This article summarizes the current technologies available to treat male-related infertility.
The causes of male-related infertility can be broadly divided into semen-related (abnormal concentration, shape or motility of sperm cells) and semen transport issues (inability of sperm cells to reach the ejaculate due to sperm duct obstruction or abnormal ejaculation process). In some cases, these changes are due to medically reversible conditions (e.g. hormone imbalances, vasectomy) and can be treated with drugs or surgery.
However, for most men, assisted reproduction technologies (ARTs) are the only method to conceive without resorting to donor sperm. Before turning to ARTs, a semen analysis and blood tests to determine hormone levels are performed. If the problem cannot be fixed otherwise, surgical techniques to retrieve sperm cells are required for in-vitro fertilization (IVF) or intracytoplasmatic sperm injection (ICSI). IVF involves the artificial matching of eggs and sperm in a laboratory dish. ICSI is a technique to directly inject the sperm into the egg.
When semen transport issues are present, conception can be achieved by retrieving sperm cells using one of several surgical techniques: microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), testicular sperm extraction (TESE) or seminal tract washout (STW). In brief, these techniques achieve the retrieval of several sperm cells from the epididymis (the tube carrying sperm cells from the testicles – MESA and PESA), directly from the testicles (TESA and TESE) or by using liquid to flush the tubes leading out of the testicles (STW). Retrieved sperm cells can then be used for IVF in the laboratory.
These surgical procedures are minimally invasive, meaning they are performed using very small cuts or using small needles and do not require extended hospital stay.
If IVF fails, or if the there are semen-related issues, the retrieved sperm cells can be used for ICSI. If enough sperm cells are collected, some of them can be kept frozen (cryopreserved) for use in future IVF or ICSI procedures. ICSI is an effective method of conception, but carries a higher risk of transmitting genetic (hereditary) abnormalities because it bypasses the normal sperm selection process – in spontaneous fertilization only one sperm cell manages to penetrate the egg's wall. Previous studies reported a higher risk of birth defects in children conceived with ICSI compared to IVF (without ICSI) or spontaneous pregnancy.
ARTs, notably ICSI, can help achieve successful pregnancies in male-related infertility. More research is needed to determine the risks of these techniques in terms of birth defects and effect on long term child development.
Published By :
The Journal of clinical endocrinology and metabolism
Date :
Jun 01, 2001
