Are there any other additional procedures that may help dealing with male factor infertility?

TESA or TESE can be done for men who would follow two different categories so you have obstructive azoospermia so that’s no sperm in the ejaculate and obstruction can be because of something like cystic fibrosis and the testicles have no way of getting the sperm out into the ejaculate or they’ve had vasectomy and it’s just a case of doing a PESA where needles placed into the epididymis and aspirated. Generally it’s quite straightforward, they’re very easy to do. You can have non-obstructive azoospermia which is more difficult to get sperm from, so that could be to do something with a hormonal problem so if you’re FSH which is what causes your testicles to produce sperm, if that’s quite high, it can actually shut your testicles off and from producing sperm – so there’s no sperm in your ejaculate and the higher the FSH gets, the less chance of finding sperm and so instead of going into the epididymis, you’ll do various needle sites into the various places in the testicles to try and aspirate bits of tissue. The tissue goes into the lab and we sort of process it and try and find sperm that way and it’s less successful because you’re not necessarily producing sperm and whereas in obstructive azospermia you in most cases producing sperm and it’s just a storage issue, it just can’t escape so you just go straight to the source and extract it.

No not really, but you can reverse a vasectomy if someone is with another partner and wishes to get them pregnant, so you can reverse that and that could be another procedure.

Apart from our techniques and tools and diagnostic tools what we always recommend to our couples is to give an emphasis to what we term as preconception optimization. It’s always worth the effort to improve lifestyle habits, improve the quality of our nutrition, the quantity of our sport, exercise and the frequency of ejaculation in an effort to optimize our fertility and this optimized form of fertility to be at the period of our IVF, ICSI or conventional attempts. In this way, we will improve the quality of the spermatozoa produced and we do know today that the paternal factor is very very important and it’s not only a matter of selecting the morphological best looking embryos without microscope because morphology is not always a good indication of the viability and the functionality of the spermatozoa. So, the more effort we place in optimizing our fertility the period before the procedure, the higher chances for a better outcome we will achieve.

Link between varicoceles and male facilities isn’t straightforward but there’s certainly some evidence that treating varicoceles can improve the quality of male sperm and it might improve pregnancy rates. It’s a little bit harder to prove but certainly that’s one thing that could be considered if the male has a large or clinical varicose or one that can be detected on examination. Sometimes sperm can be recovered surgically from patients who’ve got no sperm in their ejaculate and that’s basically it. Sometimes specialist tests are employed to try and get sperm from when you don’t have any sperm in the ejaculate for example sometimes sperm is looked for in the in the post orgasm urine, sometimes little adjuncts little tools devices are used to try and recover sperm from when you find it difficult to ejaculate normally. So those are the kind of things in which additional kinds of procedures might be needed.

For example, on the male side, if a man has had previous surgery or previous infection in childhood, for example, with mumps and things like that, if you’ve got issues which you might think may be particularly predisposed to there being a male factor, in this equation, then again at least make those investigations – do those investigations up front because, for example, if the chap has azoospermia meaning no sperm or relatively few sperm and they’re not very motile or abnormal in their morphology, that couple realistically have to have probably ICSI and their chance of getting pregnant spontaneously is close to zero.

The most important thing is to know the reason for the male factor. We recommend visiting an Andrologist first, and only after that we have several tools to confront male factors such as ICSI or if we need to go directly to testicle, we have TESA and TESE. There are other tools that we can use to overcome this problem. However, the source of the problem it is really important to know.

There are a number of different procedures that can be employed to get sperm from the testes and some of these are called TESE and some are micro TESE – depending on the way this surgeon removes that sperm. There’s also another one called PESA and that is an epididymal sperm because the sperm produced in the testis and then the epididymis is a big long looked tube which takes the sperm along and so that it can be produced in the ejaculate and you can also get sperm from the tip of the epididymis. So those are different ways that sperm can be retrieved. All of them are done of course under either local anesthetic or general anaesthetic, so the man doesn’t feel a thing.

Let’s talk about the additional procedures. Let’s summarize them as medications. We talked about Clomiphene, Anastrozole, and HCG, these are sort of hormones or hormone-producing medications. Then we have to come to the supplements, various supplements with antioxidant qualities: Carnitine, Arginine, Arginine, minerals, and vitamins that comprise the list of the supplements. And as I mentioned before in the other question; then finally intrauterine insemination (IUI) and ICSI. These are the methods of treating male factor infertility.

Many procedures help us to deal with a male factor during fertility treatments. Some of them will help us during the diagnosis, others will help us during the treatment. To avoid the risk of failure during the fertility treatment, we need to do a specific semen analysis. The most important is sperm fragmentation which, is used to determine the degree of DNA damage. The other one is a FISH test that will help us to determine if there is any chromosomal abnormality in the semen. These studies will help us, especially in the case of patients who have had many failed fertility treatments previously. DNA fragmentation is usually studied in those patients who’ve had repeated miscarriages. If there is a high degree of DNA fragmentation, there are some medical procedures that the andrologist can offer to a patient to reduce this problem and increase pregnancy rates. FISH study on sperm samples is used to determine if there is any chromosomal abnormality in spermatozoa that might give us abnormal embryos, implantation failure, or repeated miscarriages. In some cases, we need to undergo testicle biopsy and check testicular tissue to see if there is any chromosomal abnormality as well.

Once we have the diagnosis and we know which male problem we are dealing with, there are some procedures during the fertility treatment that may help us to increase the chances of pregnancy and reduce the chances of miscarriage. They’re based on sperm selection. Some of them are based on the morphological study of spermatozoa, like IMSI or PICSI. They will help us in magnifying the image of the spermatozoa head and choosing the normal forms. It refers to those patients who have a high degree of abnormal spermatozoa according to their semen analysis. We can use this technique when there’s less than 4% of normal form in the semen analysis. This will help us to reduce miscarriage rates.

We use other techniques like Fertile Chip to help us in sperm selection, especially in patients with high fragmentation or in cases where we’ve detected chromosomal abnormalities in the semen analysis. This technique will help us select the best spermatozoa to get higher pregnancy rates and lower miscarriage rates at the same time.

Infertility has come to be defined as the inability to conceive after 12 months of regular unprotected sexual intercourse. Generally, infertility can be caused by a woman’s or man’s health problems. Sometimes it’s caused by both partners’ disorders when both a man and a woman have some abnormalities, which make a natural conception impossible. Correct understanding of sterility provides a quick and effective individualized treatment plan.

The probable causes of male infertility are the following: abnormal sperm production or function, problems with the delivery of sperm associated with sexual disorders, genetic diseases, or some structural problems. They also relate to exposure to certain environmental factors, chemicals, or taking certain medications. Moreover, they may be associated with cancer and its treatment. No doubt, each infertility case is unique and requires an individual approach.

The treatment plan is to be identified only after the entire examination of the couple and diagnosis verification. We have several treatment tools for male factor infertility. The first one is intracytoplasmic sperm injection. Through this procedure, a single sperm is injected directly into the oocyte. Nowadays, just a small amount of spermatozoa is needed to achieve good results after ICSI.
There is now an alternative to a conventional ICSI procedure called the PICSI procedure. This procedure is rather simple. The only difference between the standard ICSI and PICSI is the actual dish with hyaluronic acid. This enzyme works like a magnet that attracts the strongest and the healthiest spermatozoa. The hyaluronic acid as an enzyme makes the normal spermatozoa bind to its layer. Thus, we obtain a reliable criterion for spermatozoa selection that is more than just visualization. Sperm that binds to the hyaluronic acid show more DNA integrity and fewer DNA mistakes compared to those that do not bind.

Moreover, we have one more method, the so-called intracytoplasmic morphologically selected sperm injection. It’s an actual method that allows assessing morphological features of native spermatozoa. The semen image is enlarged 6000 times using a new electro-optical microscope. However, this procedure is still under discussion, so we never use it routinely.

The first step to take an IVF normally is to perform an efficient study of the sperm sample. It means that we try to find genetic abnormalities in the sperm. The second tool that we have in the lab is ICSI, meaning intracytoplasmic sperm injection. We pick up one single sperm cell, and we inject this cell inside the oocyte. This technique allows a man with poor sperm quality to have babies.
The third tool we use in our lab is Fertile Chip. It’s a new technique to prepare and select sperm to do the injection. This allows us to reduce the fragmentation of DNA in the sperm samples.