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:
- 1MESA (Microsurgical Epididymal Sperm Aspiration)
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.
- 2PESA (Percutaneous Epididymal Sperm Aspiration)
- 3TESE (Testicular Sperm Extraction)
- 4TESΑ (Testicular Sperm Aspiration)
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.