Male Infertility Treatment

Androgen replacement is available in injectable, oral, and transdermal (skin-patch) form, but oral preparations are the least effective and carry a significant risk of liver toxicity. Hormone replacement is recommended only when there is proper laboratory and clinical documentation. Men using testosterone are monitored by their physicians at regular intervals with evaluations that include an assessment of the patient's clinical response, a digital rectal examination, and blood tests for testosterone, hemoglobin, and prostate-specific antigen. A lipid profile and liver function test may also be considered. The benefits of testosterone supplementation may include improvement in any or all of the symptoms described for androgen deficiency in the aging male.

Varicoceles are a common condition characterized by the enlargement of veins within the scrotum. While varicoceles may not always produce noticeable symptoms, they are a significant cause of male infertility, affecting sperm count, motility, and morphology. Varicocele ligation is a surgical procedure that repairs these veins.

The ejaculatory duct is a tubular structure that joins the prostatic portion of the urethra and is responsible for transporting sperm and seminal vesicle fluid into the prostatic urethra, the destination of sperm before ejaculation. Several factors can obstruct the ejaculatory duct and thus block the flow of sperm. These include problems such as congenital narrowing or scarring due to infection and compression due to a prostatic cyst or tumor. Obstructed ejaculatory ducts are usually diagnosed by transrectal ultrasound imaging or special radiographic tests called vasograms. Obstructed ducts are treated by a simple transurethral procedure whereby the obstructed part of the duct is removed, leaving normal, unobstructed ductal tissue behind.

Obstruction of the vas deferens is usually the result of an earlier elective vasectomy procedure. Over time this obstruction may lead to significant "backpressure" experienced by the fragile epididymal tubules, thus causing a secondary epididymal obstruction, often referred to as a "blowout." Vasal obstruction, and even secondary epididymal obstruction, usually can be corrected using special microsurgical techniques to bypass the obstruction. These microscopic procedures are among the most technically demanding ones performed by urologists, and individuals with special training in the area best accomplish them.

When in vitro fertilization, or IVF, is used, the male's sperm is incubated with the female's eggs in the laboratory. The development of the eggs is medically regulated with hormones, and the conditions in the laboratory dish are meticulously controlled to optimize chances for fertilization. The fertilized eggs (i.e., "embryos") can then be assessed based on their appearance, allowing for the selection and replacement into the female of the best embryos. These embryos have been shown to be the ones with the highest likelihood of resulting in a successful pregnancy. Embryos not used can be frozen (cryopreserved) for later use.

Intracytoplasmic sperm injection, or ISCI, is a modification of the IVF procedure using the same methods, except that instead of simply incubating the sperm and egg together in a Petri dish, the egg is stabilized under a special microscope with a micro-suction instrument. In contrast, a fine pipette injects a selected sperm into the egg. This sperm injection technique allows couples to overcome many barriers to sperm count, motility, morphology, and degree of sperm maturity. ICSI has made it possible for couples, who in the past would have been unable to achieve pregnancies, to bear their own biologic children.

Intrauterine insemination, or IUI, involves collecting the male's ejaculate and subsequent processing or "washing." The ejaculate is inserted into the female's cervix or uterus with a special injection catheter. This is generally considered the least invasive of assisted reproductive techniques, but its effectiveness is limited when patients have severe fertility problems.

TESE is a more invasive procedure where a small piece of testicular tissue is surgically removed, and sperm is isolated from the tissue in the laboratory.