Treatment of Male Infertility

a. Oligospermia

Oligospermia is a production defect. Oligospermia is defined as sperm count less than 20 millions/ml. Hormonal defects, testicular pathologies like trauma, infections or tumors, Varicocele, Retrogarde Ejaculation and raised Reactive oxygen species levels are few of the factors which decrease the sperm production. If the cause is known then treating the underlying condition helps. In unexplained cases antioxidants are helpful. Use of Hormonal therapy is debatable.

b. Asthenospermia

Asthenozoospermia refers to motility defects in the sperm. When Forward progression of sperm is >/= 50% (Grade a + b) or rapid progression is >/= 25% (Grade a), such a sample is called asthenozoospermic. Isolated motility problems with normal count and sperm morphology points more in favor of varicocele. However, Infections and hormonal problems and raised Reactive oxygen species levels also need to be considered for Asthenozoospermia. If the cause is known then treating the underlying condition helps. In unexplained cases antioxidants are helpful.

c. Teratospermia

Teratozoospermia refers to sperm morphology defects. Normal forms ? 15% as per Tygerberg-Kruger’s strict criteria or ? 30% of normal forms as per WHO criteria is termed as Teratozoospermia. Hormonal defects, testicular pathologies like trauma, infections or tumors, Varicocele and raised Reactive oxygen species levels are the major factors affecting the sperm morphology. If the cause is known then treating the underlying condition helps. In unexplained cases antioxidants are helpful.

d. Azoospermia

Nil or zero sperm count in the ejaculate is termed as azoospermia. Azoospermia is broadly classified as Obstructive and Non-obstructive azoospermia.

Obstructive Azoospermia

Underlying obstructions in the reproductive tract prevent the outflow of sperm and this causes azoospermia. Obstructions might be due to infections, trauma, and tumors or in certain cases it’s due to developmental defects of the reproductive tract. Creating an alternative pathway for sperm outflow might help in these cases. Consult your Andrologist for various options available.

Non-Obstructive Azoospermia

In this case there are no obstructions in the reproductive tract. The defect lies either in the testicles or in the production of reproductive hormones (this in medical terminology is termed as primary or secondary testicular failure). Any of the above mentioned conditions hinder the spermatogenesis resulting in azoospermia. Consult your Andrologist to know the various options feasible for conception. Surgical retrieval of sperm from testis might be helpful in certain cases

Surgical Sperm Retrieval (TESE/PESA/MESA)

For azoospermic man, when sperm is not present in ejaculate with use of minimal invasive techniques sperm can be obtained from either the testicles or the epididymis. In this way sperm can also be obtained from

  • Vasectomised man, where vasectomy reversal is failed.
  • Absence of vas deferens
  • Obstructive azoospermia
  • Non obstructive azoospermia, when sperm production is low.
  • There are different sperm retrieval procedures, tailored to the specific couple’s need.

PESA

Percutaneous Epididymal Sperm Aspiration (PESA) uses a needle to penetrate the scrotal skin and draw a small amount of sperm from the epididymis while Percutaneous Testicular Biopsy removes small cores of testes tissue.

MESA, TESE

The procedures are either performed through the skin (percutaneous) or through a small opening in the skin about 1/2 inch in size. Applying microsurgical techniques in a process known as Microscopic Epididymal Sperm Aspiration (MESA), sperm can be gathered from the epididymis, a sperm rich tube at the back of the testis. Testicular Sperm Extraction (TESE) involves removing small samples of testis tissue for processing and eventual extraction of sperm. Microscopic TESE (MicroTESE) is a very exacting search for sperm under high magnification in cases of extremely low sperm production.

Sperm retrieval procedures do not require an overnight hospital stay and last about one hour. The techniques are typically done at an outpatient surgery center though sometimes an office setting is adequate. Local anesthetic, IV sedation or general anesthesia provides complete pain control during the procedure. Due to the superficial nature of these procedures, patients routinely return back to desk type work in a day or two and disruption of normal activities is quite limited. Patient comfort and technical perfection are paramount.

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