What is treatment of male infertility ?
Infertility is a global health issue affecting millions of people of reproductive age worldwide. Available data suggests that between 48 million couples and 186 million individuals have infertility globally.
EVALUATION OF MALE INFERTILITY
Diagnosing male infertility problems usually involves:
- General physical examination and medical history. This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and about your sexual development during puberty.
- Semen analysis. Semen samples can be obtained in a couple of different ways. You can provide a sample by masturbating and ejaculating into a special container at the doctor’s office. Because of religious or cultural beliefs, some men prefer an alternative method of semen collection. In such cases, semen can be collected by using a special condom during intercourse.
Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.
Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.
Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:
- Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
- Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate and look for blockages of the tubes that carry semen.
- Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems might also contribute to infertility. A blood test measures the level of testosterone and other hormones.
- Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
- Genetic tests. When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
- Testicular biopsy. This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal your problem is likely caused by a blockage or another problem with sperm transport.
- Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there’s any problem attaching to the egg. These tests aren’t often used and usually don’t significantly change recommendations for treatment.
In shukan IVF Centre we have In house Embryologist,High tech Lab,Genetic counselor,Facilities of Operation theatre for Testicular biopsy,Maclard’s Chamber for Proper evaluation of Semen,In House facilities for hormonal testing of male.
Treatments for male infertility include:
Lifestyle Modification:- Lifestyle factors can influence male fertility, and your doctor may suggest that you initiate lifestyle changes when you are trying to conceive.
- Avoid using tobacco, marijuana, anabolic steroids, and “recreational” drugs.
- Avoid excessive use of alcohol.
- Maintain a healthy weight.
- Exercise moderately, but not excessively.
- Avoid testicular injury in sporting events.
- Avoid exposure to excessive heat (steam rooms, saunas, hot tubs).
- Wear looser fitting shorts and pants.
- If you bicycle, try using a softer seat.
- Learn positive ways to manage stress.
Antioxidants:- The main antioxidants are vitamin A, tocopherol or tocotrienols (Vitamin E), Vitamin C, beta-carotene and trace minerals. Some food supplements like selenium, Zinc, carthinine, arginine and vitamin B-12 have been shown to increase sperm count and motility. However, antioxidants such as vitamin C, Coenzyme Q, vitamin E and glutathione have been reported to be beneficial in the management of male infertility.
- Surgery:- For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
- Treating infections:- Antibiotic treatment might cure an infection of the reproductive tract, but doesn’t always restore fertility.
- Treatments for sexual intercourse problems:- Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
- Hormone treatments and medications:- Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
- Intra Uterine Insemination:- Intrauterine insemination (IUI) — a type of artificial insemination — is a procedure for treating infertility. Sperm that have been washed and concentrated are placed directly in your uterus around the time your ovary releases one or more eggs to be fertilized.
- Assisted Reproductive Treatment:- If Sperm Count are not improved by above treatment the ART is last option for getting sperm. Different Sperm Retrieval methods are available.
Percutaneous Epididymal sperm Aspiration (PESA)
PESA is a procedure that can be performed under local anesthesia without a microsurgical skill set. The procedure involves placing a butterfly needle in to the head of the epididymis after administration of local anesthetic. Negative pressure is applied until a milky white fluid is visualized. The tubing is then clamped and the system is flushed with sperm media in to a collection tube. The procedure can be repeated until sufficient yield is obtained. The percutaneous approach obviates the need to perform a skin incision therefore avoiding the associated morbidity such as infection and pain.PESA sperm yield is lower than MESA although usually sperm numbers are adequate for ICSI.
Testicular Sperm Aspiration (TESA):-
A procedure in which a sample of sperm cells and tissue are removed from the testicle through a small needle attached to a syringe. The sperm is separated from the tissue and looked at under a microscope in the laboratory. It may then be used right away to fertilize eggs or frozen for future infertility treatment. Testicular sperm aspiration may be useful for men who have fertility problems caused by a blockage that keeps sperm from being ejaculated. This could be caused by previous vasectomy, certain genetic conditions, ejaculation problems, infection, or other conditions. It may also be useful for men who want to have children after having treatment that may cause infertility, such as certain cancer treatments. Testicular sperm aspiration is a type of sperm retrieval method. Also called TESA.
Micro Epididymal Sperm Aspiration (MESA)
Microsurgical epididymal sperm aspiration (MESA) refers to retrieval of sperm- containing fluid from optimal areas of the epididymis that are selected and sampled using high-power optical magnification provided by an operating microscope. Retrieved sperm are subsequently used for intracytoplasmic sperm injection (ICSI) to induce fertilization and pregnancy. MESA is considered by many experts to be the gold standard technique for sperm retrieval in men with obstructive azoospermia given its high yield of quality sperm, excellent reported fertilization and pregnancy rates, and low risk of complications. However, MESA must be performed in an operating room, requires microsurgical skills and is only useful for reproduction using ICSI. Herein we present an overview of the evaluation of candidate patients for MESA, the technical performance of the procedure and the outcomes that have been reported.
Testicular Sperm Extraction (TESE ):-
TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. TESE is usually performed in the operating room with sedation, but can be performed in the office with local anesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MicroTESE has replaced this as the optimal form of retrieval for men with no sperm in their ejaculate (azoospermia) from a problem with production.
Shukan IVF Centre has facilities of In House Embryologist,In House Urologist,Operation Theater,24 Hour available Anesthetic.All this facilities make us to do Surgical Sperm Retrieval Easy.