Approximately 30% of infertile couples are found to have infertility due to male factor. This diagnosis is generally made following evaluation of semen. Once sperm abnormalities are found, a diagnostic plan is developed which may include further history, physical examination, laboratory and imaging studies. Referral to an urologist for possible surgical intervention may be necessary. Several treatments are available to improve male fertility:
Hormonal Modification: When a man is found to have abnormal sperm, an assessment of his hormonal system is necessary. If an imbalance is found, correction typically leads to improvement in sperm and an increase in fertility.
Intrauterine Insemination: Semen is processed in the laboratory to obtain the healthiest sperm which is concentrated and inserted into the endometrial cavity through a small catheter close to the time of ovulation. If sperm are sufficiently plentiful with adequate forward progression, the chance of fertilization and subsequent pregnancy significantly increases.
Intracytoplasmic sperm injection (ICSI): When sperm are either small in quantity or are very impaired in motility, fertilization is accomplished in the laboratory. A small glass needle is utilized to inject individual sperm into the egg. Sperm can be obtained from semen or for men who have blockages, from the ejaculatory ducts or from the testicle with a needle under local anesthesia.
Testicular sperm extraction (TESE): is the process of removing a small portion of tissue from the testicle under local anesthesia and extracting the few viable sperm cells present in that tissue for intracytoplasmic sperm injection (ICSI). The testicular sperm extraction process is recommended to men who cannot produce sperm by ejaculation due to azoospermia, such as that caused by primary testicular failure, congenital absence of the vas deferens or non-reconstructed vasectomy.
Intracytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) have reduced the need for donor sperm and allowing men who were previously thought to be infertile to father children of their own.