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Treatment Options for Male Infertility: From Medication to IVF & ICSI


Key Takeaways


Male reproductive health has been a topic of taboo for many decades, perhaps even since the dawn of time. It is a delicate subject and it often impacts the psychological wellbeing of a person. The inability to build a family is often a point of pain and oftentimes, embarrassment. As a result, the number of forums dedicated to discussing and finding solutions for male infertility are limited. This has resulted in limited information about the treatment options for male infertility. 



The good news is that there are many ways to address this issue. Through male fertility testing diagnostics, it is possible to determine the causes of male infertility, whether it has to do with sperm health or medical conditions. This article will be talking about male infertility treatments, in addition to sharing some tips on ways one can improve their sperm health.



Medications and Lifestyle Changes for Sperm Health


Lifestyle Changes


To begin with, sperm health is at the core of male fertility, and it is primarily linked to the health of a person. The factors that impact a person’s health will also have an impact on the health of the sperm they produce. While women have a reservoir of eggs for their fertility, men produce fresh sperm regularly. This means that a person’s habits and lifestyle will be reflected in the sperm their body produces. If there are changes, whether lifestyle based or medical issues, the sperm a person produces will also be impacted by these changes.



For many men, healthy lifestyle changes often have a positive impact on their sperm and often result in more positive fertility outcomes. Some lifestyle changes for sperm health one could consider are:



  • Eat a healthy nutritious diet
  • Manage stress
  • Get sufficient sleep
  • Exercise
  • Limit alcohol intake
  • Avoid tobacco and nicotine products
  • Avoid recreational drugs
  • Stay sexually healthy i.e. avoid contracting sexually transmitted infections
  • Wear breathable clothing especially around the scrotum area
  • Wear protective gear if you must work with toxic substances or chemicals


Medical Intervention


Medically, the treatment options for male infertility include hormone therapy for male fertility. This involves prescribing medications in order to treat hormonal imbalances in men. Hormonal imbalances can be caused by stress, prolonged use or high does of steroids or opioids, chronic diseases, nutritional issues, among others. 



As well, when a man has challenges with getting or sustaining an erection, there are medications that can be prescribed to treat this condition. Erectile dysfunction can also be caused by stress, alcohol or drug abuse, poor nutrition, as well as medical issues. In addition to medications, there are supplements that can be prescribed by a professional healthcare provider for improving male fertility. 



Surgical Treatments


Where the causes of infertility in men are more complicated, or lifestyle adjustments and medications have not succeeded, surgical interventions are at times recommended. This is particularly in cases where a person has blockages in any of the tubes or blood vessels that transport healthy sperm and seminal fluids from the testicles to the penis. 



Some of the cases in which surgical treatments are usually applied in the treatment of male infertility is when there is blockage in the seminal vesicle, obstruction of the epididymal duct or obstruction of the ejaculatory duct. As well, the blockage of blood vessels around the scrotum could also result in infertility whereby a surgical intervention would be the ideal treatment. 



Varicocele Repair


The condition whereby blood vessels around the scrotum are blocked is medically known as varicoceles. While varicoceles is common and does not typically cause infertility, sometimes, it could present challenges to people who are trying to conceive naturally. A person who has infertility challenges due to varicocele will typically have a lower sperm count in their semen. A procedure called varicocele repair is used to address this.



A varicocele repair procedure  is done following diagnostics such as a physical examination, a semen analysis, or an ultrasound. There are different levels of varicoceles, graded zero to three, with zero being varicoceles that are visible only via ultrasound, and grade three being varicoceles that are clearly visible as a swelling on the scrotum. 



Surgery on varicoceles is called a varicocelectomy. Varicoceles are performed in two categories - open surgery or minimally invasive surgery. The decision as to which approach will be used is determined on a case by case basis. A varicocelectomy is performed under anesthesia to keep the discomfort at a minimum.



Minimally Invasive Surgery


There are two types of surgery in this category, one is a laparoscopic varicocelectomy and the other is a microsurgical varicocelectomy. Let us see what each is below:



Laparoscopic Varicocelectomy: 


In this type of surgery, small incisions are made in the abdomen which give access to a laparoscope and surgical instruments. A laparoscope is a thin rod with a camera attached to it. It is used together with a monitor which gives the surgeon a visual of the surgery as they operate on the varicocele.



Microsurgical Varicocelectomy:


In this type of surgery, a surgeon makes an incision on the upper part of the groin. He or she then uses a powerful surgical microscope together with very small surgical instruments to operate on the varicoceles. 



Open Surgery


Open surgery for varicoceles is done by ligating the varicocele. There are three approaches to varicocele ligation - inguinal ligation, subinguinal ligation, and retroperitoneal ligation. Each of these accesses the varicocele from different directions. Let us see how below:



Inguinal Ligation


The inguinal canal is located around the lowest part of the groin. The surgeon creates an incision to access the varicocele and then proceed to ligate it. 



Subinguinal Ligation


In this surgery the surgeon would access the varicocele from the lower part of the inguinal canal for ligation.



Retroperitoneal Ligation


The peritoneum is the membrane that lines the abdomen. A surgeon would access the varicocele from behind the peritoneum and ligate it. 



Sperm Retrieval Procedures


Sperm retrieval procedures are done where a person does produce sperm, but not in sufficient quantities to effectively build families naturally. In such cases there are options to retrieve the sperm, and using assistive reproductive treatments such as IVF, fertilize the eggs directly. There are several sperm retrieval procedures that can be performed, but these are determined on a case by case basis. 



  • Testicular Sperm Extraction (TESE): This procedure retrieves sperm by removing the sperm directly from testicular tissue. 
  • Micro-Testicular Sperm Extraction (Micro-TESE):  As the name suggests, this is TESE at the microscopic level. It is a more advanced version of TESE. 
  • Percutaneous Epididymal Sperm Aspiration (PESA): This retrieval procedure retrieves the sperm from the epididymis.
  • Microsurgical Epididymal Sperm Aspiration (MESA): This is a similar procedure to the PESA, however it makes use of a microscope to retrieve sperm from the epididymis.  


IUI & IVF for Male Factor Infertility


There are different ways in which male factor infertility can be addressed when it comes to family building. Intrauterine insemination (IUI) and in vitro fertilization (IVF) have been successful in fertilizing eggs with retrieved sperm.



Intrauterine Insemination - IUI


Intrauterine insemination (IUI) is a non-invasive, typically painless procedure that is done in a medical facility. It relies on a woman’s natural menstrual cycle therefore a woman needs to be on the ovulation phase of her cycle to increase the chances of success. Using a prepared sperm sample and a catheter, sperm is placed into the uterus during the ovulation window. 



In Vitro Fertilization - IVF


In vitro fertilization (IVF) is a fertility treatment that is conducted over several phases. When it comes to male infertility, this treatment is advantageous because fertilization is done in a controlled lab setting. This method has proven highly successful in assisting couples facing fertility challenges to build their families.



How ICSI (Intracytoplasmic Sperm Injection) Works 


Intracytoplasmic Sperm Injection (ICSI) is a type of IVF treatment, however it uses a different approach to fertilization. With regular IVF treatments, many sperm are placed next to an egg in order for fertilization to occur, somehow simulating the natural process of conception. With ICSI, a single sperm is injected directly into the cytoplasm of an egg, which bypasses the need for sperm count and motility.


Choosing the Right Treatment Path at San Diego Fertility Center 



At San Diego Fertility, we pride ourselves in tailoring patient treatment plans to their circumstances and family building goals. A consultation with one of our fertility experts is the starting point of any fertility treatment. After diagnostic tests are carried out, you will be advised on your options, discuss risks and determine a course of action toward your family building.


FAQs:


Who needs a sperm retrieval procedure?


Typically a sperm retrieval procedure would be for men who do not have sperm in their ejaculate, also medically referred to as  azoospermia. As well, if a person has had a vasectomy, or has certain genetic conditions, they too could benefit from sperm retrieval.



Is sperm retrieval painful?


Typically, because these procedures are performed under local or general anesthesia, any discomfort is usually quite minimal.



Can retrieved sperm be used for IVF?


Absolutely yes. In fact, one of the main purposes of sperm retrieval procedures is to facilitate fertilization during IVf and ICSI treatments.



What is the success rate of sperm retrieval procedures?


Sperm retrieval is typically successful as a mode of helping males with infertility challenges to have a chance at building their families. While the success rates lie anywhere between 50 and 90 percent, the cause of infertility and retrieval approach used do play a part in success outcomes.



This blog is for informational purposes only and should not be considered medical advice.  Please consult with your physician or a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment.

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