Depending on the cause of the infertility in the male, a specific treatment is necessary. Unfortunately, most treatments of men with severely depressed sperm counts or motility are not very successful, except for IVF with Intracytoplasmic Sperm Injection (ICSI). Some of the treatments available include the following:
- Varicocelectomy: A surgical procedure to remove the swollen testicular veins. May be successful in improving abnormal sperm parameters in very few cases and only when there is a significantly enlarged varicocele.
- Hormonal treatment: In men with abnormal secretion of pituitary hormones that stimulate the testicles to produce sperm, we can provide hormonal supplementation that may be successful in many cases. These hormones are similar to the hormones taken by women undergoing IVF or ovarian stimulation and include such injectable hormones as Pergonal or Humagon.
- Surgery: Repair of a blockage in sperm transport is rarely successful but certainly an option.
- Avoiding harmful agents or activities: This includes avoiding chemicals, radiation, or staying away from heat such as jacuzzis, saunas or hot tubs. It also includes the discontinuation of smoking cigarettes, marijuana and the consumption of large quantities of alcohol.
- Intrauterine Insemination(IUI): Indicated in cases of sexual dysfunction or retrograde ejaculation or in cases where timing of intercourse is a problem. It should not be used in cases of severe depression in sperm count or motility since there is no data to support it. IUI should however be performed during treatment cycles where the woman is taking ovulation inducing medications to better time the deposition of sperm and also assure proper placement.
- Antibiotic treatment: In cases where an infection is diagnosed, a specific antibiotic treatment would sometimes be all that is needed to correct a transient sperm abnormality.
- Intracytoplasmic Injection: The procedure involves grasping a single sperm with a very fine needle-point pipette and then gently inserting it inside the egg and releasing the sperm to assure fertilization. This technique has revolutionalised the treatment of male factor infertility in the last decade. We now are able to help men with severely abnormal sperm parameters. We are even able to retrieve sperm directly from the testicles in men who have an obstruction as the cause of their infertility or in men who have such a low sperm count that there are hardly any sperm seen in the ejaculate. The procedure called Testicular Extraction of Sperm (TESE) involves the insertion of a thin biopsy needle inside the testicles under local anesthesia, and aspirating a small amount of testicular tissue and then separating the sperm present in the sample. This sperm is then used to inject the available eggs that were retrieved from the female partner. This technique is now commonly used in men with vasectomies and has made it possible for these men to avoid painful and often unsuccessful reversal surgeries.
- Artificial Donor Sperm Insemination: When the testicles are unable to produce sperm, the only alternative is to resort to sperm donation. There are many sperm banks that store frozen sperm from sperm donors. A couple can review profiles of such donors and pick a suitable donor to their liking. The sperm from these individuals is quarantined for over 6 months before it is available for donation and during this period of time the donors are repeatedly checked for infectious diseases such as HIV.
Intracytoplasmic Injection has revolutionalized the treatment of male factor infertility in the last decade.