology over 4%.
There are many and varied reasons for male infertily:
- Oligoasthenospermia: The most common cause of male infertility is idiopathic, which means, while everything looks normal (anatomy, hormones, sex drive), the testis does not produce normal sperm, but infertile.
- Varicocele: Another common reason for disruption of sperm is a varicocele, which is the concentration of varicose veins in the scrotum. The abnormal twisting of these veins leads to harmful warming in the testicle, which can be detrimental to sperm. This is due to the fact that increasing temperature even one degree in the scrotum may be harmful.
- A jam along the route where the sperm is moving: Male infertility may also be due to a jam along the route where the sperm is moving. An infection or trauma can cause scarring and can block the epididymis (organ close to the testis where sperm is stored and activated before ejaculation). Hernia surgery, previous vasectomy and cystic fibrosis may also block the seminiferous tubules. Finally, the prostate may have cyst or stone that blocks sperm entry in the urethra during ejaculation.
- Professional, environmental and psychological factors: Professional, environmental and psychological factors, such as high levels of anxiety, sleep disorders, drugs, smoking, excessive alcohol, oils, toxins, growth hormones in food, chemical or heat exposure, long-term use of Jacuzzi or hot baths can also cause male infertility.
- Ξ‘ genetic defect (e.g. syndrome Kleinefelter, cystic fibrosis)
- Azoospermia: Azoospermia is the complete absence of sperm in the ejaculate which can be caused due to a genetic defect or due to an unrecognized cause. There are two kinds of azoospermia: the Obstructive azoospermia and Non-Obstructive Azoospermia.The Obstructive Azoospermia (OA), is due to some involvement in the reproductive tract. For example, sperm is produced in the testis, but is trapped within it.The Non-Obstructive Azoospermia (NOA) is the result of serious halted or insufficient sperm production. Usually elevated levels of the Follicle-stimulating hormone (FSH) and small testes are associated with Non-Obstructive Azoospermia.
Treatments of Male Infertility
When the semen produced during ejaculation is not enough (low sperm concentration -below 15 cm / ml- and poor mobility, less than 32% correctly moving sperm), IVF can provide the solution to infertility using the technique called intracytoplasmic insemination or simply ICSI. With this technique a single sperm is injected with a very thin needle inside the ovum. In this way, the following infertility problems are effectively addressed:
- The problem of low concentration and mobility of sperm.
- Azoospermia: In the case of azoospermia, where there is the complete absence of sperm during ejaculation, things are a little more complicated. Azoospermia is found in 10% of cases of male infertility. By the mid-90s, sperm donation was the only solution for men suffering from azoospermia.
Today sperm is directly taken from the testis and is then applied ICSI to fertilize the ova of the wife. ICSI is applied because spermatozoa obtained in this way are usually few in number and are immobile or almost immovable.
Four different techniques are applied to collect sperm. Each of them has a different name and acronym. Each process has both advantages and disadvantages and not all are appropriate for every occasion.
These techniques are the following:
MESA is the microsurgical aspiration of sperm from the epididymis.This technique is appropriate where there is clogging of deferent ducts that carry the sperm from the testicles to the penis. The basic steps of this technique are the following:
- The epididymis is isolated with a small section of one centimeter in the skin of the testis.
- A surgical microscope is used, which examines very small tubes of the epididymis.
- A tube is opened and the contents are collected and tested for the presence and quality of sperm under the microscope.
- The material is transported to the laboratory where it is processed. If there is enough material, it is usually cryopreserved. It is important to freeze the extra sperm, as a second IVF attempt is often needed.
PESA is the microsurgical free, but percutaneous needle aspiration of semen from the epididymis. The needle is placed through the epididymis hoping that sperm will be found and will be drawn. With this technique a small amount of sperm is collected and it is rarely sufficient for freezing. This method is rarely recommended because it has low success rate and higher complication rate.
The collection of testicular tissue is an open process that can be done with local anesthesia and minimizes potential complications. A small piece of tissue is isolated through a small skin incision. The tissue is placed in a special cultivating material and is cut into smaller pieces. Sperm is released from seminiferous tubules, where it is produced, and then it gets isolated from the surrounding testicular tissue. This is a technique that gives good enough quality and quantity of semen, which can be frozen and stored for future use. It is a technique used in men with Obstructive (OA) and Non-Obstructive Azoospermia (NOA).
The testicular sperm aspiration is done with a fine needle of biopsy, which pierces the testicle and sucks the sperm. The main characterestics of TESA are the following:
- The technique is likely to provide sperm, but the amount in most cases is low and not sufficient for freezing.
- The chances of complications such as hematoma creation are higher than that of TESE, which is considered to be the most suitable technique in cases with Non-Obstructive Azoospermia.
Sperm is rarely found in the epididymis in men with Non-Obstructive Azoospermia, so MESA and PESA techniques are not suitable for collection of sperm from these men. TESE is the best method proposed in these cases. The techniques of taking sperm from the testis have now become routine and have given solution to many childless couples.We are now in an era in which the doctor, who sees no sperm in his semen analysis, is not in a difficult position to inform the couple that they cannot have children, but instead he refers them to infertility clinics, where the solution lies ahead.
Informative Videos about Male infertility. Watch with English sub-titles.