Treatment options for male infertility

Treatment is given according to cause identified.
There is a very little scope of giving medical treatment in male infertility. Medical problems like diabetes, hyperpolactinaemia, renal disease, liver disease which might affect fertility is to be treated. In hypogonadotrophic hypogonadism where sperm synthesis is absent or low hormonal treatment by giving hCG and FSH can improve the condition.
Other treatments

  • Vasectomy reversal: For men using a vasectomy for birth control, their vas deferens has been interrupted to prevent the passage of sperm. A vasectomy reversal can restore the opening in some cases and many couples are able to achieve pregnancy through a vasectomy reversal.
  • Vasovasostomy: It is done when there is any block in vas deferences and spermatozoa can not come in the seminal fluid. After resecting the blocked portion two patent ends joined together. Before surgery it is to be ensured that there are enough spermatozoa beyond the blocked area and fertility potential of female partner is good.

  • Varicocele ligation: When excessive dilatation of the blood vessels around the testicles occurs, excessive heat builds up. The vessels, or varicocele, can be ligated and allow the testis to return to normal temperatures. Often there is an appreciable increase in sperm parameters yet there is still some debate about varicocele ligation improving pregnancy rates. ICSI can frequently overcome the problems with sperm parameters caused by having a varicocele.

  • In-vitro fertilization (IVF): It is done when IUI failed or sperm count and motility is very low for IUI, like count is less than 10 million per ml with motility less than 50%.
  • Intracytoplasmic sperm injection (ICSI): It is done in failed IVF cases, in case of severe oligospermia and asthenospermia like sperm count is less than 5 million per ml and motility is less than 20% and in severe teratospermia that is most spermatozoa are abnormal. ICSI is the only option of treatment for azoospermia. In this procedure a single sperm is isolated under the microscope and used to inject directly into an egg. Ideally there are enough sperm to fertilize all of the oocytes. Motile, forward moving, and normal appearing sperm are preferred in the process of choosing a sperm.

  • PESA (per-epididymal sperm aspiration) or MESA (microsurgical sperm aspiration) is done in obstructive azoospermia to retrieve sperms for performing ICSI.
  • Testicular sperm extraction (TESE) is done in non-obstructive azoospemia to retrieve sperm from testicles for performing ICSI.