Male Infertility Treatments

Male infertility treatments at a glance

• Men are nearly as likely to be infertile as women.
• A low sperm count can be caused by an anatomic abnormalities, hormone imbalances or genetic disorders which affect the male reproductive organs.
• In severe cases, when men have no sperm in their ejaculate, medical treatment may be effective, but sometimes it’s necessary to retrieve sperm directly from the testes.
• Avoiding tobacco, alcohol, steroids and illegal drugs are non-invasive male infertility treatment methods.
• Nutritional supplements sometimes have modest positive effects on sperm production.
• Some medications can alter sperm production or function. Frequently, there are alternative medication choices.

About male infertility treatments

When a couple is unable to become pregnant, attention is often focused on the woman. But among couples with infertility issues, the man is almost as likely to have a problem  as the woman. The good news for both partners is that many of these cases can be resolved with male infertility treatments.

Obvious symptoms are not common with male infertility. Generally, both partners should be evaluated if they are unable to become pregnant after a year of unprotected intercourse. A semen analysis, in which the man provides a sample that is evaluated in a lab, usually helps to diagnose the problem.

Even if the man expels a limited amount of sperm, these usually can be collected fairly easily. Men who expel no sperm because of blocked tubes in their testes or due to a genetic condition that prevents sperm from being released is a larger concern. These cases often require some form of surgical retrieval.

Infertility treatments for men

Lifestyle changes

A man can improve his chances of producing healthy sperm with some simple lifestyle and behavioral changes:

• Perform regular cardiovascular exercise and reduce alcohol intake, particularly in the several months before trying to conceive.
• Limit your amount of bicycling, to avoid overheating the testicles
• Maintain a healthy weight and control your blood pressure by eating a healthy diet. Obesity and some blood pressure medications can have negative effects on sperm.
• Do not use steroids, smoke cigarettes, or use recreational drugs like marijuana or cocaine.
• Avoid prolonged exposure to high heat in groin area, such as from hot tubs and even laptops.

Sperm retrieval procedures

Sperm extraction methods for men with obstructions (blockages)

Men with anatomical obstructions that block sperm from being released, have several options , including percutaneous and open procedures. Percutaneous procedures involve placing a needle into the scrotum, while open procedures requires a small incision.

• If the man has had a vasectomy, he can attempt to have a vasectomy reversal. Vasectomy reversal involves an incision in the scrotum.  The cut ends of the vas deferens are identified, opened and then sewn back together with the hope of restoring normal ejaculation.  The success rates of this procedure are highly varied and depend greatly on the skill of the surgeon, and on how long it has been since the vasectomy was performed. Due to the formation of antibodies which affect sperm function, if a man has had a vasectomy for 7 years or more, the chances of achieving pregnancy are fairly low, even if he produces normal sperm volumes after the procedure. Some of these men will still require IVF to conceive.

• Percutaneous epididymal sperm aspiration (PESA), involves placing a needle through the skin of the scrotum and directly into the epididymis (the area on the testicle which stores sperm prior to ejaculation). When a man has had a prior vasectomy, the epididymis is usually plump with sperm and the PESA is highly successful. This is an outpatient procedure, which involves minimal recovery time.

• Microsurgical epididymal sperm aspiration (MESA), which uses a surgical microscope to precisely locate the tubules of the epididymis, so that larger numbers of sperm can be extracted from the epididymis.

PESA is the least invasive and is most appropriate for men who have a blockage which prevents sperm from being released. This is the most common procedure when men have  had a vasectomy. The sperm yield from PESA is almost always adequate. If not, a MESA can be performed.

Several small studies suggest that the MESA procedure offers a higher probability of retrieving the most sperm. But because none of these procedures obtain massive numbers of sperm, it is important for patients to know that none of the current procedures allow for men to reproduce without IVF.

All of the procedures result in some initial swelling, redness and bruising. Patients also may have to wear scrotal support for 24 hours. Full recovery occurs in about two weeks.

Sperm extraction procedures for men without an obstruction

Sometimes a man may have unobstructed tubes but still no sperm, requiring a more-invasive procedure to extract the sperm directly from the testicles.

• Testicular sperm extraction (TESE), involves opening the scrotum and taking samples of testicular tissue, perhaps from several regions of the testes. A microscope is then used to identify individual sperm within these tissue samples. This is also called a testicular biopsy.

• Testicular sperm aspiration (TESA), involves placing a needle attached to a syringe through the skin of the scrotum and removing some of the fluid inside the testicle itself. This technique is less likely to obtain sperm than a TESE and other techniques and is not frequently performed.

• Microdissection TESE is a similar procedure that includes the use of a microscope to pinpoint specific tissue to be removed, thereby causing less tissue damage.

Due to the relatively small numbers of sperm recovered, with all of these procedures, IVF is still required.