(Fort Worth Fertility)
(Fertility)
(Fort Worth)
(817-348-8145)
Treatments for male factor include medical, surgical treatment or assisted reproduction.
Medical treatment consists of the administration of certain drugs to improve seminal quality. Clomiphene citrate, aromatase inhibitors, tamoxifen, gonadotropin injections, antibiotics, steroids etc. are commonly used.
If there is a mild decrease in the sperm count or motility, the urologist may prescribe Clomiphene citrate, a fertility pill commonly used to treat women who fail to ovulate. Clomiphene (also called Clomid or Serophene) mildly stimulates the pituitary to make hormones that stimulate sperm production. Sperm counts should be re-analyzed 3-6 months after initiation of the medication to evaluate the effectiveness of this treatment. If the sperm count is very poor to begin with, this strategy is less likely to be successful. As always, the female partner should be considered, as the time necessary to give these treatments a chance to work depends on how much time she has.
Surgical treatment consist of ligation or varicoceles, vasectomy reversal or retrieval of sperm to be inserted in eggs. If a varicocele is found, sometimes surgery to ligate (tie off) the abnormally dilated veins is recommended. If the varicocele is of significant size (Grade II or Grade III), about two thirds of men undergoing the surgery will see some improvement in the sperm quality. The reported pregnancy rates following surgery are in the range of 40%, but most pregnancies occur 6-9 months following surgery, so age of the female partner needs to be a major consideration. If the initial sperm count and motility are in the severe male factor category, it is unlikely that this surgery will improve sperm counts enough to enable the couple to conceive without assistance.
After a vasectomy the choices consist of a vasectomy reversal or IVF-ICSI with epididymal or testicular sperm extraction. Age of female partner and length of time since prior vasectomy are important factors in decision-making. It can sometimes take 6-9 months to recover adequate sperm counts following vasectomy reversal. Also, the greater the length of time between the vasectomy and the reversal, the greater the chances are that the surgery will be unsuccessful or that anti-sperm antibodies will form, preventing the recovered sperm from penetrating the eggs without IVF-ICSI. Any man undergoing vasectomy reversal should request that any sperm seen at the time of the reversal be frozen in case subsequent scarring and re-obstruction occurs.
Assisted reproductive technologies are useful in situations of low sperm counts and sperm obtained from retrieved sperm after prior vasectomy, congenital absence of the vas deferens (i.e. no sperm in the ejaculate but normal testicular sperm production, also referred to as obstructive azoospermia) In these situations IVF-ICSI is utlilized with fresh sperm or surgically removed sperm with either Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE).
With a MESA procedure, under local anesthesia and general sedation, an incision is made in the scrotum, exposing the epididymis, the tubules immediately adjacent to the testicles that collect the sperm. Using an operating microscope, an incision is made into these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique. The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if his partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures.
A TESE or testicular sperm extraction is a procedure that involves directly aspirating the sperm from the testes or obtaining sperm from a testicular biopsy. It is usually performed under local anesthesia block and can be done as an office surgical procedure. The disadvantage is that in many cases, testicular sperm is much more scarce and therefore difficult to freeze. Usually, there is only enough sperm recovered for one IVF case and if further IVF attempts are needed, the TESE procedure needs to be repeated.