Diagnosing and Treating Male Infertility


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Male Infertility Diagnosis

A semen analysis is the primary test used to determine male fertility. Whatever the severity of the semen analysis abnormality, IHR has the expertise to provide highly successful fertility solutions for the majority of affected males. 

Obstruction: Blocking sperm from normal passage, obstructions can be caused by a number of factors, such as repeated infections, prior surgery (including vasectomy), inflammation or development problems. Any portion of the male reproductive tract, such as the vas deferens or epididymis, can be obstructed, preventing the normal transport of sperm from the testicles to the urethra, where it leaves the body during ejaculation. 

Hormones: Hormones produced by the pituitary gland are responsible for stimulating the testicles to make sperm. Therefore, when levels are severely low, poor sperm development can result. 

Genetics: Genetics play a central role in fertility. Abnormalities in chromosomal numbers and structure, as well as deletions on the important Y chromosome present in normal males, can impact a man’s fertility. 

Medication: Certain medications can affect sperm production, function and ejaculation.

Treatment Options

The treatment for male infertility depends on the specific problem. Many times there is a mix of medications, surgical approaches and assisted reproductive techniques (ART) available to overcome the underlying fertility problems.

The options include: 

Surgery: Minor outpatient surgery (varicocelectomy) is frequently used to repair dilated scrotal veins (varicoceles). Studies have shown that repairing these dilated veins results in improved sperm movement, concentration and structure. In some cases, obstruction causing infertility can also be surgically corrected. In the case of a previous vasectomy, surgery using an operating microscope has been found to be very successful in reversing the obstruction. 

Medication: Drugs are key in correcting retrograde ejaculation and immunologic infertility. In addition, pituitary hormone deficiency may be corrected with drugs such as clomiphene or gonadotropin. 

If these techniques fail, fertility specialists have a variety of other high-tech assisted reproductive techniques that promote conception without intercourse. Depending on your problem IHR may consider: 

Intrauterine insemination (IUI): By placing sperm directly into the uterus via a catheter, IUI bypasses cervical mucus that may be hostile to the sperm and puts them close to the fallopian tubes where fertilization occurs. IUI is often successful in overcoming sperm count and movement problems, retrograde ejaculation, immunologic infertility and other causes of infertility. 

In vitro fertilization (IVF): Refers to fertilization taking place outside the body in a laboratory. There, the egg of a female partner, or donor, is joined with sperm. With IVF, the ovaries must be overly stimulated, usually with fertility drugs that allow retrieval of multiple mature eggs. After about five days of incubation, the fertilized egg (embryo) is inserted in the uterus and normal pregnancy should result.

Intracytoplasmic sperm injection (ICSI): A variation of in vitro fertilization, this procedure has revolutionized treatment of severe male infertility, permitting couples previously thought infertile to conceive. It involves injecting a single sperm directly into the egg with a microscopic needle and then, once it is fertilized, transferring it to the female partner's uterus. ICSI can be used if you have very poor semen quality or lack of sperm in the semen caused by an obstruction or testicular failure.

Testicular sperm extraction (TESE): If sperm does not appear in the ejaculate, but they are being produced, the doctor may be able to take sperm directly from the testicles, or from the bladder (in cases of retrograde ejaculation), and use that sperm to fertilize an egg in the lab. This would be done as part of an IVF treatment. 

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