Causes, diagnosis and treatment of male infertility

What is male infertility?

Male infertility is the inability to produce or transport enough viable sperm to fertilize a female egg. Testing for male infertility should begin early in the infertility treatment process, as the woman begins to investigate the cause of her infertility.

Causes of Male Infertility

Male infertility can be caused by the absence of sperm in the semen, a low sperm count, and/or the inability of sperm to reach the egg after intercourse. Physical obstruction of the vas deferens may result from a previous vasectomy or a failed vasectomy reversal.

Imbalance in testosterone or other hormone levels, genetic or chromosomal abnormalities that affect sperm production, survival rate or motility can all cause male infertility.

Impotence caused by spinal cord injury or other psychological/emotional trauma can also lead to male infertility.

Symptoms of Male Infertility

Unfortunately, problems with sperm production, transport or genetic or chromosomal abnormalities do not always have outward clinical manifestations and can only be diagnosed through semen analysis or other special tests.

Diagnosis of Male Infertility

• What infertility tests can diagnose male infertility?

Male fertility evaluation includes a physical examination of the testes to detect absence of one or both testicles, reduced testicular size, testicular masses (which may indicate testicular cancer), scrotal varicose veins, or varicocele (a common cause of oligospermia).

A comprehensive semen analysis can determine the number of sperm, the percentage of active sperm (motility), and the percentage of sperm with normal morphology and structure. Further sperm testing includes testing for antibodies in the semen (antibodies may kill sperm or reduce sperm function), sperm DNA integrity, and blood hormone levels (blood hormones may affect sperm production).

• When is it necessary to do a male infertility test?

Generally, if a couple has not conceived for a year without contraception, it is recommended that they start testing both partners to determine the cause of the infertility. However, if there are known factors that affect pregnancy, the man may choose to undergo infertility testing earlier:

1. Cancer treatment history

2. Genetic diseases such as cystic fibrosis or congenital bilateral absence of the vas deferens

3. Impotence

4. History of testicular, penile, or genitourinary surgery

5. History of mumps in adulthood

6. Testicular trauma, indicating potential sperm problems

7. Known history of infertility or recurrent miscarriage

• Risks of Infertility Testing and Diagnosis

There are virtually no risks associated with blood hormone tests and semen/sperm analysis.

Surgical sperm retrieval, including microscopic epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), and micro testicular sperm extraction (micro TESE), carries very small risks, including the following:

1. Bruising and tenderness of the scrotum

2 Discomfort or pain

3 Risk of infection at the incision site

Treatment of male infertility

• assay

Semen can be collected directly from the testicles through masturbation, electrical stimulation, or urological procedures, and then analyzed for sperm.

Sperm retrieval procedures include microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), and testicular sperm extraction (TESE), all performed under local anesthesia or minimal sedation. If needed, these procedures can also provide sperm for future fertility treatments such as IVF.

Genetic or chromosomal abnormalities can be diagnosed with a blood test.

• Treatment options

If enough healthy sperm can be obtained, intrauterine insemination (IUI) can be performed, which means that the sperm is processed and injected directly into the woman's uterine cavity.

Another option is to do in vitro fertilization (IVF), where healthy sperm and eggs are fertilized outside the body and the resulting embryos are then transferred back into the woman's uterus.

Vasectomy can sometimes be reversed with microsurgery. However, if a man has a low sperm count or low sperm motility (sperm movement), IVF and ICSI (intracytoplasmic sperm injection), which involves injecting a healthy sperm directly into the egg, may be the best treatment option.

If there is a genetic or chromosomal abnormality, we have new technology to screen abnormal embryos and preserve healthy embryos.