Treatment of Infertility
Treatments for male infertility may include lifestyle changes, medication, surgery, or assisted reproductive technologies. The treatment selected depends on what is causing the condition and is not always covered by insurance.
- Avoidance of certain lubricants.
- Decreasing stress.
- Avoidance of excess heat (hot tubs, saunas).
- Maintaining a healthy weight.
- In some cases, the addition of certain antioxidants may be helpful.
- Avoidance of tobacco, marijuana, and excess alcohol.
Medications may be used to restore normal hormone balance or assist with sperm production. These may include clomiphene citrate, anastrozole, human chorionic gonadotropin, or recombinant forms of follicle stimulating hormone.
Most surgeries are outpatient, minimally invasive, and recovery time is usually only a few days. A few of the more common procedures are outlined below:
Microsurgical varicocele correction
A varicocele is an enlarged collection of veins within the scrotum and is present in up to 40% of men with infertility. The presence of a varicocele can contribute to diminished sperm production and impaired sperm development. Surgical correction is performed with the use of an operating microscope to permanently tie off these veins. Successful surgery will often increase the chances of pregnancy.
A variety of sperm retrieval procedures are utilized to assist in sperm banking (cryopreservation) or ART. This may include microsurgical epididymal sperm aspiration (MESA) or microdissection testicular sperm extraction (microTESE). During a MESA, sperm is extracted from a tube within the epididymis and the sperm used for ART. In some cases, enough sperm may be found for multiple cycles of ART and the remainder frozen (cryopreserved). MicroTESE is most commonly used in men who have no sperm in their semen but may have sperm present within the testicle which can be utilized for ART. Both procedures are performed with an operative microscope on a outpatient basis and are typically timed with your partner’s IVF cycle.
Transurethral resection or balloon dilation of the ejaculatory ducts (TURED)
Patients with ejaculatory duct obstruction will demonstrate a low ejaculate volume on semen analysis in association with no sperm count or very low sperm motility. The ejaculatory duct may be blocked due to a stricture, cysts, or stones. Confirmation of the diagnosis is obtained with a transrectal ultrasound which shows enlargement of the seminal vesicles or dilation of the ejaculatory duct. Following diagnosis, this can be treated by a procedure performed through the urethra (urinary tube) to resect the ejaculatory duct (TURED). This may be done in coordination of a seminal vesicle aspiration to evaluate for sperm.
500,000 vasectomies are preformed yearly in the United States. Up to 6% of these men elect for vasectomy reversal. For more information on microsurgical vasectomy reversal (vasovasostomy and epididymovasostomy), click here. (taken to vasectomy reversal page)
Testicular biopsy and Sperm Mapping
Testicular biopsy may be utilized in cases of azoospermia (no sperm in the ejaculate) to assist in determining if there is an issue with sperm production or a blockage within the reproductive tract. This procedure is outpatient and provides additional information as to whether a patient with azoospermia is a candidate for sperm retrieval. It is not required in all cases. Alternatively, a technique called sperm mapping can also be utilized to evaluate for the presence of sperm.
Men suffering from neurologic impairments, such as spinal cord injury, diabetes, or following surgery, may have difficulty with ejaculation. In some cases, there is a complete absence of visible ejaculate. Vibratory stimulation of the genitourinary tract may allow some men to initiate ejaculation. If this technique is not successful, electroejaculation may be required. This is a procedure performed under general anesthesia in which additional stimulation is provided to the ejaculatory nerves through a rectal probe to promote ejaculation. The specimens collected through these techniques may be used in ART.
Some men may have an obstruction within the epididymis caused by trauma, infections, congenital (born with), or cystic fibrosis. By performing a microsurgical connection between the vas deferens and epididymis (epididymovasostomy), this blockage can be bypassed.
Assisted Reproductive Technologies (ART)
Assisted reproductive technologies involve the manipulation of human sperm, eggs and embryos to help with conception. The eggs and sperm can be from you and your partner or may be donated.
Intrauterine insemination (IUI)
IUI is the process in which semen is collected and processed within the fertility lab and then is inserted directly into the woman’s uterus. This bypasses the normal anatomic barrier of the cervix and may be helpful inn some men with low sperm counts and decreased sperm motility, quality or function.
In vitro fertilization (IVF)
IVF involves fertilization of an egg, outside the body and in the laboratory. An IVF cycle involves stimulation of the ovary to produce multiple mature eggs which are then mixed (incubated) with sperm in a laboratory. The embryos are then evaluated and selected for placement into the uterus.
In vitro fertilization with Intracytoplasmic sperm injection (IVF with ICSI)
This is an advanced technique in which a single sperm is injected into a mature egg cell which has been retrieved through the process of IVF described above. This allows for fewer numbers of sperm to be required for a cycle of IVF.