Male Infertility Treatments
Friday, October 20, 2006
Carl M. Herbert, MD
A vast majority of the talk surrounding infertility surrounds female treatments. Male factor infertility does indeed play a role in a significant number of the cases I see. Thankfully, with today’s reproductive medicine, even men with the most severe infertility cases (i.e., men who have undergone chemotherapy and have scant amounts of sperm), can have biological children thanks to techniques such as IVF-ICSI with either Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE). (Be advised that these procedures may also be utilized in instances where a man has undergone a vasectomy.)
With a MESA procedure, under local anesthesia and general sedation, an incision is made in the scrotum, exposing the epididymus, the tubules immediately adjacent to the testicles that collect the sperm. Using an operating microscope, an incision is made into these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique. The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if his partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures.
A TESE or testicular sperm extraction is a procedure that involves directly aspirating the sperm from the testes or obtaining sperm from a testicular biopsy. It is usually performed under local anesthesia block and can be done as an office surgical procedure. The disadvantage is that in many cases, testicular sperm is much more scarce and therefore difficult to freeze. Usually, there is only enough sperm recovered for one IVF case and if further IVF attempts are needed, the TESE procedure needs to be repeated.
ICSI or intracytoplasmic sperm injection is a new procedure that allows couples with sperm problems to have IVF treatment. Developed in Belgium in 1992, ICSI is the process of injecting a single sperm into an egg. It is a remarkable procedure since it allows men with only very few sperm to have a chance of having their own children.
If you or someone you know has questions about these male factor infertility treatments or wants to know the way of getting started with them, please drop me a line. I’d love to hear from you!
5 Comments:
At Mon Nov 13, 11:08:00 AM 2006,
Richard A Schoor MD FACS said…
Thank you for mentioning the male factor in your blog, but I fear that your approach to the male factor, MESA, TESE, etc, actually ignores it. For a variety of reasons, good medical care being one, men involved in an infertile relationship need to be evaluated by a urologist. In my area, the urologists and IVF groups work closely together to provide couples with the best chances for pregnancy, natural or otherwise. This approach allows couples to achieve the highest success rates with the lowest complication rates.
Richard A Schoor MD FACS
www.thexyfactor.com
At Tue Nov 14, 02:59:00 PM 2006,
Anonymous said…
Dear Dr. Schoor,
Thank you taking the time to read our blog and offer your cogent comments.In my post I was trying to provide information which is more pertinent to men with "the most severe infertility cases", especially those who were once told their only option is the use of donor sperm. As I am sure you are aware, these men have previously been unable to consider producing a genetic offspring of their own but now have these high- tech options to do so. I could not agree with you more regarding the need for a comprehensive evaluation of anyone suspected of having male infertility. I wish all urologists were as aware and concerned about the evaluation and management of male factor infertility as you. We are quite fortunate to have several excellent urologists working with our clinic and certainly appreciate the expertise they bring to the care of our patients. However, as with any professional, the title doesn't guarantee excellence. I am afraid I have encountered too many urologists who see men with low sperm counts but who don't have either an interest or a background to provide the important and comprehensive care these men deserve. Unfortunately, this can lead to the dissemination of misinformation, the performance of unnecessary surgery and sometimes delays implementation of therapies which "achieve the highest success rates with the lowest complication rates". I say this only as a warning to our readers to be sure the urologist they see has the interest and credentials to properly evaluate and treat male factor infertility. As you clearly point out, those urologists who align themselves with comprehensive infertility clinics (IVF Centers)are perhaps the most reliable and best first-choice for men seeking evaluation and treatment. Please keep up the good work and thank you again for your input.
Carl M. Herbert,M.D.
At Wed May 16, 01:20:00 PM 2007,
Anonymous said…
Thank you for taking the time for responding. I had a vasectomy in 1997. I am 52 now. I am taking a herbal product that promotes sperm count, spermatogenesis, epidydimal and seminal vesicular functions, increases Lh-Fsh producing basophill cells and helps on erectil disfunction.
The question is: Is it possible that my wife could become pregnant again?? She is 43.
At Thu May 17, 10:33:00 AM 2007,
Carl M. Herbert, MD said…
Dear Anonymous,
You report having had a vasectomy in 1997. A vasectomy is a surgical procedure to block your vas deferens (one on each side). The vas deferens are the tubes which transmit sperm from your testicles to the prostate and penis for ejaculation into your wife during intercoarse. Because those tubes are blocked, no sperm can be released and your wife cannot conceive. You would need to undergo another surgical procedure (vasovasostomy) to repair and unblock these tubes before you can hope to produce a pregnancy the usual way through intercoarse. You and your wife can undergo an IVF/ICSI treatment which will allow your wife's eggs to be retrieved and placed in a dish in the laboratory (IVF) where they can be mechanically fertilized with sperm extracted from your testicles (ICSI). The sperm can be extracted fairly easily under local anesthesia but is not capable of producing pregnancies by simply placing them into your wife as there are too few and they are often not as able to bind and enter an egg. Regardless of how the sperm are obtained, your wife is 43 and that can present problems with conception because of decreased egg quality. Therefore, before making any decisions about further surgery or an IVF cycle, I would recommend your wife be evaluated by a fertility specialist who can give you both an idea of your wife's fertility potential.
Dr. Carl M. Herbert
At Sat Jul 14, 06:37:00 PM 2007,
New Journey said…
Thank you for better educating me and the community. It's amazing the 40% of fertility problems is due to men, but men don't know much about the subject. We need more information on male infertility treatments.
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