MI

Male Infertility

Male factor infertility can result in a variety of issues such as complete absence of sperm in the ejaculate (azoospermia) due to either an obstruction/blockage (obstructive azoospermia) or retrograde ejaculation into the bladder. Causes of obstructive azoospermia often include previous vasectomy or congenital birth defects while retrograde ejaculation is commonly seen in those diagnosed with diabetes.

 

Options for male infertility patients include:

Factors of Male Infertility

  • Varicoceles commonly cause low sperm production and decreased sperm quality, which can lead to infertility.

  • Blocked ejaculatory ducts can cause zero sperm count (obstructive azoospermia). Men with this condition have a low chance of conceiving a biological child without treatment.

  • Damage to the testes (ie the glands that produce sperm and testosterone which is the main male sex hormone) from infections such as mumps, COVID-19, treatments for cancer such as radiation or chemotherapy, trauma (e.g testicular torsion), or surgery like inguinal hernia repair, can lead to infertility.

    In some cases, infertility results from a hormone deficiency. Conditions that lower luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, e.g. using anabolic steroids or taking testosterone hormone therapy, can result in low or no sperm production.

  • Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. Viral Infections like the Mumps or COVID-19 can cause inflammation of the epididymis (epididymitis) or testicles (orchitis). Other sexually transmitted infections like gonorrhea or HIV can also compromise sperm production. Although some infections, like Mumps, can result in permanent testicular damage, most often sperm can still be retrieved.

Microsurgical Sperm Aspiration

A surgical option can retrieve sperm from either the vas deferens, epididymis or testis for use in an IVF cycle(s) to conceive. Because the surgically retrieved sperm are immature, fertilization is achieved by injecting selected sperm directly into the egg by a process called intracytoplasmic sperm injection (ICSI).

Males considering this option are required to see a urologist prior to surgery to help determine the best approach for retrieving sperm including Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Aspiration (TESA) or MicroTESE.

  • MESA collects sperm by aspirating fluid from the epididymis of the male reproductive tract. A fine needle is inserted through the scrotum into the epididymis and sperm are obtained by gentle suction. This procedure is used for cases of obstructive azoospermia.

  • TESA is where a fine needle is inserted into the testis, a sample of tissue is obtained by gentle suction and then examined under the microscope. If sperm are not found, a small tissue sample (testicular biopsy) is taken through a small incision in the scrotum and testis, where sperm can then be extracted. This procedure is used for cases of non-obstructive azoospermia.

    If possible, MESA and TESA procedures are timed to coincide with the egg retrieval step during the IVF cycle. For some, scheduling may be an issue. Surgical sperm retrieval can be completed before the IVF cycle begins and frozen (cryopreserved) for future use. The extraction of sperm completed by MESA and TESA typically results in enough sperm to allow several IVF cycles. These procedures can be performed on an outpatient basis using sedation to eliminate any pain or discomfort.

  • Microscopic testicular sperm extraction (microTESE) is a procedure that takes sperm directly from the testicular tissue of a man's reproductive system. If a man can't release or make enough healthy sperm naturally, this medical procedure may be recommended for fertility reasons (to enable the man to father a child).In this procedure, the patient is sedated with anesthesia and then a tiny incision (cut) is made into the testicle and sperm is identified within tiny sections of the tubules where they are manufactured This procedure has to be performed by a subspecialty trained Urologist who completed advanced fellowship training in Andrology.