After male
infertility is diagnosed, there are three possible treatments. Medical therapy may be used to reverse or
improve some types of inflammation or hormone deficiency. Surgery may be done to treat problems with the
male anatomy, such as varicocele, ejaculatory duct obstructions, or reversal of
a past vasectomy. Surgery may also be used to remove sperm from the testicles
in some men. Assisted reproductive technologies (ART) may be
advised for some men.
Medical Therapy
Hypogonadism
Hypogonadotrophic
hypogonadism (HH) results when the testes do not receive the right hormone
signals from the pituitary gland in the brain. This means that the testes
cannot work normally.
The
pituitary gland may be affected by tumors, medicines, or a congenital condition
(physical conditions that someone is born with). If one of these is the cause
of HH, the pituitary hormones (FSH and LH) can be replaced. This will restore
the function of the testes.
Surgeries and Procedures
Varicoceles
Varicoceles are
large veins that allow the blood to flow backward. They can occur inside the
spermatic cord and scrotum. Varicoceles are linked with low sperm count, poor
motility, and abnormal morphology (physical structure).
Semen
quality improves in about 2/3 of men who have surgery to repair varicoceles.
Research shows that natural pregnancy rates increase after this treatment.
Of all the
causes of infertility, varicoceles are the most easily corrected. Since they
are very common, the surgery should be considered only if there are no other
infertility risk factors.
Varicoceles
can be treated in two ways:
- With venous embolization, where a small
catheter, guided by X-ray, is fed through the large veins of the neck or groin.
- Through a small incision in the groin region.
Vas Deferens or Epididymal Blockage
Infection or
injury can cause scarring and blockage of the male reproductive tract. The most
common cause of a blockage that surgery can correct is having had a vasectomy.
About 6% of men (6 out of 100) who have a vasectomy also have a vasectomy
reversal (vasovasostomy or epididymovasostomy).
The success
of a vasectomy reversal depends on many things. The most important factors are
the skill of the surgeon and what is found at the time of surgery. If all goes
well, 85% to 99% of men (85 to 99 out of 100) can expect a return of sperm
after vasovasostomy. If you do not want to have this surgery, sperm extraction
can be done along with ART.
Assisted Reproductive Technologies
Even when no
sperm are found in the ejaculate (called azoospermia), sperm may be found in
the vas deferens, epididymis, or testes. This sperm may be retrieved using
minimally invasive techniques. After sperm is retrieved, intracytoplasmic sperm
injection (ICSI) may be used to assist in pregnancy.
ICSI has
changed how we treat male infertility. With this technology, only a small
number of healthy sperm are needed to achieve pregnancy. This means we are
often able to obtain healthy sperm for egg fertilization even from men who have
a very low sperm count.
The underlying reason for azoospermia will decide where the sperm is taken from and
the chances of retrieving it successfully. In vitro fertilization (IVF) must be
done along with ICSI to achieve pregnancy. Success depends on a complex program
of assisted reproduction for both partners.
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